About all

Liver function test normal levels: Liver function tests – Mayo Clinic

A review on laboratory liver function tests

1. Mauro P, Renze B, Wouter W. In: Tietz text book of clinical chemistry and molecular diagnostics. 4th edition. Carl AB, Edward R, David EB, editors. Elsevier; 2006. Enzymes; pp. 604–616. [Google Scholar]

2. Diana Nicoll C. In: Current medical diagnosis and treatment. 46th edition. Stephen JM, Maxine AP, editors. Mc Graw hill; 2007. Appendix: Therapeutic drug monitoring and laboratory reference ranges; pp. 1767–1775. [Google Scholar]

3. Thapa BR, Anuj W. Liver Function Tests and their Interpretation. Indian J Pediatr. 2007;74:663–671. [PubMed] [Google Scholar]

4. Wong HY, Tan JYL, Lim CC. Abnormal liver function test in symptomatic pregnant patient: The local experience in Singapore. Annals academy of Medicine. 2004;33:204–208. [PubMed] [Google Scholar]

5. Beckingham IJ, Ryder SD. Clinical review ABC of diseases of liver, pancreas, and biliary system Investigation of liver and biliary disease. BMJ. 2001;322:33–36. [PMC free article] [PubMed] [Google Scholar]

6. Thomsen HF, Hardt F, Juhl E. Diagnosis of Gilbert’s syndrome. Scand J Gastroenterol. 1981;16:699–703. [PubMed] [Google Scholar]

7. Tiribelli C, Ostrow JD. New concepts in bilirubin and jaundice: report of the Third International Bilirubin Workshop, April 6–8, 1995, Trieste, Italy. Hepatology. 1996;24:1296–1311. [PubMed] [Google Scholar]

8. Alvarez F, Berg PA, Bianchi FB. et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–38. [PubMed] [Google Scholar]

9. Daniel SP, Marshal MP. In: Schiff’s diseases of the liver. 10th edition. Eugene RS, Michel FS, Willis CM, editors. Vol. 1. Lippincott Williams and Wilkins; 2007. Laboratory test; pp. 19–54. [Google Scholar]

10. Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases. Kathmandu Univ Med J. 2006;4:281–289. [PubMed] [Google Scholar]

11. Bacq Y, Zarka O, Brechot JF. et al. Liver function tests in normal pregnancy a prospective study of 103 pregnant women and 103 matched controls. Hepatology. 1996;23:1030–1034. [PubMed] [Google Scholar]

12. Perlstein TS, Pande RL, Creager MA. et al. Serum total bilirubin level prevalent stroke and stroke outcomes. NHANES 1999–2004. Am J Med. 2008;121:781–788. [PMC free article] [PubMed] [Google Scholar]

13. Kallei L, Hahn A, Roder VZ. Correlation between histological findings and serum transaminase values in chronic diseases of the liver. Acta Medica Scandinavika. 1964;175:49–56. [PubMed] [Google Scholar]

14. Marcellin P. Hepatitis C: the clinical spectrum of the disease. J Hepatol. 1999;31:9–16. [PubMed] [Google Scholar]

15. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med. 1997;126:137–145. [PubMed] [Google Scholar]

16. James D, Tania SB, Sara ET. et al. Alanine Aminotransferase Levels and Fatty Liver in Childhood Obesity: Associations with Insulin Resistance, Adiponectin, and Visceral Fat. J Clin Endocrinol Metab. 2006;91:4287–4294. [PubMed] [Google Scholar]

17. Tzong-Hsi L, Yung-Hsuan S, Wei-Shiung Y. et al. Bright Liver and Alanine Aminotransferase Are Associated with Metabolic Syndrome in Adults. Obesity Research. 2005;13:1238–1245. [PubMed] [Google Scholar]

18. Everhart JE, Ruhl CE. Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2005;128:24–32. [PubMed] [Google Scholar]

19. Panteghini M, Falsetti F, Chiari E. et al. Determinaton of Aspartate aminotransferase isoenzymes in hepatic disease. Lab J Res Lab Med. 1983;10:515–519. [Google Scholar]

20. AGA Technical Review on the Evaluation of Liver Chemistry Tests. Gastroenterology. 2002;123:1367–1384. [PubMed] [Google Scholar]

21. Cohen JA, Kaplan MM. The SGOT/SGPT ratio – an indicator of alcoholic liver disease. Dig Dis Sci. 1979;24:835–838. [PubMed] [Google Scholar]

