What are normal AST and ALT levels. How do COVID-19 infections affect liver enzymes. What are the implications of elevated liver enzymes in COVID-19 patients. How should healthcare providers approach elevated liver enzymes in COVID-19 cases.

The Significance of AST and ALT in Liver Function

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are crucial enzymes that serve as indicators of liver health. These enzymes are normally found within liver cells, but when the liver is damaged, they leak into the bloodstream, resulting in elevated levels detectable through blood tests.

Understanding the normal ranges for AST and ALT is essential for accurate interpretation of liver function tests:

• Normal AST range: 5 to 40 units per liter of serum
• Normal ALT range: 7 to 56 units per liter of serum

It’s important to note that these ranges can vary slightly depending on the laboratory and the specific testing method used.

COVID-19 and Its Impact on Liver Enzymes

The COVID-19 pandemic has brought to light various systemic effects of the SARS-CoV-2 virus, including its impact on liver function. Recent studies have shown a significant correlation between COVID-19 infections and elevated liver enzymes.

How prevalent are liver enzyme abnormalities in COVID-19 patients? According to a meta-analysis of 107 studies involving 20,874 COVID-19-positive patients, the pooled incidence of elevated liver enzymes on presentation was 23.1%. This statistic underscores the importance of monitoring liver function in COVID-19 patients.

Patterns of Liver Injury in COVID-19

The pattern of liver injury in COVID-19 patients is predominantly hepatocellular, with AST and ALT elevations being the most common abnormalities. A retrospective study of 2,273 COVID-19 patients revealed the following breakdown of liver injury severity:

• 45% had mild liver injury (ALT above the upper limit of normal but below 2 times ULN)
• 21% had moderate liver injury (ALT between 2-5 times ULN)
• 6.4% had severe liver injury (ALT above 5 times ULN)

Interestingly, AST levels are often higher than ALT levels in COVID-19 patients, suggesting that AST could be a useful indicator of COVID-19 infection. However, it’s crucial to note that severe acute hepatitis associated with COVID-19 is rare.

Mechanisms Behind Elevated Liver Enzymes in COVID-19

Understanding the mechanisms causing elevated liver enzymes in COVID-19 patients is crucial for effective management. While the exact pathways are still under investigation, several theories have been proposed:

1. Direct viral cytopathic effect: SARS-CoV-2 enters host cells by binding to angiotensin-converting enzyme-2 (ACE2), which is present in hepatocytes. However, limited histopathologic data have not definitively identified SARS-CoV-2 in liver tissue.
2. Systemic inflammatory response: The cytokine release syndrome associated with severe COVID-19 can lead to liver damage.
3. Ischemia: Severe respiratory distress can result in hypoxic liver injury.
4. Drug-induced liver injury (DILI): Medications used to treat COVID-19 may contribute to liver enzyme elevations.

Are there other hepatic manifestations of COVID-19 beyond elevated enzymes? Indeed, there are. Acute portal vein thrombosis has been reported in some COVID-19 patients, likely representing a prothrombotic state associated with the systemic inflammatory response to the virus.

Differential Diagnosis of Elevated Liver Enzymes in COVID-19 Patients

When evaluating COVID-19 patients with elevated liver enzymes, it’s crucial to consider other potential etiologies. This comprehensive approach ensures accurate diagnosis and appropriate treatment.

Non-COVID-19 Related Causes

• Viral hepatitis (A, B, C)
• Alcoholic liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Autoimmune hepatitis
• Hemochromatosis
• Wilson’s disease

COVID-19 Related Causes

• Direct viral effect on hepatocytes
• Systemic inflammatory response
• Ischemic hepatitis due to respiratory distress
• Drug-induced liver injury from COVID-19 treatments

How can healthcare providers distinguish between these various causes? A thorough patient history, physical examination, and additional laboratory tests are essential. For instance, testing for hepatitis viruses, assessing alcohol consumption, and reviewing medication lists can help narrow down the differential diagnosis.

Drug-Induced Liver Injury in COVID-19 Treatment

Drug-induced liver injury (DILI) is a significant concern in the treatment of COVID-19 patients. Various medications used in COVID-19 management have been associated with liver enzyme elevations.

