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Elevated liver enzyme numbers: Nonalcoholic Fatty Liver Disease (NASH) Symptoms, Diet, Causes, Treatment


Causes, symptoms, tests, and treatment

Elevated liver enzymes may be a sign that a person’s liver is not working properly. Damaged or inflamed liver cells release enzymes into the bloodstream, which a blood test will detect.

Doctors test people for elevated liver enzymes if they have symptoms of conditions that typically cause liver damage.

In this article, learn about the causes of elevated liver enzymes, as well as the symptoms and treatment of each of these conditions.

Share on PinterestIf a person has elevated liver enzymes, a doctor may investigate possible underlying causes.

If a person’s blood test results show elevated liver enzymes, a doctor will investigate possible underlying causes. They may do further tests in addition to asking about a person’s lifestyle and dietary habits.

The most common cause of elevated liver enzymes is fatty liver disease. Research suggests that 25–51% of people with elevated liver enzymes have this condition.

Other health conditions that typically cause elevated liver enzymes include:

  • metabolic syndrome
  • hepatitis
  • alcohol or drug use disorder
  • cirrhosis, which is liver tissue scarring

Other conditions that less commonly cause elevated liver enzymes include:

Certain medications, including some pain relievers and statins, can also cause elevated liver enzymes.

Elevated liver enzymes are themselves asymptomatic, but the underlying conditions responsible for them may cause symptoms.

Below are the common causes of elevated liver enzymes, as well as their symptoms:

Fatty liver disease

Fatty liver disease occurs when fats build up in the liver. If this buildup is due to alcohol consumption, it is called alcoholic fatty liver disease.

When alcohol is not a causative factor, the buildup of fat in the liver is called nonalcoholic fatty liver disease (NAFLD). People with metabolic syndrome are at a higher risk of NAFLD.

Fatty liver disease may sometimes cause tiredness and pain on the right side of the abdomen, but it often causes no symptoms.

A doctor may test someone with alcohol use disorder or metabolic syndrome for elevated liver enzymes to check for fatty liver disease.

Learn about what to eat to help manage fatty liver disease here.

Metabolic syndrome

Metabolic syndrome is a group of symptoms that increase the risk of heart disease. These symptoms include:

The doctor may test people with one or more of these symptoms for elevated liver enzymes.


Hepatitis is a virus that leads to liver inflammation. There are several different strains of hepatitis, which are called A, B, C, D, and E. The symptoms of all of the strains are similar.

Common hepatitis symptoms include:

  • fatigue
  • muscle soreness
  • joint pain
  • nausea
  • loss of appetite
  • stomach pain
  • fever
  • dark urine
  • skin itching
  • yellowing of the eyes and skin (jaundice)

The doctor may test a person with symptoms of hepatitis for elevated liver enzymes.

Alcohol or drug use disorder

Drinking too much alcohol or using illicit drugs may lead to liver inflammation or damage.

Liver inflammation due to alcohol consumption is called alcoholic hepatitis. When drugs are the underlying cause, doctors call it toxic hepatitis.

The symptoms of alcoholic and toxic hepatitis are similar to those of other strains of hepatitis.

If a person is experiencing symptoms of alcohol or drug use disorder, the doctor may check their liver enzyme levels and offer various forms of treatment and support.


Cirrhosis is a type of liver damage. A person with cirrhosis has permanent scarring of the liver, which can prevent it from working properly. Cirrhosis may eventually lead to liver failure.

Cirrhosis symptoms include fatigue and skin itching. People are at risk of cirrhosis if they do not receive treatment for hepatitis or fatty liver disease.

If a person has cirrhosis symptoms, the doctor may check their liver enzyme levels.

A blood test can show elevated liver enzymes. The blood test checks for raised levels of AST and ALT, which are enzymes that the liver releases when it becomes inflamed or damaged.

If a doctor finds that a person has raised AST or ALT levels, they are likely to carry out further tests to determine the underlying cause.

Different ratios of AST to ALT may indicate various underlying causes.

The treatment for elevated liver enzymes will focus on managing the underlying condition causing the increased levels.

The treatments for some common causes of raised AST or ALT levels include:

Fatty liver disease

People can work with their doctor to treat NAFLD with weight loss. The doctor may advise a person to make lifestyle changes to lose weight, such as:

  • exercising more
  • eating a healthful, balanced diet
  • trying to burn more calories than they consume

Speaking with a nutritionist or even a personal trainer can help someone stay on track with their weight loss plan.

If a person has fatty liver disease due to alcohol consumption, the doctor will support them in reducing their alcohol intake.

Metabolic syndrome

Share on PinterestSomeone with metabolic syndrome may benefit from exercising more, losing weight, and reducing their stress levels.

Treatments for metabolic syndrome include:

  • losing weight
  • exercising more
  • eating a healthful, balanced diet
  • managing blood sugar levels
  • reducing stress levels

Lifestyle changes that may help a person manage stress include:

  • exercise
  • meditation
  • mindfulness
  • yoga
  • journaling
  • reducing commitments


Treatments for hepatitis depend on whether it is acute or long term. A doctor may recommend the following treatments for acute hepatitis:

  • bed rest
  • plenty of fluids
  • avoiding alcohol

Treatment for long term hepatitis usually includes antiviral medication.

Alcohol or drug misuse disorder

Treatments for alcohol or drug use disorder include:

  • behavioral therapies
  • medications
  • support groups

Anyone who feels as though their alcohol or drug use is causing health problems or interfering with their everyday life should speak to their doctor.


Cirrhosis is permanent liver damage, so it is not always treatable. However, the underlying cause of liver damage is usually responsive to treatment. The conditions that we discussed above may all lead to cirrhosis.

Treatments such as a modified diet, weight loss, and reduced alcohol consumption can all reduce the risk of further liver damage. The prompt diagnosis and treatment of conditions that affect the liver can help prevent cirrhosis.

Elevated liver enzymes are a sign that a person has an inflamed or damaged liver. Many conditions may cause liver inflammation or damage.

Doctors use a blood test to check for elevated liver enzymes. They may test anyone with symptoms of one of the conditions that they know to raise liver enzyme levels.

If a person’s blood test results reveal that they have elevated liver enzymes, the doctor will investigate the underlying cause. Once they make a diagnosis, the doctor will recommend suitable treatments.

Fatty liver disease is the most common cause of elevated liver damage. People with fatty liver disease can manage their condition by losing weight, if necessary, or reducing their alcohol consumption. Other causes of liver inflammation are also treatable.

Elevated liver enzymes are usually a temporary sign. Liver enzyme levels may return to normal quickly if a person follows the doctor’s recommended treatment plan for the underlying condition.

Abnormal Liver Enzymes | Digestive Care Physicians

Abnormal liver enzymes can be a sign of chronic and acute alcohol use, chronic hepatitis B and hepatitis C and possibly liver cancer.

The liver is one of the most important organs in the body, and is responsible for a number of functions that keep the body working as it is designed. The liver detoxifies your blood, produces proteins that help with clotting, handles cellular waste, processes nutrients, stores vitamins, and helps your body make glucose. Liver Enzymes are proteins within the liver that help to speed up certain chemical reactions. If any of these processes are inhibited it could lead to serious complications. Elevated liver enzymes may indicate inflammation or damage to cells in the liver. Inflamed or injured liver cells leak higher than normal amounts of certain chemicals, including liver enzymes.

Abnormal Liver Enzymes Symptoms

Symptoms of mild to moderate elevation of liver enzymes may vary from no symptoms to the following:

  • Fatigue
  • Fever
  • Nausea and Vomiting
  • Upper right quadrant abdominal pain and tenderness
  • Mental changes
  • Itching

Elevated liver enzymes most commonly found:

  • Alanine Transaminase (ALT): In most types of liver disease, the ALT level is higher than AST and the AST/ALT ratio will be low (less than 1). There are a few exceptions; the AST/ALT ratio is usually increased in Alcoholic Hepatitis, Cirrhosis, and in the first day or two of Acute Hepatitis or injury from bile duct obstruction. With heart or muscle injury, AST is often much higher than ALT (often 3-5 times as high) and levels tend to stay higher than ALT for longer than with liver injury. AST is often performed together with the ALT test or as part of a liver panel.
  • Aspartate Transaminase (AST): Very high levels of AST (more than 10 times normal) are usually due to Acute Hepatitis, sometimes due to a viral infection. With acute Hepatitis, AST levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. Levels of AST may also be markedly elevated (often over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver. With Chronic Hepatitis, AST levels are usually not as high, often less than 4 times normal, and are more likely to be normal than are ALT levels. AST often varies between normal and slightly increased with Chronic Hepatitis, so the test may be ordered frequently to determine the pattern. Such moderate increases may also be seen in other diseases of the liver, especially when the bile ducts are blocked, or with cirrhosis or certain cancers of the liver. AST may also increase after heart attacks and with muscle injury, usually to a much greater degree than ALT.