22. Diehl AM, Potter J, Boitnott J. et al. Relationship between pyridoxal 5′-phosphate deficiency and aminotransferase levels in alcoholic hepatitis. Gastroenterology. 1984;86:632–636. [PubMed] [Google Scholar]

23. Edoardo Giannini, Domenico Risso, Federica Botta. et al. Validity and Clinical Utility of the Aspartate Aminotransferase–Alanine Aminotransferase Ratio in Assessing Disease Severity and Prognosis in Patients with Hepatitis C Virus–Related Chronic Liver Disease. Arch Intern Med. 2003;163:218–224. [PubMed] [Google Scholar]

24. Sayal SK, Gupta CM, Das AL. et al. A comparative study of liver function tests in patients of chronic liver disorders with and without cutaneous manifestations. Ind J Dermatol Venereol Leprol. 1997;63:15–19. [PubMed] [Google Scholar]

25. Giannini E, Botta F, Testa E. et al. The 1-year and 3-month prognostic utility of the AST/ALT ratio and model for end-stage liver disease score in patients with viral liver cirrhosis. Am J Gastroenterol. 2002;97:2855–2860. [PubMed] [Google Scholar]

26. Giannini E, Botta F, Fasoli A. et al. Progressive liver functional impairment is associated with an increase in AST/ALT ratio. Dig Dis Sci. 1999;44:1249–1253. [PubMed] [Google Scholar]

27. 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;94:1018–1022. [PubMed] [Google Scholar]

28. Christoph E, Olivia S, Wolfgang S. Diagnostic criteria for acute liver failure due to Wilson disease. World J Gastroenterol. 2007;13:1711–1714. [PMC free article] [PubMed] [Google Scholar]

29. Bayraktar M, Van T. Abnormalities in measures of liver function and injury in thyroid disorders. Hepatogastroenterology. 1997;44:1614–1618. [PubMed] [Google Scholar]

30. Rosalki SB, Mcintyre N. 2nd ed. New York: Oxford university press; 1999. Biochemical investigations in the management of liver disease; pp. 503–521. Oxford textbook of clinical hepatology. [Google Scholar]

31. Simko V. Alkaline phosphatases in biology and medicine. Dig Dis. 1991;9:189–193. [PubMed] [Google Scholar]

32. Ilham MA, Cookson A, Dheerendra S. et al. Idiopathic severe elevation of serum alkaline phosphatase following adult renal transplantation: case reports. Transplant Proc. 2008;40:2059–2061. [PubMed] [Google Scholar]

33. Cheung BM, Ong KL, Wong LY. Elevated serum alkaline phosphatase and peripheral arterial disease in the United States National Health and Nutrition Examination Survey 1999–2004. Int J Cardiol. 2009;135:156–161. [PubMed] [Google Scholar]

34. Giannini E, Botta F, Fasoli A. et al. Increased levels of gamma GGT suggest the presence of bile duct lesions in patients with chronic hepatitis C: absence of influence of HCV genotype, HCV-RNA serum levels, and HGV infection on this histological damage. Dig Dis Sci. 2001;46:524–529. [PubMed] [Google Scholar]

35. Wu A, Slavin G, Levi AJ. Elevated serum gamma-glutamyl-transferase (transpeptidase) and histological liver damage in alcoholism. Am J Gastroenterology. 1976;65:318–323. [PubMed] [Google Scholar]

36. Sugiura M, Nakamura M, Ikoma Y. et al. High serum carotenoids are inversely associated with serum gamma-glutamyl transferase in alcohol drinkers within normal liver function. Journal of epidemiology. 2005;15:180–186. [PMC free article] [PubMed] [Google Scholar]

37. McCullough AJ. Update on nonalcoholic fatty liver disease. J Clin Gastroenterol. 2002;34:255–262. [PubMed] [Google Scholar]

38. Martin JV, Hague RV, Martin PJ. et al. The association between serum triglycerides and gamma glutamyl transpeptidase activity in diabetes mellitus. Clin Biochem. 1976;9:208–211. [PubMed] [Google Scholar]

39. Smith K, Varon HH, Race GJ. et al. Serum 5′-nucleotidase in patients with tumour in the liver. Cancer. 1966;17:1281–1285. [PubMed] [Google Scholar]