Which COVID-19 treatments are most commonly associated with liver enzyme abnormalities? The following medications have been implicated:

• Remdesivir: Associated with increased liver enzymes in about 15.2% of patients
• Lopinavir/ritonavir
• Hydroxychloroquine (less commonly)
• Azithromycin
• Tocilizumab

It’s important to note that while these medications can cause liver enzyme elevations, abnormal liver biochemistries are not a contraindication to using COVID-19 therapies. However, regular monitoring of liver enzymes is recommended for all hospitalized COVID-19 patients.

Management of DILI in COVID-19 Patients

Managing DILI in COVID-19 patients requires a delicate balance between treating the infection and protecting liver function. Here are some key considerations:

1. Regular monitoring of liver enzymes
2. Dose adjustment of hepatotoxic medications when possible
3. Consideration of alternative treatments in cases of severe liver injury
4. Close collaboration between infectious disease specialists and hepatologists

Prognostic Implications of Liver Injury in COVID-19

Liver injury in COVID-19 patients is not just a laboratory abnormality; it has significant prognostic implications. Research has shown that liver injury is more common in patients with severe COVID-19 and is associated with negative outcomes.

What are the specific risks associated with liver injury in COVID-19 patients? Studies have identified several concerning trends:

• Increased risk of ICU admission
• Higher likelihood of requiring mechanical ventilation
• Increased mortality rates

A large retrospective study of 1,059 COVID-19 patients found that those with abnormal liver tests had higher odds of progressing to severe disease compared to patients with normal liver tests. This underscores the importance of closely monitoring liver function in COVID-19 patients and considering it as part of the overall risk assessment.

Impact on Specific Patient Populations

Certain patient populations may be at higher risk of severe outcomes when liver injury is present in the context of COVID-19:

• Patients with preexisting liver disease, such as cirrhosis
• Liver transplant recipients
• Individuals with underlying metabolic conditions (e.g., diabetes, obesity)

For these high-risk groups, extra vigilance in monitoring liver function and aggressive management of COVID-19 may be warranted.

Approach to Managing Elevated Liver Enzymes in COVID-19 Patients

Given the potential implications of liver injury in COVID-19 patients, a structured approach to managing elevated liver enzymes is crucial. Healthcare providers should consider the following steps:

1. Comprehensive evaluation: Perform a thorough history and physical examination, considering both COVID-19 related and unrelated causes of liver enzyme elevations.
2. Additional testing: Consider viral hepatitis serologies, autoimmune markers, and imaging studies as appropriate.
3. Regular monitoring: Implement consistent monitoring of liver enzymes throughout the course of COVID-19 treatment.
4. Risk stratification: Use liver enzyme levels as part of the overall assessment of disease severity and prognosis.
5. Medication management: Carefully review and adjust medications that may contribute to liver injury, while balancing the need for effective COVID-19 treatment.
6. Specialist consultation: Involve hepatologists or gastroenterologists in complex cases or when liver injury is severe.
7. Patient education: Inform patients about the importance of liver health and potential long-term implications of COVID-19-related liver injury.

By following this structured approach, healthcare providers can effectively manage the complexities of liver enzyme abnormalities in COVID-19 patients, potentially improving outcomes and reducing complications.

Future Directions and Research Needs

As our understanding of COVID-19 and its impact on liver function continues to evolve, several areas require further research and investigation:

• Long-term hepatic consequences of COVID-19 infection
• Development of liver-specific therapies for COVID-19 patients
• Identification of biomarkers to predict severe liver injury in COVID-19
• Optimization of treatment protocols for COVID-19 patients with preexisting liver disease
• Investigation of potential protective factors against COVID-19-related liver injury

What role might artificial intelligence and machine learning play in predicting and managing liver injury in COVID-19 patients? These technologies could potentially analyze large datasets to identify early warning signs of liver complications, allowing for more proactive interventions.

As the medical community continues to grapple with the challenges posed by COVID-19, ongoing research into its hepatic manifestations will be crucial. This knowledge will not only improve our ability to manage current patients but also enhance our preparedness for future viral pandemics that may impact liver function.

In conclusion, understanding the intricate relationship between COVID-19 and liver enzyme abnormalities is vital for comprehensive patient care. By remaining vigilant, employing structured management approaches, and continuing to expand our knowledge base, healthcare providers can better navigate the complexities of liver involvement in COVID-19, ultimately improving patient outcomes and advancing our understanding of this multifaceted disease.