The human liver contains thousands of enzymes, which are special types of protein cells that help necessary chemical reactions to take place. Liver enzymes trigger activity in the body’s cells, speeding up and facilitating naturally occurring biochemical reactions, and maintaining various metabolic processes within the liver. A wide range of health problems can lead to elevated liver enzymes:

Diagnostic Testing

When the liver is damaged, cells release higher levels of the two major enzymes, Alanine Transaminase (ALT) and Aspartate Transaminase (AST), into the bloodstream. To determine if your liver is damaged, several blood tests will be conducted to check the type and amount of Liver Enzymes in the blood. If elevated abnormal liver enzymes are present, it could indicate liver damage, as these enzymes are normally only found within the liver. In most cases, liver enzyme levels are only mildly or temporarily elevated and don’t signal a serious liver problem.

  • Physical Examination
  • Ultrasound
  • CAT scan (computed axial tomography)
  • Liver Biopsy
  • Liver Blood tests – Alanine Transaminase (ALT) and Aspartate Transaminase (AST)

Dietary Guidelines

The liver helps maintain good health and is important for many body functions including digestion, metabolism, detoxification and blood clotting. Liver Enzymes are proteins that help to speed up reactions, and elevated levels are signs of a liver impairment that must be treated. While a variety of conditions and some medications can cause enzyme imbalances in the liver, diet also plays a crucial role.

Lifestyle Changes Food to Add Food to Avoid
Stop drinking alcohol Garlic Sugar
Limit caffeine Eggs White bread
No non-prescription drugs Broccoli Pasta
No fast food Spinach Pastries
Take fish oils Brown Rice Desserts
Increase fiber intake Mustard Greens Fried food
Eat whole foods Fruit Processed food

Liver Function Test

What Is a Liver Function Test?

A liver function test is one of a group of tests that check levels of certain enzymes and other proteins in your blood.

Some of the tests look for enzymes that you’d find in your blood only when your liver is damaged or has a disease. Others check that the organ is working the way it should.

Your liver does all kinds of work that’s crucial for your health. It helps break down food, clean your blood, make proteins, and store energy. If something goes wrong with it, you might have a number of symptoms, from yellow skin to slurred speech. That’s when you might need a liver test.

Why Are Liver Function Tests Done?

You might have this test to check for a liver disease such as hepatitis (an illness in which your liver swells and can cause serious issues). General symptoms of liver problems include:

Often, however, you don’t notice any symptoms.

Your doctor may order a liver test if you’re more likely to have liver damage or disease, like if you:

The liver test can also help your doctor learn whether an illness is getting worse or how well treatment is working.

Types of Tests and What They Measure

There are a number of liver tests, with lots of complex names. Some common ones include:

  • Alanine transaminase (ALT) test. ALT is an enzyme that helps break down proteins and is found mainly in your liver. High levels in your blood could mean you have liver damage.
  • Alkaline phosphatase (ALP) test. ALP is an enzyme in your liver, bile ducts, and bone. You might have high levels if you have liver damage or disease, a blocked bile duct, or bone disease.
  • Albumin and total protein test. Your liver makes two main proteins: albumin and globulin. Low levels might mean damage or disease. Keep in mind that your immune system also makes globulin.
  • Aspartate transaminase (AST) test. AST is another enzyme in your liver. High blood levels could be a sign of damage or disease.
  • Bilirubin test. Your body makes bilirubin when it breaks down red blood cells. Usually, your liver cleans bilirubin out of your body. If you have high levels in your blood, a problem called jaundice, you may have liver damage.
  • Gamma-glutamyltransferase (GGT) test. High levels of the GGT enzyme could point to liver or bile duct damage.
  • L-lactate dehydrogenase (LD) test. LD is another enzyme that’s high when you have liver damage, but other conditions can also raise its level.
  • Prothrombin time (PT) test. This test measures how long it takes your blood to clot. If it takes a long time, that could be a sign of liver damage. Medications that thin your blood, such as warfarin (Coumadin), can also lead to a longer PT. You probably won’t have this test until you have had other liver tests.

How to Prepare for a Liver Function Test

Make sure to tell your doctor about any medicines you’re taking, including over-the-counter medications and herbal supplements. They may tell you to stop eating the night before the test.

What Happens During a Liver Function Test?

Your doctor uses a thin needle to take a small amount of blood, usually from your arm near your elbow. You’ll feel a pinch or stinging when the needle goes in.

You’ll probably have these tests more than once over a few days or weeks. Your doctor can look at how levels change to be sure of your condition.

If you get your test at a clinic that has a lab on site, you can get results in a few hours. If not, it might take a few days.

Liver Function Test Results

The results usually show normal values for the specific test, along with your numbers. Keep in mind that what’s normal can vary with different labs. It also depends on whether you’re male or female.

If your results aren’t normal, you’ll probably get more tests.

By itself, a liver test can’t tell for sure that you have a certain illness. Your doctor can help you understand what your results mean.

Liver Function Test Risks

Liver function tests are generally safe, with few risks. You may have some soreness or a bruise where the blood is taken. Call your doctor if it doesn’t get better after a couple of days.

Are You Drinking Too Much? How Alcohol Consumption Can Affect Your Health

Many people enjoy a drink now and then. But how is that alcohol affecting your body? The liver is where a lot of your metabolism lives. It filters out harmful substances, like alcohol and toxins, from your blood. But its duties don’t end there. It processes what you eat and drink into energy and nutrients for your body, produces bile to help you digest those nutrients, stores blood sugar in the form of glycogen, and performs many other essential functions. So a healthy liver is critical to your overall well-being and performance. But how can you find out whether your liver is healthy, or whether you may have pushed it too far? Well, the best way to monitor your liver health is through a blood test for liver damage biomarkers, such as ALT. 

Found primarily in your liver cells, ALT is an enzyme that plays a role in converting stored glucose into usable energy. When liver cells are damaged, ALT can leak out into your bloodstream. Normally, there is only a small amount of ALT in your blood; higher levels of ALT typically indicate liver injury or inflammation

The normal range for ALT is 10-40 units per liter (U/L) of blood for men and 7-35 U/L for women. Blood tests from InsideTracker will tell you your optimal range for ALT based on your age, gender, ethnicity, athletic activity, alcohol consumption, BMI, and smoking history. And if your levels of ALT are elevated, InsideTracker will recommend diet, lifestyle, and supplement changes that can help to reduce your ALT levels. Since high levels of ALT indicate liver damage or disease, it’s important to consult your physician if you have elevated ALT.

Many lifestyle factors can influence your ALT levels, including:

One of the more frequent causes of high ALT levels is a condition commonly referred to as a fatty liver, which is a reversible condition that occurs when large amounts of triglycerides (the type of fat typically found in food) accumulate in liver cells. In the United States, alcohol abuse is one of the largest contributors to fatty liver, but other causes include elevated blood glucose and excess body weight. Disease and certain medications can also increase ALT.


The good news is that many people can lower their elevated ALT with changes in their lifestyle and exercise:

InsideTracker will recommend personalized lifestyle changes to help you decrease your ALT.

What you eat also has an effect on ALT. Limiting high-fat foods, especially ones that are derived from animal sources, may help decrease elevated ALT levels. High-fat foods increase fat levels in your blood, which may end up being deposited in the liver.

Helpful changes can include:

  • Choosing lean proteins, such as chicken breast, fish, or beans, and low-fat dairy products.
  • Reducing the refined carbohydrates and sugars in your diet. Instead, eat whole foods like beans, whole grains, berries, oatmeal, and vegetables, which provide fiber, vitamins and antioxidants.
  • Eating foods high in folate, which studies have shown can help to reduce ALT and improve liver health. Foods include black-eyed peas, fortified breakfast cereals, Brussels sprouts, and avocado.  

With an InsideTracker Ultimate test you can easily check whether you have elevated ALT, and learn how to improve your liver health using simple interventions such as food, supplement, exercise, and lifestyle changes.

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Alanine Aminotransferase (ALT) | Lab Tests Online

Receiving test results

Results for your ALT test are usually available within a few business days. You may be told of your test results by your doctor’s office. You can also normally obtain a copy of the test report by mail or electronically. 

Results from at-home tests of ALT are typically accessed electronically through a smartphone app or a specific website. Getting the results may take a few extra days because of the time it takes for your sample to arrive by mail to the laboratory.  

Interpreting test results

The test report should have a line that shows both your ALT level as well as the reference range that the laboratory uses to categorize ALT levels as normal or abnormal. In most cases, ALT will be measured in units per liter (U/L) or international units per liter (IU/L). 

When reviewing your results, keep in mind that there is no universal reference range for ALT. There can be variation in laboratory methods that affect what is considered normal. For this reason, it’s important to look at the range provided by the specific lab that analyzed your blood. 

Most often, ALT is tested along with other liver enzymes and proteins in a panel test. Your test report will show your levels and the lab’s reference range for each measurement. This is important because your test results are interpreted by looking at these test components together. 