40. Pratibha K, Usha A, Rajni A. Serum adenosine deaminase, 5′ nucleotidase and malondialdehyde in acute infective hepatitis. Ind J Clin Biochem. 2004;19:128–131. [PMC free article] [PubMed] [Google Scholar]

41. Miya F, Shigeru A, Fumitada H. et al. 5′-nucleotidase activities in sera and liver tissues of viral hepatitis patients. Journal of Gastroenterology. 1990;25:199–205. [PubMed] [Google Scholar]

42. LaRusso NF, Summerskill WH, McCall JT. et al. Abnormalities of chemical tests for copper metabolism in chronic active liver disease: differentiation from Wilson’s disease. Gastroenterology. 1976;70:653–655. [PubMed] [Google Scholar]

43. Zhifang Xie, Hai Zhang, Wenwei Tsai. Zinc finger protein ZBTB20 is a key repressor of alpha-fetoprotein gene transcription in liver. PNAS. 2008;105:10859–10864. [PMC free article] [PubMed] [Google Scholar]

44. Stewart Sell. Alpha-Fetoprotein, Stem Cells and Cancer How Study of the Production of Alpha-Fetoprotein during Chemical Hepatocarcinogenesis Led to Reaffirmation of the Stem Cell Theory of Cancer. Tumor Biol. 2008;29:161–180. [PMC free article] [PubMed] [Google Scholar]

45. Grizzi F, Franceschini B, Hamrick C. et al. Usefulness of cancer-testis antigens as biomarkers for the diagnosis and treatment of hepatocellular carcinoma. J Transl Med. 2007;5:3. [PMC free article] [PubMed] [Google Scholar]

46. Males S, Gad RR, Esmat G. et al. Serum alpha-foetoprotein level predicts treatment outcome in chronic hepatitis C. Antivir Ther. 2007;12:797–803. [PubMed] [Google Scholar]

47. Zhou L, Liu J, Luo F. Serum tumor markers for detection of hepatocellular carcinoma. World J Gastroenterol. 2006;12:1175–1181. [PMC free article] [PubMed] [Google Scholar]

48. Hagiwara S, Kudo M, Kawasaki T, Nagashima M. et al. Prognostic factors for portal venous invasion in patients with hepatocellular carcinoma. J Gastroenterol. 2006;41:1214–1219. [PubMed] [Google Scholar]

49. Asmaa IG, Shahid AK, Edward LS. Diagnosis of hepatocellular carcinoma. World J Gastroenterol. 2009;15:1301–1314. [PMC free article] [PubMed] [Google Scholar]

50. Gordon CS, Angela M. Second-Trimester Maternal Serum Levels of Alpha-Fetoprotein and the Subsequent Risk of Sudden Infant Death Syndrome. N Engl J Med. 2004;351:978–986. [PubMed] [Google Scholar]

Liver Function Test – About, Normal Range, Preparation, Test Results & More

what is a liver function test?

It is a group of tests that gives a statement on the health of a patient’s liver. It determines the health of the liver by evaluating the level of liver enzymes, proteins or bilirubin in the blood. The main tests in the liver function tests are prothrombin time, APTT, albumin, bilirubin. 

A liver function test is recommended for the following reasons:  

  • To screen for any infections such as hepatitis C in the liver
  • If you are consuming any medications that might have a side effect on the liver functions
  • To monitor an already existing liver disease and its status during treatment like liver cancer
  • If you have any symptoms of any liver problems or liver disease
  • Planning for pregnancy 

symptoms of liver problems:

  • Jaundice fever – skin and eyes turn yellowish
  • Swelling and pain of the abdominal
  • Swelling of legs and ankles
  • Itching of the skin
  • Dark colour Urine
  • Stool is either bloody, tar-coloured or pale
  • Fatigue 
  • Queasiness or vomiting
  • Appetite loss
  • Easily getting bruised

causes of liver problem:

There may be many liver damage causes. Some of them are: 

  • Infection 
  • Immune system abnormality 
  • Genetics
  • Cancer 
  • Habits such as excessive alcohol intake

why do i need liver function test?

The liver is a vital organ of the human body and liver functions play a vital role in the overall health of your body.

A liver function test helps in determining the condition and health of your liver in order for it to perform the following liver functions efficiently. 

what is the function of a liver?