Hepatic manifestations of COVID-19 | Cleveland Clinic Journal of Medicine

ABSTRACT

Patients with COVID-19 commonly have elevated liver enzyme levels, which is associated with adverse outcomes during hospitalization including increased risk of ICU admission, intubation, and mortality. When assessing these patients, it is important to consider causes of liver injury unrelated to COVID-19. Therapies for COVID-19 may increase liver enzyme levels but are not contraindicated in patients with baseline abnormal liver tests. Liver enzymes should be regularly monitored in all hospitalized patients with COVID-19. Patients with preexisting liver disease such as cirrhosis and those who have received a liver transplant may be an increased risk of severe COVID-19 outcomes.

PREVALENCE AND PATTERN OF LIVER INJURY

Physician burnout has serious consequences to the individual physician, to patients, and to healthcare institutions. Research has shown the prevalence of burnout to be more than 40%, with highest rates in frontline healthcare providers such as emergency medicine, primary care, and critical care. ¹ COVID-19 presents new stressors for healthcare providers, and recent events involving self-harm by physicians have brought increased attention to the emotional impacts of caring for these critically ill patients.²

NEW STRESSORS IN COVID-19

Elevated liver enzyme levels can be found in 14% to 76% of patients with coronavirus disease 2019 (COVID-19).^1,2 In a recent meta-analysis of 107 studies consisting of 20,874 COVID-19–positive patients, the pooled incidence of elevated liver enzymes on presentation was 23.1%.³

The pattern of liver injury is more commonly hepatocellular¹ and is mild and transient in most patients.^4–6 In a retrospective study of 2,273 patients with COVID-19, 45% had mild liver injury, which was defined as a levels of alanine aminotransferase (ALT) above the upper limit of normal (ULN) and below 2 times ULN.⁶ Liver injury was moderate (ALT between 2-5 times ULN) in 21% of cases and severe (above 5 times ULN) in 6. 4% of cases.⁶ Severe acute hepatitis associated with COVID-19 is rare, but has been described.⁷

In a large retrospective study out of New York City, levels of aspartate aminotransferase (AST) were frequently higher than levels of ALT, suggesting that AST may be a useful indicator of COVID-19 infection.⁸ A cholestatic pattern of injury, however, is rarely associated with COVID-19.^6,9 Other abnormalities in liver enzymes include elevations in gamma-glutamyl transferase (GGT), which, in one study, occurred in 13.6% of patients with COVID-19.¹⁰

APPROACH TO ELEVATED LIVER ENZYMES

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells by binding to angiotensin-converting enzyme-2 (ACE2), which is present in hepatocytes.¹ Although a direct viral cytopathic effect is possible, limited histopathologic data have not identified SARS-CoV-2 in liver tissue.⁵

When evaluating COVID-19 patients with elevated liver enzymes, other etiologies should be considered including COVID-19 unrelated causes such as hepatitis A, B, and C. Ischemia,¹ cardiac and muscle injury,¹¹ and cytokine release syndrome can be associated with COVID-19 and transaminase elevations.³ In addition, other hepatic manifestations of COVID-19 have been reported. Acute portal vein thrombosis in a patient with abdominal pain, fever, jaundice, and elevated levels of transaminases has been reported and likely represents a prothrombotic state associated with the systemic inflammatory response to the virus.¹² Furthermore, drug-induced liver injury (DILI) can be seen in up to 25.4% of patients with COVID-19.³ Remdesivir is associated with increased liver enzymes in about 15.2% of patients.³

The severity and pattern of liver test abnormalities have not yet been well described.¹³ Although a hepatocellular pattern appears to be more common,³ hyperbilirubinemia has also been described.¹⁴ Liver enzyme elevations are predominantly mild to moderate in severity and infrequently lead to treatment discontinuation. ^13–15 Lopinavir/ritonavir, hydroxychloroquine (less commonly), azithromycin, and tocilizumab have also been associated with abnormal AST and ALT levels in this setting.^3,8 Although it is important to note that abnormal liver biochemistries are not a contraindication to using COVID-19 therapies, liver enzymes should be monitored regularly in all hospitalized COVID-19 patients.¹ A summary of recommendations for the evaluation of patients with abnormal liver enzymes and COVID-19 can be found in Table 1.