High levels of ALT can be a result of damage or injury to cells. Because ALT is most concentrated in the liver, abnormal ALT test results are generally associated with conditions affecting the liver, such as inflammation (hepatitis) and scarring (cirrhosis).  

At the same time, ALT can be elevated without any underlying health problem. Multiple factors can affect ALT, and in most cases, high ALT is not a sign of severe liver disease. 

In order to interpret your test result, your doctor takes multiple factors into account. These include your current health and health history as well as the levels of other measurements on your test. In addition, your doctor may consider individual factors that can influence your normal level of ALT, including:

  • Exercise: Intense or extreme exercise can cause a temporary boost in ALT levels. 
  • Medications: A number of medications and supplements can alter ALT measurements.
  • Sex: Males typically have higher levels of ALT, which is believed to be related to hormonal differences. 
  • Menstruation: ALT levels can go up or down during the course of the menstrual cycle. 
  • Age: There is a tendency for ALT levels to decrease with older age, although the exact reason for this is not known.  
  • Body mass index: Several research studies have found an association between ALT levels and body mass index, which may change the interpretation of test results in people with obesity. 

When ALT levels are very high, it may be a sign of an acute liver problem. Mild or moderate elevation, especially if it persists on several tests over time, can be an indicator of a chronic disease. However, the degree of elevation alone is not a reliable predictor of the extent of injury to the liver. 

Because many types of liver problems can cause ALT levels to increase, the test alone cannot identify an underlying cause. Although uncommon, ALT can be elevated as a result of disease outside the liver. Looking at how ALT levels relate to other liver enzymes can provide clues that may help the doctor assess your situation and recommend any appropriate follow-up testing. 

Your physician can best help you understand the diverse factors that affect the interpretation of your ALT test and what your results mean for your overall health.  

Are test results accurate?

Laboratory methods for measuring ALT have been shown to be reliable and reproducible. However, no test is 100% accurate. When errors occur, they are most often related to problems with improperly taking the blood sample. 

Do I need follow-up tests?

Follow-up tests are common if an abnormal level of ALT was found on your liver panel or comprehensive metabolic panel test. Further testing may be immediate if you have significantly elevated ALT and/or symptoms of a problem affecting your liver. This follow-up testing may be more thorough and include blood tests, imaging, and in some cases a biopsy. 

After an initial abnormal ALT test, repeat testing may be recommended shortly after your first test or at a later date. A series of tests over time may provide a more robust assessment of your liver health and can sometimes avoid the need for more costly or invasive testing.

The most appropriate follow-up depends on your health situation and the interpretation of your test result, and your physician can review the pros and cons of different options for further testing.  

Questions for your doctor about test results

A conversation with your doctor about your ALT test can help ensure that you are informed about your results. Some of the following questions may make it easier to cover key information when you talk with your physician: 

  • What was my ALT level? Was it in the normal reference range? 
  • Were any other measurements taken? If so, were they normal or abnormal? 
  • What do the test results mean for my overall health?
  • Do you recommend any follow-up tests? If so, which ones and what are their benefits and risks? 

How to interpret liver function tests

Author(s): Christina Levick

Translational Gastroenterology Unit, University of Oxford, UK

Correspondence: Christina Levick [email protected]


Careful interpretation of liver function tests within the clinical context can help elucidate the cause and severity of the underlying pathology. Predominantly raised alkaline phosphatase represents the cholestatic pattern of biliary pathology, whilst predominantly raised alanine aminotransferase and aspartate aminotransferase represent the hepatocellular pattern of hepatocellular pathology. The severity of liver dysfunction or biliary obstruction is reflected in the bilirubin level and the degree of liver synthetic function can also be indicated by the albumin level. Beyond the liver function tests, prothrombin time provides another marker of liver synthetic function and a low platelet count suggests portal hypertension.


Key words: Liver function test, cholestatic pattern, hepatocellular pattern, liver synthetic function.


Derangement of liver function tests (LFTs) is a common problem that can be difficult to interpret. The clinical context is an important guide, but liver disease can be asymptomatic until the late stages and abnormal blood tests may be the first indication of disease. This review will guide you through the individual LFT’s and how to interpret them.

What are the LFTs?

LFTs include liver enzymes, albumin and other proteins, and bilirubin. The liver enzymes are produced by cells within the liver. They include alkaline phosphatase (ALP), ɣ–glutamyl transpedtidase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), but the combination of liver enzyme results you receive depends on your local laboratory. The protein components comprise total protein, albumin and globulin [N.B. Total protein = Albumin + Globulins]. The globulins are a mixture of globular proteins such as immunoglobulins, enzymes, carrier proteins and complement.

The LFT’s reflect a limited range of hepatic metabolic processes. Bilirubin is an indication of the detoxification/excretory function and albumin reflects the synthetic function.

Typical normal ranges for LFTs and other blood tests are shown in Table 1, but may vary according to your local laboratory.


Table 1. Normal values for blood tests




Normal range



<21 µmol/l

Alkaline phosphatase


30-130 IU/l

ɣ–glutamyl transpedtidase


11-55 IU/l

Alanine aminotransferase


15-45 IU/l

Aspartate aminotransferase


15-42 IU/l



35-50 g/l



20-40 g/l

Total protein


60-80 g/l



135-185 g/l

Mean cell volume


78-100 fl

White cell count


4-11 x109/l



140-400 x109/l

Prothrombin time


9-12 s

International normalized ratio


0. 9-1.2



2.5-7.8 mg/dl



60-110 µmol/l

C-reactive protein


<5 mg/l

Liver enzymes


The liver enzymes are in two main groups – ALP and GGT, produced predominantly by the bile ducts; and ALT and AST, produced predominantly by hepatocytes. Liver enzymes are a poor reflector of liver function, but rather of cholestasis and liver cell integrity, respectively [1].

Liver enzymes have different normal ranges, so assessment of their relative abnormalities by number of times greater than their upper limit of normal (ULN) can be more informative than the absolute values.

When ALP is raised more times its ULN than either ALT or AST, this suggests a cholestatic pattern indicating biliary pathology. In the acute setting, a cholestatic pattern of LFTs is seen with bile stones, when accompanied by colicky right upper quadrant pain or in cholestatic drug-induced liver injury when there is a history of a new causative medication. A more chronic presentation may be due to pancreatic, liver or bile duct tumours or cholestatic autoimmune liver disease such as primary biliary cholangitis or primary sclerosing cholangitis.

ALP is also produced outside the liver by organs such as bone, placenta, kidneys and gut.  Hence ALP may be raised in the presence of normal liver health, most commonly due to bone disease or pregnancy. A raised GGT and/or other abnormalities in the LFTs would indicate a liver source of raised ALP. The ALP isoenzyme can also help differentiate a liver versus bone origin. If all other liver tests are normal, raised calcium or phosphorus levels may also indicate a bone source.

GGT is induced by alcohol and other drugs and so lacks specificity for many liver diseases, except in the context of ALP.

ALT and AST are produced mostly by hepatocytes. However, ALT occurs at low concentrations in skeletal muscle and kidney, and AST is found in kidney, heart, brain, red blood cells and skeletal muscle [1]. Abnormalities in ALT and AST are fairly specific to the liver however.

When ALT or AST are raised more times their ULN than ALP, this is described as a hepatocellular pattern. This state reflects disease processes affecting hepatocytes such as viral hepatitis, metabolic liver diseases, drug or alcohol toxicity and autoimmune hepatitis. Abnormalities in these liver enzymes are generally considered mild if <5 times the ULN, moderate if 5-10 times the ULN or marked if >10 times the ULN.

In alcoholic hepatitis, an ALT over 300 IU/l is rare, but increased AST/ALT ratio is often observed. In contrast, the AST/ALT ratio is low in non-alcoholic steatohepatitis [2], often accompanied by a modestly elevated GGT. Although there are many differential diagnoses for mild to modest elevations in ALT or AST, marked elevations are usually only caused by acute drug-induced liver injury, viral hepatitis or ischaemic liver injury. Detailed history for drug and toxin exposure, viral hepatitis risk factors and inter-current illness resulting in hypotension should be taken. The patient should also be monitored for fulminant liver failure.

In reality, the pattern of LFTs may not be clear-cut and an apparently hepatocellular pattern can reflect an acute cholestatic cause such as biliary stones. Typically, the raised ALT or AST in this situation resolves quickly once the obstruction is relieved. Clinical context and further assessments are therefore needed to help make the diagnosis. The timing of liver enzyme abnormalities may differentiate acute from chronic liver disease, but note that in the chronic setting, significant liver damage such as cirrhosis can exist with normal liver enzyme levels. Raised liver enzymes are not a reliable screening test for cirrhosis.