  • Cleanses your blood by removing contaminants eliminating liver infections
  • Helps in converting nutrients from your food intake
  • Stores vitamins and minerals in your body 
  • Regulates blood clot
  • Produces enzymes, proteins and bile
  • Produces infection fighting factors
  • Removes bacteria from the blood
  • Processes harmful substances from the body
  • Helps in balancing hormones

With so much liver functions, a problem caused in the liver can cause life-threatening diseases to the person.

what do my test results mean?

The most common blood test taken for liver function test is aminotransferases.

If your liver function test results range between 7-56 units/litre for ALT and 10-40 got AST, your liver function is normal. Anything outside the liver function test normal range means there might be some liver problems or liver infection and needs to be diagnosed and treated.  

how is liver function test done?

The liver function test is like any other blood test. It may be taken at a hospital, clinic or specialised testing facility. You can administer the test by checking if the following steps are done: 

  • Your skin will be cleaned by the blood test technician to prevent any substances on your skin to avoid contamination of the test. 
  • They will wrap your arm with some sort of pressure device to make the veins more visible. They will then insert the needle into the vein to draw enough blood samples for the test. 
  • Once the blood is drawn, they will cover the pierced area to avoid any infection and will send the blood samples for testing to the laboratory.  

does liver function test pose any risk?

Blood tests are a very common routine to check several diseases and diagnosis like the liver disease. The rare cases of risks that might happen while giving a blood sample are: 

  • Internal bleeding under the skin
  • excessive bleeding
  • fainting due to weakness after blood withdrawal
  • Infection

how do i prepare for the test?   

You will be guided by the doctor with instructions to follow before taking the tests. You may have to avoid certain foods and medicines before the test as they might affect the levels of enzymes and proteins present in your blood. 

how can we help?

Do you find yourself searching for “Liver function test near me” on google? Worry no more. We now provide services for home liver function test. If you have noticed any symptoms of a liver problem or liver infection and your doctor can recommended you to take this tests, all you have to do is contact us!

We will have a health care expert sent to your house and do the necessary procedures. The samples will be sent for testing and you will receive your liver function test report at your doorstep.

at-home lipid liver function test in top location include:

Bangalore, Delhi-NCR, Chennai, Hyderabad, Kolkata, Pune, Lucknow, Indore.

liver function test (lft) cost 2022 in india

The average cost of at home Liver Function Test in India is Rs.600, Book from Portea to get tested at your home

Understanding results ofLiver Function

SGOTThe normal range for the AST test is 10 to 34 IU/L (international units per liter)
GGTThe normal range for GGT in blood is 0 to 51 international units/liter.
Total ProteinThe total protein is between 6 and 8.3 gm/dL (grams per deciliter)
AlbuminThe typical value for albumin is 3.4 to 5.4 g/dL of blood
BilirubinIn an older child or adult, normal values of direct (conjugated) bilirubin are from 0 to 0. 3 milligrams per deciliter (mg/dL). Normal values of total bilirubin (direct and indirect) are from 0.3 to 1.9 mg/dL. In a newborn, higher bilirubin is normal due

‘*A Reference range is a set of values which helps the healthcare professional to interpret a medical test. It may vary with age, gender, and other factors. Reference ranges may also vary between labs, in value & units depending on instruments used and method of establishment of reference ranges’


  1. https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/diagnosing-liver-disease/
  2. https://medlineplus.gov/liverfunctiontests.html
  3. https://www.labtestsonline.org.au/learning/test-index/liver-function
  4. https://www.drugabuse.gov/news-events/nida-notes/2013/12/medications-treat-opioid-addiction-do-not-impair-liver-health
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609680/

How to decipher a biochemical blood test: the norm of indicators



November 11, 2020

This is a quick way to check your liver, kidneys, blood sugar and metabolic quality.

Why do we need a biochemical blood test

The meaning of a biochemical blood test (BAC) can be explained in a nutshell. If a general blood test (CBC) gives an idea of ​​the state of the body as a whole, then the BAC adds details – it tells whether specific organs and systems are healthy.

A biochemical blood test helps to detect liver, kidney, diabetes and other ailments.

In addition, the LHC allows you to find out if everything is in order with the level of sugar in the blood, metabolism and what important vitamins, micro and macro elements, hormones, enzymes the body lacks for normal operation.

What the biochemical blood test shows

The laboratory assistant will take a few milliliters of blood from your vein. This must be done on an empty stomach – 8-12 hours after the last meal. The sample taken is then examined for several key components. They are divided into groups.