TABLE 1

Approach to elevated liver enzymes in patients with COVID-19

PROGNOSTIC IMPLICATIONS OF LIVER INJURY

Liver injury appears to be more common in patients with severe COVID-19^3,16 and is associated with negative outcomes. In a large retrospective study of 1,059 COVID-19 patients, liver injury at presentation was an independent predictor of the composite outcome of death or intensive care unit (ICU) admissions.¹⁷ In fact, in this study, liver injury was the second most informative predictor of poor outcomes among patients with severe hypoxia. ¹⁷

In another study, severe liver injury was associated with elevated levels of inflammatory markers and a more severe disease course, including higher rates of intubation, ICU admission, and mortality.⁶ Furthermore, an Italian retrospective study of 515 SARS-CoV-2 positive patients found that abnormal baseline liver enzyme levels were associated with an increased risk of ICU admission.¹⁰ Finally, a recently published meta-analysis of 107 studies found that patients with elevated liver enzyme levels had an increased risk of severe disease and mortality.³

Specific patterns of liver enzymes have also been shown to be negative prognostic markers. Hypoalbuminemia on admission to the hospital appears to be a marker of severe disease.^6,18 In addition, peak ALT was found to be associated with death or discharge to hospice in a large US cohort study,⁶ while an elevated baseline AST level has been associated with ICU admission, intubation, and death in another study. ⁸ Finally, alkaline phosphatase peak values have also been shown to correlate with the risk of death.¹⁰

COVID-19 IN PATIENTS WITH UNDERLYING LIVER DISEASE

Chronic liver disease

It is still unclear if patients with underlying liver disease are at higher risk of negative outcomes with COVID-19.¹ Using a large US database, a study of 2,780 COVID-19–positive patients found that those with preexisting liver disease were at increased risk for mortality compared with patients without underlying liver disease. Patients with cirrhosis were at particularly increased risk (risk ratio [RR], 4.6; 95% confidence interval [CI], 2.6–8.3).¹⁹

In addition, metabolic-associated fatty liver disease (MAFLD, previously termed non-alcoholic fatty liver disease) appears to be associated with an increased risk of severe disease.^1,20 In a study of 202 COVID-19–positive patients, those with MAFLD had an increased risk of severe disease and a longer viral shedding time. ⁹ However, MAFLD is frequently associated with other comorbidities such as diabetes or cardiovascular disease, which are also established risk factors for severe COVID-19 and could contribute to worse outcomes among these patients.²¹

Contrary to previous findings, a recent meta-analysis showed that patients with chronic liver disease were not at higher risk of severe COVID-19.³ In this study, chronic liver disease was defined as cirrhosis of any cause, autoimmune hepatitis, chronic hepatitis B and C, and MAFLD.³ Although this was the largest systematic review published on this topic to date, the high heterogeneity among the included studies may limit the generalizability of the findings.

Liver transplantation

While early data from Italy did not show worse outcomes among liver transplant recipients^22,23 more recent US data have found these patients to be at increased risk of severe COVID-19 disease,²⁴ with a mortality rate of 29% among hospitalized patients. ²⁵ Of note, hepatitis associated with COVID-19 has been described in a living donor liver recipient on postoperative day 6. The donor was subsequently found to be SARS-CoV-2 positive.²⁶

CONCLUSION

In summary, elevated levels of liver enzymes are often seen in patients with COVID-19 and are associated with more severe outcomes, including increased risk of ICU admission, intubation, and mortality. Other causes of liver injury should be considered when evaluating patients with COVID-19. Although COVID-19 therapies may be associated with abnormal liver tests, they may still be used in patients with elevated liver enzyme levels with close monitoring.

Emerging data suggest that patients with preexisting liver disease such as cirrhosis and those who have received a liver transplant may have an increased risk of severe COVID-19 outcomes. The American Association for the Study of Liver Diseases has released expert consensus statements to help guide management of patients with liver disease in the context of the COVID-19 pandemic. ¹ Selected recommendations for patients with severe liver disease are summarized in Table 2. Further research is needed to better characterize the disease course and outcomes among COVID-19 patients with chronic liver disease.

TABLE 2

Recommendations for outpatient management of patients with decompensated cirrhosis, for liver transplant evaluations, and on a transplant waiting list during the COVID-19 pandemic

Footnotes

• The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations can-not be substituted for the clinical judgment of clinicians caring for individual patients.

• Copyright © 2020 The Cleveland Clinic Foundation. All Rights Reserved.