Bilirubin is the product of haemoglobin breakdown. Lipid-soluble, unconjugated bilirubin is conjugated in the liver, making it water-soluble, and then excreted into bile. When a raised bilirubin or clinical jaundice is found we should consider haemolysis (production of unconjugated bilirubin), liver cell function (conjugation and excretion of bilirubin) and biliary tree function (excretion of bile). A raised bilirubin level is a strong indicator of underlying pathology and should always be investigated with a careful clinical history and appropriate investigations. A liver ultrasound is usually necessary.

In haemolysis, red cell rupture releases free haemoglobin, raising blood levels of unconjugated bilirubin. The diagnosis of haemolysis may be supported by reduced haemoglobin, reduced haptoglobins, increased reticulocyte count and an abnormal blood film, whilst other LFTs and liver ultrasound are normal.

Unconjugated bilirubin is also raised in Gilbert’s syndrome, a benign, inherited disease. Patients are well in Gilbert’s syndrome, but their bilirubin levels may rise particularly during inter-current illnesses, whilst other liver tests and liver ultrasound remain normal. Gilbert’s syndrome can be diagnosed clinically.

In liver cell or biliary pathology with a raised bilirubin, a hepatocellular or cholestatic liver enzyme pattern is often present and possible abnormalities in liver synthetic function. Consideration of these other LFTs, the clinical history and a liver ultrasound to look for biliary obstruction, liver lesions or liver parenchymal change are useful.

Unlike the liver enzymes, the bilirubin can be a useful marker of liver function, as bilirubin rises with increasing severity of liver disease. Bilirubin has been incorporated into a number of composite scores, which assess liver disease severity including the Child Pugh [3] and model for end-stage liver disease (MELD) scores [4][3].


Albumin is a protein synthesized exclusively in the liver. As such it is a marker of liver synthetic function and liver health. The half-life of albumin is 20 days and so a low albumin may be seen in chronic or sub-acute liver disease, but may not be observed in acute liver injury [1]. Albumin levels can be reduced by many kinds of illnesses and so has relatively low specificity as a marker of liver function. None-the-less a low albumin has prognostic significance and forms part of the Child Pugh score.

Other assessments of liver function

The LFTs are not the only blood tests indicating liver function. In particular the prothrombin time (PT) or international normalised ratio (INR), and platelet count contribute to a more comprehensive assessment.

The PT is governed by the activity of clotting factors, which are produced by the liver and have a half-life of about one day [1]. The production of these clotting factors is dependent on adequate vitamin K and so clotting may also be prolonged by vitamin K deficiency. In the absence of vitamin K deficiency or anticoagulants (e. g. warfarin), PT is a good marker of liver function in both acute and chronic settings. The international normalized ratio (INR) also reflects clotting and liver synthetic function in the same way and unlike PT, is standardised across laboratories. Liver function must be quite severely impaired to affect PT or INR and so mild liver disease or a state of compensated cirrhosis will likely have normal values. The PT and INR form part of the Child Pugh and MELD scores, respectively.

Importantly, the liver makes both clotting and fibrinolytic products and so it should not be assumed that a raised PT indicates a hypocoagulable state in the context of liver disease.

Cirrhosis can cause increased pressure in the portal vein that carries blood from the gut and the spleen to the liver. This is called portal hypertension. When this develops, the spleen becomes engorged with blood and consumes platelets. A low platelet count is a marker of portal hypertension [5] and may be the first indicator of chronic liver disease. Portal hypertension causes many of the complications of chronic liver disease such as variceal bleeds, ascites and hepatic encephalopathy and so the finding of a low platelet count in this context is a poor prognostic sign.

The underlying etiology

Despite meticulous interpretation of the LFTs, the underlying cause of liver disease may still not be apparent. When presented with a patient with liver test abnormalities or a clinical suspicion of chronic liver disease, it is often necessary to perform a liver screen. Detailed discussion of the liver screen is beyond the context of this article, but is summarised in Table 2. The liver screen does not contain specific tests for alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD) or drug-induced liver injury amongst others, so careful history and assessment of liver disease risk factors are still vital.

In the acute setting, hepatitis A, hepatitis E, Epstein-Barr virus, cytomegalovirus, human immunodeficiency virus and stool examination for schistosomiasis ova may also be considered.


Table 2. Chronic liver disease screen



Biliary obstruction, tumours and frank cirrhosis

Abdominal US

Viral hepatitis

Hepatitis B and C serology

Autoimmune hepatitis

Liver autoimmune profile





Hepatocellular carcinoma



Wilson’s disease




α1-antitrypsin deficiency





Simple non-invasive scores of liver fibrosis

Although the simple presence of raised liver enzyme levels is not a reliable way of diagnosing cirrhosis, liver function blood tests can be used in combination to predict the presence of liver fibrosis. Detailed description and discussion of these scores is beyond the scope of this article, but commonly used scores include the AST/ALT ratio [6], AST to platelet ratio index (APRI) [7], fibrosis 4 (FIB-4) [8] and NAFLD fibrosis risk score [9]. The World Health Organisation recommends the use of APRI or FIB-4 scores for the assessment of chronic hepatitis C related liver fibrosis to aid decision-making on hepatitis C treatment allocation [10].


Deranged LFTs are a common problem and their interpretation is complicated by the production of liver enzymes from multiple organs and the lack of specificity for markers of liver function.  Therefore it is important to interpret liver tests within the clinical context. Raised ALP reflects biliary tree injury and cholestasis, whereas raised AST and ALT levels usually reflect hepatocyte injury. Raised bilirubin and low albumin are the LFT components that can reflect impaired liver function, whilst raised PT or INR also provide a marker of liver synthetic function. A low platelet count may be seen in cirrhosis and signify the onset of portal hypertension.


  1.  Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians, CMAJ 2005; 172(3):367-79.
  2. Sorbi D, Boynton J, Lindor KD, The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease, Am J Gastroenterol 1999; 94(4):1018-22.
  3.  Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices, Br J Surg 1973; 60(8):646-9.
  4.  Kamath PS, Wiesner RH, Malinchoc M, Kremers W, etal. A model to predict survival in patients with end-stage liver disease, Hepatology 2001; 33(2): 464-70.
  5.  de Franchis R, Baveno VIF Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension, J Hepatol 2015; 63(3):743-52.
  6. Williams AL, Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis, Gastroenterology 1988; 95(3):734-9.
  7.  Wai CT, Greenson JK, R.J. Fontana RJ. etal. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C, Hepatology 2003; 38(2):518-26.
  8.  Vallet-Pichard A, Mallet V, Nalpas B etal. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest, Hepatology 2007; 46(1):32-6.
  9. Angulo P, Hui JM, Marchesini G, etal. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD, Hepatology 2007; 45(4):846-54.
  10.  World Health Organization.  Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection, Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection, Geneva, 2014.

Liver Function Panel | Michigan Medicine

Topic Overview

A liver (hepatic) function panel is a blood test to check how well the liver is working. This test measures the blood levels of total protein, albumin, bilirubin, and liver enzymes. High or low levels may mean that liver damage or disease is present.

The liver serves several important functions in the body, including changing nutrients into energy for the body and breaking down toxic substances.

Your doctor may order a liver function panel if you have symptoms of liver disease. These symptoms include fever, vomiting, abdominal pain, yellowing of your eyes or skin (jaundice), dark yellow urine, and feeling very tired. This blood test also may be done if you have recently been exposed to a hepatitis virus or are taking a medicine that may cause liver damage.


Other Works Consulted

  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.


Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
W. Thomas London MD – Hepatology

Current as of: September 23, 2020

Healthwise Staff

Medical Review:Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & W. Thomas London MD – Hepatology

Indicator “AlAt” in the blood test: norm and deviations

The quantitative content of AlAt in the blood is an important indicator of many diseases of the liver – the largest gland of the human body. It can also inform about diseases of other internal organs. What blood test results indicate an increased or decreased ALT content, and what about normal? What can the deviation from the norm of the content of AlAt lead to? We find out in this article.

AlAt in the blood and its role in metabolic mechanisms

AlAt, or alanine aminotransferase, is an enzyme that is produced in the greatest amount in the liver and, to a lesser extent, in the kidneys, pancreas, myocardium and skeletal muscles.With damage to the listed organs in the blood, an increase in the level of ALT is observed. In a healthy body, the enzyme is contained in plasma in an insignificant amount.

Analysis for the content of ALT (ALT, GPT) helps in the diagnosis of diseases of the liver, pancreas and bile ducts, diseases of the heart muscle and skeletal muscles [1]. Also, the doctor can give a referral to donate blood for an ALAT test if he wants to find out the degree of liver damage in hepatitis, the effect of drugs or other toxic substances on the condition of this gland.This test is mandatory for blood donors.

Often, together with the analysis for ALT, a study for AST (aspartate aminotransferase) is prescribed. Both of these enzymes help in the diagnosis of liver and heart diseases, but their number relative to each other is of particular importance. This ratio is called the de Ritis ratio. Its value is normally 0.91–1.75 [2]. Calculation of the coefficient is advisable only when AlAt and / or AsAt go beyond the reference values.A coefficient below 1 indicates damage to liver cells (hepatocytes), and above 2 indicates cardiovascular disease, possibly myocardial infarction. The procedures for donating blood for ALAT and ASAT are the same.