Or blood sugar. Glucose is a source of energy for body cells. The body regulates its amount in the blood with various hormones (such as insulin) and enzymes. If there is too much or too little sugar, then something is wrong with the endocrine or excretory system.


  • Albumin . It is a protein that is produced by the liver. Blood plasma is approximately 60% albumin.
  • Total protein . There are several dozen different proteins in the blood. Total protein is the average total of them.
  • Specific proteins . These are separate types of blood proteins, a change in the level of which may be associated with serious diseases. Specific ones include, in particular, C‑reactive protein (it signals an acute inflammatory process in the body), ferritin (needed for normal absorption of iron), myoglobin (creates the necessary supply of oxygen in muscles, including the heart), rheumatoid factor (antibodies that are produced only in case of serious diseases: infectious, muscular and connective tissues, autoimmune, oncological and others). Analysis for specific proteins is not always included in the standard LHC. If the doctor wants to find out the content of a particular substance in the blood, he will write about it in the direction for the study.


The so-called lipid panel allows you to check the level of various types of cholesterol.

  • High density lipoproteins (HDL) . This is the so-called good cholesterol, which removes harmful substances from the blood and helps the liver break them down.
  • Low density lipoproteins (LDL) . We are talking about “bad” cholesterol, which causes the formation of plaques in the vessels and increases the risk of cardiovascular disease.
  • Total cholesterol . The sum of the values ​​of “good” and “bad”.

Liver tests

This is the name given to the assessment of the level of certain enzymes associated with the state of the liver.

  • Total bilirubin . It is an orange-yellow pigment that is formed when hemoglobin is broken down. Bilirubin is toxic, so normally the liver quickly removes it from the body. But if hemoglobin is destroyed too actively or the liver cannot cope with normal volumes of bilirubin, the level of pigment in the blood rises sharply. This is often manifested externally – yellowing of the skin and whites of the eyes (jaundice).
  • Alanine aminotransferase (AlAt, ALT) . Liver enzyme necessary for amino acid metabolism. Its level rises with liver damage.
  • Aspartate aminotransferase (AsAt, AST) . Another enzyme that is released into the blood during serious disorders in the liver.
  • Alkaline Phosphatase . This is an enzyme involved in phosphorus metabolism. Its increase is also a marker of liver problems.

Kidney tests

  • Creatinine . This is a waste product that is formed in the muscles. It is excreted from the blood by the kidneys, so the level of creatinine is a good indicator of the work of this paired organ.
  • Uric acid . Formed in the liver and again excreted from the blood by the kidneys. If they fail (or, on the contrary, are unhealthy active), the level of uric acid in the blood rises (or falls).
  • Urea . It is also formed in the liver, where proteins are broken down, and excreted from the blood by the kidneys.

Inorganic substances (minerals, electrolytes) and vitamins

  • Calcium . One of the most important minerals in the body. Without it, the normal functioning of muscles, nerves, and heart is impossible. In addition, it is critical for bone development and repair.
  • Sodium . Responsible for the transmission of nerve impulses and helps to absorb calcium.
  • Magnesium . Like sodium, it is actively involved in the transmission of nerve impulses.
  • Chlorine . Helps to regulate the amount of fluid in the body and maintain acid-base balance.
  • Potassium . Critical to the normal functioning of the heart.
  • Iron . Necessary for the delivery of oxygen to organs and tissues.
  • Phosphorus . The nervous, muscular and skeletal systems are in great need of it.
  • Folic acid . Participates in a huge number of processes in the body – from the absorption of amino acids and glucose to the production of blood.
  • Vitamin B12 . It is essential for the production of red blood cells – erythrocytes.

What are the norms of blood parameters in LHC

The form with the results of a biochemical blood test, as a rule, is a table of three columns. The first contains the name of the indicator, the second contains the range of its normal values, and the third contains your result.

To check the norm, first of all, be guided by the numbers indicated on the form issued to you. The fact is that laboratories conduct tests on different reagents and under different conditions. Therefore, the optimal value ranges may vary slightly depending on the organization that processed your analysis. Only one thing is important for you: to check whether the result falls within the limits of the norms established by a particular laboratory.

The figures below are indicative for the most common indicators.