5 Ways to Lower ALT Levels Naturally

• To lower ALT levels, you can drink coffee, improve your diet, get more folic acid or folate, lower your cholesterol, and avoid alcohol or smoking.  
• High ALT levels can indicate a liver problem, as these liver enzymes do not function properly and leak into the bloodstream. 
• This article was medically reviewed by Rudolph Bedford, MD, gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA. 
• Visit Insider’s Health Reference library for more advice. 

If you have high ALT levels — a liver enzyme known as alanine aminotransferase — it may be due to a liver problem. Here’s what you need to know about these liver enzymes and how to lower your ALT levels naturally.

What is ALT? 

ALT is an enzyme in your liver cells that helps convert proteins from the foods you eat into energy. If your liver cells are inflamed or injured, they may leak higher amounts of these enzymes, which causes them to be released into your bloodstream. 

Your ALT level can be measured through an ALT blood test. For males, the normal amount ranges from 29 to 33 units per liter (IU/L) of blood. For females, the range is 19 to 25 IU/L.

Some of the common causes of a high ALT level include:

Fortunately, an elevated ALT level is usually temporary and doesn’t indicate a serious liver problem. 

“If you have an elevated liver enzyme test, step one is to give it some time and repeat it,” says hepatologist Zachary Henry, MD, an associate professor in the Division of Gastroenterology and Hepatology at the University of Virginia. “Sometimes these levels go up and down, and it may have just been a red herring.” 

But, if you do have persistently high ALT levels, the following lifestyle changes may help lower them and improve your liver health overall. 

1. Drink more coffee

“Coffee is a fascinating drink for the liver,” Henry says. In fact, drinking up to four cups a day can help lower your ALT levels, according to a 2017 review.

A large 2014 study found that both caffeinated and decaffeinated coffee lowered levels of abnormal liver enzymes. Of the 27,793 adult participants, those who drank at least three cups of coffee a day had lower ALT levels than participants who didn’t drink coffee. 

Related

Is coffee bad for you? It can have many health benefits — as long as you drink it in moderation

One caveat is that you should drink coffee without sugar and cream since these can have a detrimental effect on your liver. “It’s best to drink it black,” Henry says. 

2. Improve your diet 

Studies have found that eating a healthy, well-balanced diet can help lower your ALT level. After 10 men in Japan ate low-calorie lunches for a month that were high in vegetables and low in animal-based proteins, their ALT levels were lowered by 20. 3%, according to the results of a small 2013 study. 

There are no specific foods or beverages that will lower your ALT level, Henry says. But a healthy diet is important, especially if the cause of an elevated ALT level is nonalcoholic fatty liver disease.

The American Liver Foundation recommends that you eat more of these foods for a healthier liver:

• Fruits and vegetables
• Lean meats
• Fish containing omega-3 fatty acids, such as salmon and trout
• High-fiber foods like whole-grain breads, rice, and cereal
• Fat-free or low-fat milk and other dairy products 

On the other hand, you should avoid eating the following:

• Foods high in sugar, fat, or salt
• Fried foods
• Raw or undercooked shellfish like clams or oysters
• Foods containing partially hydrogenated vegetable oils

3. Get more folic acid 

Folic acid is a form of vitamin B-9 found in supplements and in its natural form as folate in some foods. It’s essential for the production, growth, and function of red blood cells. 

A folic acid deficiency may lead to a higher ALT level. A 2011 study of 480 participants with mild hypertension found that a daily dose of 800 milligrams of folic acid may help lower ALT levels, especially for men and people with elevated ALT levels.

However, Henry warns that you should always consult with your doctor before taking folic acid or other supplements to make sure there are no perceived health risks. Instead of taking folic acid supplements, he recommends eating foods that are high in folate. These include:

• Leafy, dark green vegetables like spinach, kale, and brussels sprouts
• Beans
• Peanuts
• Sunflower seeds
• Whole grains
• Liver

4. Lower your cholesterol 

A large 2018 study suggests that high cholesterol levels are associated with elevated ALT levels. 

Related

5 ways to lower your cholesterol naturally

While lowering your cholesterol level may not necessarily also lower your ALT level, making lifestyle improvements like eating a healthy diet and exercising regularly are still important.  

“Patients who have fatty liver disease frequently have comorbid medical conditions like

high cholesterol
, and we certainly want good control of those conditions because of the increased risk of heart disease,” Henry says. 