In order to get a reliable result of the analysis, you need to properly prepare for its implementation. Blood is taken in the morning, on an empty stomach. After the last meal, at least eight hours should pass. Heavy physical exertion should be avoided the day before. Eliminate alcohol five days before analysis.The biomaterial is taken from the vein. Vacutainer tubes (vacuum blood collection systems) are used, usually with a gel phase (preservative) without an anticoagulant. The material for research is blood serum. The Commission on Enzymes of the International Biochemical Union proposed to use “U / L” to designate the unit of measurement of indicators.

Norma AlAt

The level of alanine aminotransferase in a healthy body is quite low. Throughout life, the rate of enzyme production changes.So, in newborns, an overestimated indicator is considered normal, which is explained by the presence of physiological postpartum jaundice. It occurs due to the fact that during childbirth, a large amount of hemoglobin is “thrown” into the baby’s bloodstream. Within three to four weeks, hemoglobin in the baby’s body is actively decomposed, as a result of which bilirubin is formed. And it is precisely its high concentration that causes the icteric manifestations.

In the first five days of a child’s life, it reaches 49 U / L, from five days to six months – up to 56 U / L.Further, the level of the indicator decreases: from six to 12 months – to 54 U / l, from one to three years – to 33 U / l. From three to six years, an amount of up to 29 U / l is considered the norm. From six to 12 years, the indicator will rise again – to 38–39 U / L, and from 12 to 17 years old depends on the gender of the child (for girls – up to 24 U / L, for boys – up to 27 U / L). The rate of the indicator in an adult man is up to 41 U / l. The norm for women is up to 31 U / l. Note that in women in the first trimester of pregnancy, a slight increase in ALT is possible, which is the norm. However, in late pregnancy, an increase in the enzyme content may indicate gestosis (a complication expressed in a feeling of weakness and increased blood pressure). The greater the deviation of AlAt from the norm, the more severe the symptoms of preeclampsia.

Deviations from normal values ​​indicate an inflammatory process in the body.

Reasons for the increase in AlAt

It is believed that the level of AlAt in the blood serum is increased if it exceeds the norm by tens or even hundreds of times.Thus, the indicator increases more than 20 times with the development of acute forms of hepatitis A, B and C. Approximately six times the concentration of AlAt increases in alcoholic hepatitis. If a disease such as fatty degeneration of the liver occurs, the level of ALT can exceed the norm by several times [3]. But with tumor lesions of the liver, the jump in the enzyme may be quite insignificant, but even the specialist should pay close attention to it.

Pay attention!

AlAt indicators can be affected by the intake of choleretics, steroids, oral contraceptives, psychotropic drugs, immunosuppressants, antineoplastic agents and others. If you are taking any of these drugs, you should consult your doctor before getting tested.

How to reduce the concentration of the enzyme?

The surest way to lower the level of AlAt in the blood is to diagnose and cure the pathology that caused the changes. In the treatment of liver diseases, which most often cause an increase in ALT, medications are taken that improve digestion, hepatoprotectors and choleretic agents. All of them have a number of contraindications, so they should be taken only as directed by a doctor.

If an increase in the amount of AlAt is caused by taking any medications, then it is worth stopping their use if possible. Let’s admit the selection of alternative therapy. In addition, in order to reduce the concentration of the enzyme, it is recommended to diversify your diet with foods containing vitamin D (these are fish, green vegetables, soy milk, dairy products and eggs). Carrots, squash, nuts, whole grains, and lean meats are also beneficial. Do not overuse fatty and salty foods. It is, of course, important to follow a healthy lifestyle.

During the course of treatment, the biochemical composition of the blood is periodically examined to find out how effective the prescribed therapy is.

Why AlAt can be downgraded?

A decrease in the concentration of AlAt in the blood indicates a possible rupture of the liver, the occurrence of such serious diseases as cirrhosis and necrosis [4]. Another likely reason for the decrease lies in the lack of vitamin B6 in the body and in the intake of certain drugs containing aspirin, interferon, phenothiazine.

Alanine aminotransferase is present in almost all cells of the human body, but in different proportions. And when its content in the bloodstream changes, it affects the state of many systems. In order to avoid the serious consequences of possible diseases, one should not neglect diagnostic procedures, in particular, donating blood.

All information related to health and medicine is presented for informational purposes only and is not a reason for self-diagnosis or self-medication.

No. AN8ALT, ALT (alanine aminotransferase in the blood): indicators, norm

Alanine aminotransferase (ALT) is an enzyme belonging to the group of transaminases. ALT is localized mainly in the cytosol of cells and catalyzes a reversible transamination reaction, that is, the transfer of an amino group from alanine to α-ketoglutaric acid with the formation of pyruvate and glutamic acid.

The reaction takes place in the presence of a coenzyme, a vitamin B6 derivative.Excess or deficiency of vitamin B6 proportionally affects the activity of transaminases. In dogs and cats, the highest ALT concentrations are found in hepatocytes (especially near the portal area), therefore the determination of ALT in serum is usually included in the biochemical profiles for these animals. This enzyme is also present, but in lower concentrations, in the kidneys, pancreas, intestines, skeletal and cardiac muscle tissues and erythrocytes. In some mammals (for example, in rabbits), the ALT content in the liver and heart muscle is almost the same. Since ALT is predominant in the liver tissue in dogs and cats, serum activity is a more specific indicator of liver damage than AST. The level of serum ALT activity is proportional to the number of damaged cells, but not always associated with the severity of tissue damage. The serum ALT activity may be higher after sublethal damage to a large number of hepatocytes than after necrosis of several hepatic cells. Cholestasis and biliary obstruction can increase serum ALT activity due to toxic effects of bile salts on hepatocytes.Simultaneous study of the level of alkaline phosphatase and GGT in serum will reveal a possible cholestatic component in hepatic pathology. With an increase in ALT activity, a study of bile acids or the level of ammonia in the blood plasma will allow the assessment of liver function. An increase in ALT activity is also observed in severe muscle damage (especially in dogs).

Despite the fact that the activity of ALT in skeletal and cardiac muscles is significantly lower than the activity of this enzyme in the liver and amounts to 5 and 25%, respectively, damage to these muscles can cause a significant increase in ALT levels due to the greater mass of muscle tissue. In severe muscle injuries, the levels of AST and CPK also increase, but the increase in ALT is less pronounced than the increase in AST. Examining the activity of a more specific enzyme found in muscle, such as CPK, can help determine if muscle tissue is the source of the ALT leak. An increase in ALT activity is also noted due to acute intestinal enteropathies, intravascular hemolysis (especially in cats), during hypoxia, as a result of toxic effects on hepatocytes, and in a number of other cases.

Serum ALT levels are usually not considered significant unless they are 2–3 times the upper limit of normal. The serum half-life of ALT is 17 to 60 hours in dogs and 3.5 hours in cats. After severe acute hepatocellular liver damage (for example, exposure to toxic substances), the level of the enzyme increases significantly after 12 hours and reaches a peak within 1–2 days.

With the termination of exposure to damaging factors, the rate of normalization of serum ALT activity does not always correspond to the expected one, taking into account the half-life of the enzyme in the blood serum, and is 1–3 weeks. This slow decrease can be explained by an increase in ALT activity during the reparative regeneration of the liver tissue.


To obtain more accurate results, animals should be on a fast diet for at least 12 hours before the study. The sample is stable for 1 week at a storage temperature of + 2 ° C … + 8 ° C; keeps stability for more than 1 week when freezing -17C … -23C. Severe hemolysis and lipemia can cause a moderate increase in the ALT value in the test sample.


Study results contain information for physicians only. The diagnosis is made on the basis of a comprehensive assessment of various indicators and additional information.

Units of measurement of laboratory VET UNION : Unit / l.

Reference values:

  • Dogs: 0 – 6 months. – 10–32 U / l; 6-12 months – 10–45 U / l; over one year old – 10–65 U / l.
  • Cats: 0-6 months – 10-50 U / l; 6-12 months – 10–75 U / l; over one year old – 10–85 U / l.
  • Ferrets: 78–149 U / L – albinos; 82–289 U / L – dark.
  • Horses: 4–20 U / L.
  • Leopard: 10-146 U / l.
  • Tiger: 21-109 U / l.
  • Chinchilla: 10–35 U / l.
  • Hamster: 22–128 U / L.
  • MRS: 60–84 U / l.
  • 90 094 cattle: 17–37 U / l.

  • Rabbit: 14–80 U / l.
  • Rat: 20–92 U / l.
  • Guinea pig: 10–25 U / l.
  • Mouse – 26 -77 U / l.