901 47

Indicator Norm for an adult
Glucose 3, 9-5.6 mmol/l
Albumin 34-54 g/l
Total protein 60–83 g/l
HDL cholesterol 40 mg/dl and above for men; 50 mg/dl and above for women
LDL cholesterol Less than 100 mg/dL
Total cholesterol 125–200 mg/dL
Total bilirubin 1.71–20.5 µmol/l
Alat , ALT 4–36 U/L
AsAt, AST 8–33 U/L
Alkaline Phosphatase 20-140 U/L
Creatinine 74 –107 µmol/L
Uric acid 3. 5-7.2 mg/dl
Urea 2.5-7.1 mmol/l
Calcium 90 151

2.2-2.7 mmol/l

How to decode a biochemical blood test

This can and should be done only by the doctor who issued you the referral for the analysis. For the reason that many different factors affect blood biochemistry.

Thus, an elevated blood glucose level can be both a symptom of prediabetes or diabetes, and a sign that you were irresponsible about the analysis and, let’s say, drank sweet coffee before it.

There are other examples. Elevated liver function tests are a marker of hepatitis and sometimes cirrhosis. But at the same time, ALT and AST can rise if you are being treated for a bacterial infection by taking antibiotics and other medications. A low urea level is a sign of serious liver damage. Or banal malnutrition if you are on a strict diet.

In general, let’s repeat it again. Only the doctor observing you should decipher the LHC. It is unacceptable to analyze the results of the tests on your own, and even more so to start self-treatment based on them.

Read also 💊💉💊

  • How to test for allergens correctly
  • What is genetic analysis and who needs it
  • Why people have different blood types and what it affects
  • How to recognize a lack of hemoglobin and increase it
  • What tests and vaccinations are needed at different periods of life

Interpretation of liver tests and their disorders


PDF article

It is not uncommon for a clinician to examine the liver to assess its functional state. The most commonly used indicators for this are alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and bilirubin. The measurement of these indicators is traditionally called “liver tests”. Some recommendations of the American College of Gastroenterology (2016) regarding the appointment and interpretation of liver tests are presented in the table.

Hepatocyte damage is usually characterized by a disproportionate increase in AST and ALT against a background of normal or slightly altered ALP; cholestasis, on the contrary, a sharp increase in alkaline phosphatase compared with ALT and AST. As for bilirubin, most of it circulates in the blood in an unconjugated form, and increased conjugated bilirubin may indicate both hepatocyte damage and cholestasis.

Diagnostic search for detected laboratory lesions of hepatocytes should include tests for viral hepatitis A, B and C, detection of NAFLD and ALD, screening for hereditary hemochromatosis, autoimmune hepatitis (AIH), Wilson’s disease, α-1-antitrypsin deficiency. The medical history should also be taken into account. With an increase in alkaline phosphatase, it is necessary to diagnose PBC and primary sclerosing cholangitis.

It is important that normal laboratory values ​​are usually defined as the average value in a healthy population ± 2 standard deviations. This definition of the norm covers 95% of people, i.e., in 2.5% of the world’s population, these indicators, by definition, will exceed the norm. The normal levels of ALP and bilirubin differ less in different laboratories, while there is significant variability for ALT.

For example, in one study, 67 laboratories analyzed used an upper limit of normal (ULN) ALT of 31 to 72 U/L. It depends on the equipment of the laboratory, different methods for determining the quantitative indicator of the norm, the characteristics of the population used as healthy.

ALT is a more specific marker of liver damage than AST, but a normal ALT level does not rule out significant liver disease. An increase in AST without a concomitant increase in ALT may indicate damage to the heart or muscles. A borderline increase in AST and/or ALT is considered to be <2×ULN, slight - 2-5×ULN, moderate -5-15 ULN, severe - >15×ULN, and massive – >10,000 IU/L. The diagnostic algorithm at various levels of increase is shown in Figures 1-5.
AP is a member of the zinc metalloproteinase family that catalyzes the hydrolysis of phosphate esters at alkaline pH.

Interestingly, in people with blood type 1 or 2, serum ALP may increase after eating fatty foods, although this metabolic feature is rarely used in practice. The main reasons for the increase in the level of alkaline phosphatase are obstruction of the biliary tract (most often; possibly even in the absence of elevated bilirubin), pregnancy; Also, the level of alkaline phosphatase is increased in children and the elderly, especially in women. With a parallel increase in GGT, it can be concluded that the hepatic cause of the increase in alkaline phosphatase.