In neonatals with colostrum feeding, the ALT level in the first three days of life can reach 337 U / L. The test result is influenced by substances that change the concentration of phosphopyridoxal (vitamin B6). Due to the lack of vitamin B6, the level of ALT activity remains at a low level even in cases of hepatocellular lesions. With the appointment of acetaminophen (paracetamol), an increase in the activity of serum ALT is sometimes noted as a result of the action of the formed reactive hepatotoxic metabolites.An increase in serum ALT activity can be observed in dogs with hyperadrenocorticism or with the administration of corticosteroid hormone drugs (with steroid hepatopathy). The increase in ALT levels is usually insignificant (2-5 times) and is detected a few days after the start of therapy. After discontinuation of therapy, the activity of serum ALT decreases slowly. Such changes are individual and depend on the dose and duration of treatment. Some drugs are hepatotoxic and therefore increase serum ALT levels (eg, sulfonamides, sodium thiacetarsamide, erythromycin, rifampicin).Anticonvulsants (eg, phenobarbital, primidone, phenytoin) also cause mild increases in serum ALT in dogs.

Level up:

  • Hepatitis.
  • Hypoxia (anemia, cardiovascular disease).
  • Neoplasias of the hepatobiliary system.
  • Steroidal hepatopathy.
  • Action of hepatotoxic drugs or toxins.
  • Liver lipidosis.
  • Pancreatitis.
  • Traumatic lesions of the liver tissue.
  • Parasitizing the liver fluke.
  • Copper storage disease.
  • Injury or extensive necrosis of muscle tissue, myositis.
  • Muscle fatigue.

Decreasing the level:

  • Liver atrophy (congenital portosystemic shunts).
  • Decreased vitamin B6 levels.

Increased GGTP – Gamma-glutamyl transpeptidase in liver diseases – tests in liver diseases

Gamma glutamyl transferase (gamma glutamyl transpeptidase) catalyzes the transfer of gamma glutamyl to an amino acid or peptide.GGTP is a membrane-bound enzyme.

Changes in serum GGTP activity are of great diagnostic value in diseases of the liver and hepato-biliary tract. This enzyme is more sensitive to abnormalities in liver cells than ALT, AST, alkaline phosphatase.

GGTP is polysemantic in terms of diagnostics. At least 5 processes cause an increase in its activity in the blood:

– fatty degeneration of the liver – Fatty hepatosis

– necrosis of hepatic cells;

– violation of the outflow of bile – cholestasis;

– alcohol intoxication;

– tumor growth in the liver;

– medicinal damage to the liver.

This etiological variety of mechanisms for increasing GGTP requires a very careful and careful assessment of the causes of this hyperenzymemia. The detection of high activity of GGTP makes us look for the reason for this increase. As a “screening out” test and control over the course of a known pathological process, the study of GGTP is literally irreplaceable in terms of clinical significance.

GGTP is especially sensitive to the effects of long-term alcohol consumption on the liver. In alcohol abusers, serum GGTP levels correlate with the amount of alcohol consumed.The test is especially valuable for monitoring alcoholism treatment. Stopping alcohol intake reduces enzyme activity by about 50% over a period of 10 days.

Determination of GGTP activity is used to establish the fact of damage to liver cells and is usually increased in 90% of cases of liver disease. In most cases, in such patients, an increase in the activity of ALT and GGTP is observed in the blood. An isolated increase in the activity of GGTP is observed in 6-20% of patients with pathology of the hepato-biliary system.

In acute hepatitis, the GGTP activity rises earlier than the ALT activity. At the peak of the disease, the activity of GGTP is lower (increased by 2-5 times) than the activity of ALT, and normalizes much more slowly. This allows the use of GGTP as a control of the patient’s recovery.

An increase in the activity of GGTP by more than 3 times is caused by anticonvulsant drugs, fatty degeneration of the liver and heart failure.

The highest activity of GGTP (5-30 times higher than the reference interval) is observed in intra- and extrahepatic cholestasis.Slightly lower values ​​of the enzyme activity are recorded in primary liver tumors and liver metastases. A persistent and long-term recorded increase in GGTP may be the only clinical and laboratory sign of liver metastatic lesions.

ALT (ALT, Alanine aminotransferase, alanine transaminase, SGPT, Alanine aminotransferase)


September 29


The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct treatment prescription, you should contact your doctor.

We remind you that independent interpretation of the results is unacceptable, the information below is for reference only.

ALT (ALT, Alanine aminotransferase, alanine transaminase): indications for the appointment, the rules for preparing for the test, interpretation of the results and normal indicators.

Indications for prescribing a study

Alanine aminotransferase is an intracellular enzyme, the content of which in the blood of healthy people is low. It is mainly found in the cells of the liver, myocardium, skeletal muscles, and pancreas. When cells containing ALT are damaged or destroyed, the enzyme is released into the bloodstream, and its concentration in the blood increases.

Determination of the level of alanine aminotransferase is carried out for the diagnosis of liver diseases and dynamic monitoring of their treatment. The analysis is performed on suspicion of acute or chronic hepatitis of viral or toxic etiology, cirrhosis of the liver, primary tumors or metastatic liver disease.

The growth of alanine aminotransferase in the blood during hepatitis is noted much earlier than the onset of the icteric stage, which makes it possible to identify pathology at the initial stage.

As part of a screening examination (preventive examination of persons who do not have complaints) to assess the state of the liver, before a planned hospitalization and surgical treatment, an ALT test is prescribed together with another enzyme – AsAT (aspartate aminotransferase).

The level of ALT together with other enzymes is assessed in diseases of the pancreas and gallbladder – pancreatitis, cholecystitis, cholelithiasis; in the presence of complaints of unexplained general weakness, rapid fatigue, yellowness of the skin and sclera, abdominal pain, including a feeling of heaviness in the right hypochondrium, nausea, vomiting.

In addition, the level of ALT is taken into account in myocardial infarction and myocarditis, although in cases of heart damage it is only of secondary importance.The study is prescribed for suspicion of myositis, muscular dystrophy, when complaints of muscle pain cannot be explained by injuries or excessive physical exertion.

Donation is a mandatory reason for passing the test for ALAT.

ALT values ​​are assessed for any chronic diseases, before prescribing drug therapy, for example, anticancer, anti-tuberculosis drugs, to assess the initial state of the liver and in dynamics to assess the tolerability of drugs.

Preparation for procedure

It is better to take the test in the morning on an empty stomach (after an 8-14 hour break after the last meal).

Drinking water is allowed.

If necessary, it is permissible to donate blood 4-6 hours after a light meal.

The day before, it is advisable to avoid physical and emotional overload, overeating.

5-6 days before the test, exclude alcohol intake.

You should refrain from smoking for 30 minutes before taking blood.


The research is carried out within one working day.

What can influence the results

Intense physical activity the day before and even a few days before the test can lead to damage to muscle tissue (the so-called muscle fiber tear) and, accordingly, an increase in the level of ALT. For the same reason, the analysis taken after the injury is not informative.

Taking alcohol, certain medicines (antibiotics, non-steroidal anti-inflammatory drugs, antineoplastic drugs, oral contraceptives, etc.)) often distort the research result. The list of medications to be taken should be discussed with the doctor who ordered the analysis, and those that are possible should be canceled without risk to health.

ALT (ALT, Alanine aminotransferase, alanine transaminase)

For research, blood is taken from a vein. Usually, AST (AST, Aspartate Aminotransferase) is simultaneously determined and the AST / AlAT ratio (de Ritis coefficient) is assessed.

You can take a blood test for ALT (ALT, Alanine aminotransferase, alanine transaminase) at the nearest medical office of INVITRO.The list of offices where biomaterial is accepted for laboratory research is presented in the “Addresses” section.

Interpretation of test results contains information for the attending physician and does not constitute a diagnosis. The information in this section cannot be used for self-diagnosis and self-medication. An accurate diagnosis is made by a doctor, using both the results of this examination and the necessary information from other sources: anamnesis, results of other examinations, etc.

Normal values ​​

Units of measurement: Unit / l.

Reference values ​​

Floor Age ALAT level, U / l
Both <5 days <49
5 days – 6 months <56
6 – 12 months <54
1 – 3 years <33
3 years – 6 years <29
6 – 12 years old <39
Male 12 – 17 years old <27
> 17 years old <41
Female 12 – 17 years old <24
> 17 years old <31

Interpretation of indicators

The ALT level depends on the age and gender of the patient. Minor deviations from the norm, as a rule, do not require drug therapy, and related recommendations, such as a balanced diet, avoiding alcohol, etc. should be discussed with your doctor.

The ratio of AsAT / ALAT (de Ritis coefficient) is normally from 0.91 to 1.75.

What do the lowered figures mean?

A significant decrease in the level of ALT can be detected in severe liver damage, for example, at the terminal stage of liver cirrhosis, when the number of liver cells is significantly reduced.

What the increased numbers mean

First of all, with an increase in ALT, liver problems should be suspected: fatty hepatosis, hepatitis of viral or toxic etiology, liver cirrhosis, liver cancer – primary or metastatic.