Bilirubin, bound to albumin, is formed from the breakdown of old red blood cells and predominantly circulates in unconjugated form. Unconjugated (indirect) bilirubin is not excreted in the urine. In turn, conjugated bilirubin becomes water-soluble and excreted into bile, then converted by intestinal bacteria into urobilinogen, excreted in urine and feces. It is the absence of urobilinogen that gives the feces a discolored appearance in violation of the outflow of bile. Unconjugated bilirubin makes up about 70% of total serum bilirubin.

Determination of bilirubin fractions is especially important when ALT, AST and ALP are in the normal range or slightly changed. If total bilirubin is elevated, mainly due to unconjugated bilirubin, hepatocellular damage is unlikely. An increase in direct bilirubin indicates such lesions or cholestasis.

Liver tests (ALT, AST, ALP, bilirubin) are markers of liver damage, not liver function. Albumin and PTT are indicators of hepatocyte function. Decreased albumin levels (normally ≥3.5 g/dL) usually indicate liver disease lasting ≥3 weeks, although any significant disease can decrease albumin levels due to cytokine exposure. PTT is a more sensitive measure of liver function as it may be elevated in patients with severe liver disease lasting <24 hours.

Of note, albumin, bilirubin, and PTT may be affected by extrahepatic factors. For example, in the presence of vitamin K deficiency and steatorrhea (in the absence of liver disease), cholestasis, or significant hepatocellular dysfunction, PTP lengthens. Treatment with warfarin, heparin bolus administration, disseminated intravascular coagulation syndrome, and hypothermia can also lead to an increase in PTT.

Certain liver diseases

Viral hepatitis B and C

The screening test for chronic hepatitis C is an antibody to the virus with a sensitivity of 92-97%. False positive results are observed in 5% of all cases and in 30% of patients without risk factors. Confirmation of chronic infection is provided by highly sensitive polymerase chain reaction (PCR) with the determination of viral RNA. Individuals with identified RNA should be referred to a specialist for further evaluation of infection and liver fibrosis, and a decision on antiviral therapy.

Acute hepatitis C, accompanied by higher levels of transaminases than chronic, usually occurs without jaundice and other clinical symptoms. The diagnosis of acute hepatitis C can be suspected in the presence of risk factors and confirmed using antibodies to the virus (positive 6-8 weeks after infection) and then by determining the virus RNA by PCR.

Hepatitis B testing should be done in all patients with persistently elevated AST/ALT. Determining the status of infection can be done using three serological tests: HBsAg, indicating the presence of infection; total antibodies to HBcAg, reporting previous exposure to infection or the presence of chronic HBV infection; antibodies to HBsAg, signaling the presence of immunity to this hepatitis that arose as a result of vaccination or a disease transferred in the past.

Chronic infection is confirmed by the presence of HBsAg, antibodies to the core antigen of the virus and / or the determination of viremia using a highly sensitive analysis for the detection of viral DNA. Individuals with chronic hepatitis B should be referred to a hepatologist for further evaluation and a decision on antiviral therapy. The diagnosis of acute hepatitis B is made with a positive test for IgM to HBcAg and the presence of HBsAg. Acute hepatitis B is more often than acute hepatitis C accompanied by clinical symptoms.


NAFLD is a very common metabolic syndrome-associated disease. Unlike ALD, there is no unique pattern of changes in ALT and AST for NAFLD, although ALT levels are usually more elevated than AST levels, and levels of both aminotransferases rarely exceed 300 IU/L. Although many individuals with NAFLD suspected of having steatosis on imaging studies may have normal liver tests, the presence of abnormal liver tests indicates a greater likelihood of non-alcoholic steatohepatitis. An accurate diagnosis of this diagnosis requires a liver biopsy, although the role of a non-invasive method for determining the degree of fibrosis and steatosis, elastography, is also increasing.


Alcohol use is a common cause of elevated liver tests, either alone or in association with chronic liver disease. Specific patterns of changes in liver tests are associated with ALD, in particular the AST:ALT ratio of at least 2:1, and transaminase values ​​rarely exceed 300 IU / L. A further increase in this ratio (3:1, 4:1, etc.) increases the likelihood of ABP. An additional test is the measurement of GGT. All patients with elevated liver tests should be directly asked about alcohol use, recommending that it should be completely discontinued.