The degree of increase in ALT is usually associated with the volume or severity of liver damage, but cannot be considered as a determining factor for the prognosis of the disease. The maximum levels of ALT (and AST) – more than a hundred times higher than the norm, are observed in patients with acute viral and drug hepatitis.

A significant increase in alanine aminotransferase can be observed in acute cholecystitis, gallstone disease, in acute destructive pancreatitis. Another reason may be taking hepatotoxic drugs that damage liver cells.

An increase in the level of ALT is detected with extensive injuries of skeletal muscles, severe myositis and myodystrophy, frequent intramuscular injections.

A less significant increase in ALT is recorded in acute myocardial infarction and myocarditis.

Additional examination when the indicator deviates from the norm

When a change (more often an increase) in the level of ALT is detected, patients are consulted
general practitioners,
gastroenterologists, hepatologists, infectious disease specialists.

To clarify the diagnosis, in addition to ALT, other liver enzymes (AsAT, gamma-HT, alkaline phosphatase, bilirubin), clinical blood parameters are usually examined and markers of viral hepatitis, primarily hepatitis B and hepatitis C are determined.

An ultrasound examination of the abdominal organs is performed, if indicated – computed tomography (CT) with contrast.
If skeletal muscle damage is suspected, the CPK enzyme is additionally examined and a rheumatologist is consulted.

If you suspect a heart muscle injury, consultation with a cardiologist is required. Usually the doctor prescribes additional electrocardiography (ECG), echocardiography, blood test for MV-CPK, troponin I.


  1. Shipovskaya A.A., Lutokhina A.A., Larina N.A., Dudanova O .P. The role of new reference values ​​of alanine aminotransferase in the diagnosis of various forms of non-alcoholic fatty liver disease in patients with metabolic syndrome.Journal of Biomedical Technologies No. 1. 2015. S. 9-15.

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct treatment prescription, you should contact your doctor.

Information checked by expert

Lishova Ekaterina Alexandrovna

Higher medical education, work experience – 19 years

90,000 Blood test for ALT – biochemistry for alanine aminotransferase to take in Moscow

Alanine aminotransferase (ALT) is an endogenous enzyme related to transaminases.It is produced intracellularly. Participates in the metabolism of amino acids. It is found in large quantities in the liver and kidneys, somewhat less in striated muscles.
Plays an important role in the diagnosis of liver pathology. As a rule, it is assigned together with AST.
Alanine aminotransferase (ALT, HPT, GPT, glutamate pyruvate transaminase) is an enzyme that normally has low serum activity in the blood, as it is concentrated inside cells. Its main amount is found in liver cells.ALT begins to be released into the bloodstream if liver damage is present. Moreover, it is often possible to identify this enzyme in the blood much earlier than the first noticeable symptoms appear. Therefore, the Alanine Aminotransferase test is used by specialists as an indicator of liver damage.

Indications for the appointment of a blood test for alanine aminotransferase (ALT):

  • Presence of risk factors for liver damage.
  • Clinical manifestations characteristic of liver pathologies.
  • During treatment, a study is prescribed at regular intervals to monitor the effectiveness of therapy.


The liver has many different functions in the body. Its damage leads to the appearance of pain, yellowness of the skin and sclera, nausea, weakness, bloating, fatigue, discoloration of urine and other manifestations. The liver is involved in the synthesis of bile, protein metabolism, the processing of nutrients and other processes in the body.Damage to its cells is manifested by the release of GPT into the blood.
A blood test for ALT (glutamate pyruvate transaminase) is part of the liver function test. It is prescribed by a doctor to check if a patient’s liver is damaged due to medication, a previous illness, or for other reasons.

A moderate increase in the amount of the enzyme is characteristic of liver tumors. High ALT can be in patients with cirrhosis, biliary obstruction.The abnormalities identified during the study also make it possible to suspect diseases characterized by a slowdown in blood flow to the liver, hepatitis and other viral infections. The amount of the enzyme increases with the use of drugs toxic to the liver, some dietary supplements. The interpretation of the results takes into account the age and gender of the patient. Only a doctor can correctly evaluate the test results. If necessary, he will recommend an examination program or prescribe treatment.
If the test results exceed the norm, this necessarily indicates liver pathology.The indicators increase with intense sports, hard physical work, after injections into muscle tissue. A slight excess of the norm can be observed in people who often eat fast food, as this negatively affects the liver. After the transition to a balanced diet, the indicators are normalized without special treatment.

Blood test for biochemistry

Biochemical blood test is a laboratory diagnostic method that allows you to evaluate the work of many internal organs: kidneys, liver, pancreas and others.In addition, this study shows the full spectrum of trace elements in your body, accurately determining which it is currently lacking.

Tatiana Veselova, general practitioner, Ph. D.

A standard biochemical blood test includes the determination of a large number of indicators. What parameters will be investigated in this analysis depends on the disease and is determined by the attending physician. Let’s try to decipher some of them. Citing the norms (reference values) for individual indicators, we recall that in different laboratories they may differ slightly.

Total protein

Determination of total protein in blood serum is used to diagnose diseases of the liver, kidneys, cancer, nutritional disorders.

The norm of of the total blood protein content is 64–83 g / l.

Increased protein content occurs in acute and chronic infectious diseases, oncological pathology, blood diseases, dehydration. Decreased protein levels are most often caused by diseases of the liver, kidneys, intestines, starvation and some others.

Albumin and globulins

Changes in the ratio of individual protein fractions (albumin and globulins) in the blood often give the doctor more meaningful information than just knowing the level of total protein.




globulins, total amount


9025 407

1 9025 902 9025 902 9502 9025 902 9025



α-1 globulins







The ratio of individual fractions can be used to judge a variety of conditions and disorders.For example, a drop in albumin levels may indicate liver, kidney, or bowel disease. Usually this indicator is reduced in diabetes mellitus, severe allergies, burns, and inflammatory processes. Normally, it is lowered in nursing mothers and smokers. An increased level of albumin is a signal of disorders of the immune system or metabolism. An accurate assessment of why there was a shift in the ratio of proteins can only be given by the doctor who ordered the analysis.


C-reactive protein (CRP) is an indicator that responds faster than others to tissue damage.

SRB rate: – less than 0.5 mg / l.

In inflammatory processes of an infectious nature (bronchitis, tonsillitis, etc.) and systemic inflammation (systemic lupus erythematosus, rheumatism), as well as in tumors, its content increases. Using this indicator, you can determine the severity of the disease and the effectiveness of treatment.


Rheumatoid factor (RF) is an indicator of rheumatoid arthritis (found in 75–80% of patients).The indications for the appointment of this analysis are rheumatoid arthritis, acute inflammatory processes, systemic diseases, hepatitis, sarcoidosis.

RF is determined in two ways, for qualitative analysis the norm is “negative”, for quantitative analysis – less than 14 IU / ml.

Transferrin, ferritin, YSS

These indicators are studied for in-depth diagnosis of anemia, to determine the relationship of anemia with impaired intake or metabolism of iron in the body.Transferrin is a protein in blood plasma, the main carrier of iron. Ferritin is the main indicator of the body’s iron stores. The iron-binding capacity of blood serum (YSS) is an indicator characterizing the ability of blood serum to bind iron.



the ratio of these indicators, the doctor makes a conclusion about the nature of the disease and the methods of treatment.

Glycosylated hemoglobin

According to the recommendations of the World Health Organization (WHO), this is the most effective and necessary indicator in the diagnosis of diabetes mellitus. Patients with diabetes mellitus are recommended to take a biochemical blood test for glycosylated hemoglobin at least 1 time per quarter.

The norm of glycosylated hemoglobin

for men –135–160 g / l,

for women 120–140 g / l.


This is the main indicator of carbohydrate metabolism.

The norm of glucose in the blood is 3.8-5.83 mmol / l,

from the age of 60, the glucose level normally increases to 6.38 mmol / l.

An increase in glucose is observed in diabetes mellitus. An increase in this indicator can be in the first hours of a stroke, heart attack, with injuries, infections, pancreatitis, as well as against the background of severe stress and smoking.A decrease in blood glucose levels accompanies some endocrine diseases, impaired liver function.


Bilirubin is a breakdown product of hemoglobin. It is part of the bile. A bilirubin test is done to assess how well the liver and gallbladder are working. Bilirubin comes in two forms – direct and indirect. Together, these forms form total bilirubin.



2.0–4.0 g / l

/ L

ferritin for women

10–120 μg / L


30–85 μmol / L

total bilirubin

3.4–17.1 μmol / L

straight bili 4 μmol / L

If there is an increase in bilirubin in the blood, this is often accompanied by yellowing of the skin and whites of the eyes (jaundice), which is a sign of trouble in the body.Most often, a deficiency of vitamin B12, liver and gallbladder diseases lead to an increase in the level of bilirubin.

Urea and creatinine

These are protein breakdown products. They are formed in the liver and excreted by the kidneys.



2.5–6.4 mmol / l

53507251 for women / L

Creatinine for men

62-115 μmol / L

Increased urea levels are found in diseases of the kidneys and urinary tract conditions, heart failure, and shock physical activity and while taking hormonal drugs.An increase in creatinine levels is observed not only with kidney pathology, but also with muscle damage.

The most common causes of a decrease in urea and creatinine in a blood test are: fasting, a vegetarian diet, a decrease in muscle mass, the first half of pregnancy, and taking corticosteroids.

Uric acid

Uric acid is responsible for removing excess nitrogen from the body. It is synthesized in the liver and excreted by the kidneys. If kidney function is impaired, then it accumulates in the body and leads to damage to various organs.

Uric acid rate

for women

145–400 µmol / L


/9507 µm

An increase in the level of uric acid occurs primarily in gout, as well as in acute infections, kidney stones, diabetes mellitus.


Alanine aminotransferase (ALT or ALAT) and aspartate aminotransferase (AST or AST) are liver enzymes involved in protein metabolism.They are found in large quantities in the liver, kidneys, heart muscle and skeletal muscles.




up to 30 units / l


The degree of increase in these indicators in combination with other deviations gives the doctor information about a number of possible problems in the body.

Alpha-amylase (diastase)

It is produced in the salivary glands and pancreas, while pancreatic amylase is produced only in the pancreas. Both are involved in the digestion of carbohydrates.


amylase 950–2000 units./ l


28–100 units / l

These indicators, as a rule, increase in diseases of the pancreas, diabetes mellitus, renal failure. A decrease in the level of amylase in the blood may indicate hepatitis and endocrine disorders.

Mineral metabolism

Also, a biochemical blood test allows you to investigate the state of mineral metabolism. The most frequently studied are iron, potassium, sodium, calcium, magnesium, chlorine, vitamin B12.




9-30 μmol / l



136-145 mmol / L


2.15-2.50 mmol / L

9000 9000 , 65–1.05 mmol / l


98–107 mmol / l

vitamin B12

180-900 pg / ml


The change in the level of these substances is an auxiliary indicator for assessing a variety of pathological conditions.

Analysis results

Having received the result of a biochemical blood test, it is easy to compare the indicators of your analysis with the norm. A deviation from the norm is a signal that there have been violations in the activity of the body.

Only an experienced doctor can correctly evaluate the results of the analysis and make a diagnosis.

Enzymes and their functions


A number of chemical transformations of substances coming from outside are constantly taking place in the body.These reactions can only take place in the presence of certain catalysts. The latter, in turn, are presented in the form of substances of a protein nature – enzymes. They speed up the metabolic process and help to achieve balance. Thanks to the action of enzymes, the reactions taking place in the body are accelerated hundreds of times. A change in the concentration of these substances in the body indicates the development of very dangerous diseases. In this case, the activity of enzymes decreases much earlier than more obvious signs of the disease appear.This type of analysis allows you to accurately diagnose the presence of a disease and start treatment in a timely manner. In our laboratory you can go through all the necessary research.

Medical specialists

Senior nurse


Endoscopy office nurse


Result within 25 minutes, from the moment of delivery of biomaterial

Our clinics in St. Petersburg

Medical Center South-West

Etc.Marshal Zhukov 28k2
Kirovsky district

  • Avtovo
  • Veterans Avenue
  • Leninsky Prospect

You can get detailed information and make an appointment by calling
+7 (812) 640-55-25

Properties of enzymes:

  • First of all, as mentioned above, enzymes directly affect the rate of chemical reactions taking place inside the body.
  • Specificity of action. Since a huge number of reactions constantly occur in the body, to accelerate each of them, its own special enzyme is produced, which cannot act on other processes. Due to the specificity of the action, two groups of enzymes are distinguished:
  1. relative – the enzyme catalyzes a certain type of reaction;
  2. 90,094 absolute – when the enzyme is responsible for the course of only one reaction.

  • The activity of enzymes characterizes their ability to speed up reactions in the body to varying degrees.This indicator depends on the following factors: temperature, pH of the medium, etc.

Types of tests for enzymes

Alanine aminotransferase (ALT) is a liver enzyme and is involved in the exchange of amino acids. When the cells of the kidneys, liver, skeletal muscles and heart muscle are destroyed, the concentration of ALT in the blood increases. Test results may indicate the following diseases:

  • viral hepatitis A and other types of hepatitis;
  • cirrhosis or liver cancer;
  • damage to the liver by toxins;
  • chronic alcoholism;
  • 90 094 pancreatitis;

  • jaundice;
  • myocardial infarction;
  • burns.

Amylase is produced in the pancreas and salivary glands. Provides the breakdown of carbohydrates entering the body along with food. An increased content of alpha-amylase is a symptom of the following diseases: cyst, peritonitis, pancreatitis, mumps, diabetes mellitus, renal failure. Also, an increase in alpha-amylase occurs with abortion or abdominal trauma. Pancreatic amylase is synthesized in the pancreas. Its level increases with injuries of the pancreas, acute pancreatitis, renal failure, alcoholism, ulcers.

Aspartate aminotransferase (AST) – an enzyme that is found in the nervous, skeletal tissues, as well as in the cells of the heart, kidneys, liver and other organs. The results of the analysis can give both increased values ​​(with liver cancer, hepatitis, heart failure, angina pectoris), and also show a low level due to rupture of the liver and serious diseases.

Creatine kinase is part of the cells of the brain, lungs, thyroid gland, skeletal muscles, heart muscle.An increase in creatine kinase is noted when there is a disruption in the work of any of the listed organs. Most often, an increase in activity is observed in acute myocardial infarction, diseases of skeletal muscles, brain, hypothyroidism.

Lipase is synthesized by the organs for the breakdown of fats. The analysis is carried out to detect and diagnose diseases. An increased content of lipase in the blood indicates the presence of the following diseases:

90,093 90,094 tumors;

90 094 pancreatitis;

90,094 diseases of the gallbladder;

  • breast cancer;
  • 90 094 renal failure;

    90,094 obesity;

  • gout.
  • A decrease in the level occurs in the case of oncological diseases.

    Cholinesterase is formed in the liver. A cholinesterase test is done to assess liver function or in case of insecticide poisoning. The enzyme content decreases sharply in severe liver diseases, myocardial infarction, cirrhosis, oncological diseases, hepatitis (for example, in hepatitis B). A decrease in the level of this enzyme is characteristic in the last stage of pregnancy, while its increase is noted at the initial stage.Increased cholinesterase is a symptom of the following diseases: obesity, breast cancer, tetanus, diabetes mellitus, alcoholism, manic-depressive psychosis, neuroses.

    Alkaline phosphatase takes part in the exchange of phosphoric acid. An analysis is carried out to diagnose diseases of the liver, skeletal system. An increase in alkaline phosphatase occurs in myeloma, rickets, infectious mononucleosis, bone lesions, liver diseases, a decrease in is a sign of a lack of vitamins, magnesium, zinc, anemia.When monitoring pregnancy, an alkaline phosphatase test is also performed. A decrease in its activity occurs in case of insufficient development of the placenta.


    Zadorozhnaya Maria Nikolaevna



    I would like to express my gratitude to the gastroenterologist Tatiana Petrovna Bannikova! For many years this doctor has been supervising me, he always conducts correct diagnostics, prescribes adequate treatment !!! The best doctor!
    In addition to professional skills, the doctor is the most beautiful person! There would be more such doctors! Thank you very much, Tatyana Petrovna!

    Tsareva Svetlana



    I went to the department on Zhukov to the traumatologist Baizhanov with severe pain in the heel, could not step, there was a heel spur and flat feet. I am very grateful to Abyl Khair for the treatment, the pain did not completely go away, but in comparison with what it was, day and night, I could not step on my foot. I also want to note an important point, the doctor explained to me in detail and in a language understandable to me the cause and essence of the disease, gave recommendations for further treatment.Thank you very much, best recommendations for a young specialist 🙂

    Nosovets Vlada Vitalievna



    I would like to recommend and express my gratitude to Doctor surgeon Djoraev Agamurat (Okhtinskaya alley 18) for his professionalism, sensitive approach to patients, I was always afraid of surgeons, but after treatment this doctor turned everything upside down.Agamurat, if you are reading this, thank you very much.

    Alexey Gruzdev



    Passed an endoscopic examination by a group of doctors consisting of: Anna Akhatovna Mordvintseva, Timur Ruslanovich Suydyumov, Alexandra Vladimirovna Lokotkova.The attitude to the patient is attentive, responsible. The work is done professionally, confidently, without fuss. Thank you!

    I would like to express my gratitude to Agamurat Orazmamedovich for the responsiveness and professional help to my son, thank you for our pen !!!

    I would like to express my gratitude to Vladimir Aleksandrovich Sidorkin (ENT).

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