Autoimmune liver diseases

Chronic AIH, in which persistently elevated transaminases are noted, can develop in parallel with other autoimmune disorders (hypothyroidism, ulcerative colitis, Sjögren’s syndrome, rheumatoid arthritis, psoriasis). AIH is more common in women than in men (4:1). The characteristic laboratory signs of AIH are the presence of antinuclear antibodies, antismooth muscle antibodies, and less commonly, antirenal and antihepatic microsomal antibodies. The diagnosis of AIH requires histological confirmation with analysis taken from a liver biopsy of a tissue sample.

Drug injuries of the liver

Almost all drugs are associated with at least a minimal risk of elevated liver tests with or without concomitant hepatotoxicity. Among such drugs are antibiotics, antiepileptics, non-steroidal anti-inflammatory drugs, statins, anti-tuberculosis, chemotherapeutic and antiretroviral drugs. It should be noted that although statins are associated with increases in ALT and AST, cases of hepatotoxicity of these agents are rare, even in patients with chronic liver disease. Natural supplements associated with hepatotoxicity include ephedra preparations, green tea extract, and shark cartilage. An online source for information on drug hepatotoxicity is the livertox.nih.gov website. To determine drug damage, treatment should be stopped empirically until ALT/AST normalizes.


PBC, formerly known as primary biliary cirrhosis, is a rare chronic liver disease that predominantly affects the intralobular bile ducts at a microscopic level. PBC is more common in women than men and is associated with increased fatigue and itching. Laboratory examination reveals elevated alkaline phosphatase with or without elevated bilirubin, as well as the main criterion for diagnosis – a positive analysis for antimitochondrial antibodies (in > 95% of patients).


In patients with jaundice and abdominal pain, a history of previous hepatobiliary disease, including cholelithiasis and inflammatory bowel disease, should be taken. Other extrahepatic causes of abnormal liver function tests include heart failure (congestive hepatopathy), early stages of emphysema, celiac disease, and thyroid disease.

Physical examination findings in patients with abnormal liver tests are usually normal, but some symptoms (jaundice, ascites, splenomegaly, palmar erythema, hepatic encephalopathy) may help confirm the presence of liver disease. In addition, the etiology of the disease can be suspected by specific symptoms. For example, contractures

Dupuytren in combination with an increase in the parotid salivary glands and testicular atrophy may accompany ALD; bronze skin color – hereditary hemochromatosis; severe hepatomegaly – acute viral or alcoholic hepatitis; enlarged nodular liver – a malignant process; right hypochondrium tenderness and a positive Murphy’s sign are hepatobiliary diseases (primarily cholecystitis).

Paul Y. Kwo, Stanley M. Cohen, Joseph K. Lim. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol advance online publication, 20 December 2016; doi:10.1038/ajg.2016.517

Prepared by Larisa Strilchuk

Medical newspaper “Health of Ukraine 21 stories” No. 17 (438), spring 2018

  • Number:
  • Medical newspaper “Health of Ukraine 21 stories” No. 17 (438), spring 2018


Therapy and family medicine A solution to the problems of antisepsis: focus on povidone-iodine

Topical antimicrobial preparations may be important in the treatment of wounds, shards of stink facilitate the process of wounding, protecting and at the same time rejoicingly early infections [1]. The most important is to use broad-spectrum antiseptics, which are highly effective against bacterial infections, as well as to make biofuels resistant to antimicrobial drugs [2]. In addition, pathogenic microorganisms Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter strains, as the main pathogens that cause internal infections in the animal world , which is combined with the ESKAPE acronym, also becomes multidrug-resistant [3] ….


Therapy and family medicineCurrent trends in medical treatment of endometriosis

In herbal opinion VI International Congress “Reproductive Health: multidisciplinary approach to uninterrupted professional development of doctors”, organizations of All Ukrainian association of uninterrupted professional education of doctors and pharmacists. Obstetrician-gynecologists, oncologists, neonatologists and fahivtsі other specialties took part in the entrance, as they shared their best clinical knowledge and advanced knowledge in the field of reproductive health. Professor of the Department of Obstetrics and Gynecology No. 1 of the Vinnytsia National Medical University named after. M.I. Pirogova, doctor of medical sciences Dmitro Gennadiyovich Konkov, speaking from the supplementary report “Endometriosis, drug treatment – ​​de mi contagion?”….


Therapy and family medicinePhysiological anticoagulants in the human body and the mechanism of blood

Blood is the most important integrative system, as it ensures the exchange of metabolites and information between patients and fabrics. Flowing in a closed circuit, there is a plastic and protective function, contacting with other organs, delivering sourness and life of speech.