5. Avoid alcohol and smoking 

It’s a well-known fact that drinking alcohol can damage your liver, leading to serious health issues like cirrhosis. 

A large 2010 study found that normal ALT levels were elevated by 6% for those who drank about two alcoholic drinks each day, and 10.4% for those who had four drinks daily. 

Related

All of the amazing ways your body heals itself when you quit smoking: A timeline from 20 minutes to 15 years after your last cigarette shows your dramatic decrease in risk of premature death

Smoking cigarettes should also be avoided since it can harm your liver in several ways. For example, it produces potentially toxic chemicals that could cause liver inflammation and scarring of your liver tissue. Researchers have found that for people who don’t drink alcohol, smoking may be a significant risk factor for developing nonalcoholic fatty liver disease.

Takeaways 

While making these lifestyle changes may help lower your elevated ALT level and improve your health overall, it’s important to see a doctor if the level continues to be high after follow-up ALT tests. Your doctor may recommend additional bloodwork and an ultrasound of your liver, or may refer you to a specialist, to determine why your liver is injured or inflamed.

ALT liver function test | The London Clinic

The London Clinic through its Liver Centre provides access to the latest developments in the diagnosis and treatment of liver disease and performs private ALT Liver function tests.

Assessing liver health: ALT testing

ALT testing is a liver function test. It measures the level of alanine transaminase (ALT), an enzyme that is produced and used inside liver cells. If the liver is under stress, levels of ALT present in blood can start to rise. The test required involves taking only a tiny blood sample, and the results from The London Clinic’s diagnostics lab come back within hours.

ALT is an enzyme that is mostly produced by liver cells and therefore it is a good marker of liver disease. When ALT levels rise, it is usually a clear sign that the liver cells are showing signs of damage.

One of the biggest causes of raised ALT levels is fat in the liver, usually caused by drinking too much alcohol too frequently and/or eating a diet that is high in saturated fat. Raised ALT levels are an early sign of fatty liver disease. Viral hepatitis, side effects from prescription drugs and genetic or autoimmune conditions that affect the liver can also cause ALT levels to rise.

Why should I know my Serum ALT?

This is a simple and quick test and it can give a good indication if your liver is healthy, or it can indicate potential problems that need investigating further. The liver is unusual in that it can become extremely damaged without you noticing. Checking on your liver health with a simple ALT test can be life saving.

What does an ALT test involve?

A blood sample from a vein is required for the test. The blood is tested in the diagnostic laboratory at The London Clinic and the ALT level will be sent back to your consultant hepatologist, usually the same day.        

What causes ALT levels to rise?

• Fatty liver disease: perhaps the most common cause in the UK, Europe, the USA and other affluent countries is fat accumulation within liver cells. Fat can accumulate anywhere in the body, but when this happens in the liver cells, it proves toxic. Anyone who is obese, has type 2 diabetes, or a raised cholesterol level may be at risk for having fat within the liver. 
• Drinking too much alcohol: men who regularly drink more than the recommended 21 units of alcohol per week, women who drink in excess of 14 units per week, or people of both sexes who engage in regular binge drinking can risk damage to the liver cells.
• Infection by chronic hepatitis viruses such as viral infections transmitted through blood and bodily fluids such as hepatitis B and Hepatitis C
• Drug toxicity: even the common painkiller paracetamol can cause extensive liver damage when taken in quantities above the recommended dose. Other drugs can also have a toxic effect on the liver and your treatment will include regular monitoring of liver function.
• Haemochromatosis: a genetic liver disease associated with an excess accumulation of iron in the liver.
• Autoimmune hepatitis: this occurs when the body mounts an immune response to its own liver cells.

How often should I have my serum ALT measured?

If you are at particular risk of liver disease, either because of infection, underlying disease, or lifestyle factors, an ALT test done once a year could help monitor any changes in your liver health.

Treatment at The London Clinic

For more information about a private ALT Liver function test at The London Clinic complete the enquiry form or call the Liver Centre on +44 (0) 20 7616 7719.

Make an enquiry

Mistakes in liver function test abnormalities and how to avoid them | UEG

Ignoring nonhepatic causes of abnormal LFT results

None of the LFTs discussed in this article is 100% liver specific. The possibility of a nonhepatic origin of LFT abnormalities should, therefore, always be considered. This holds especially true for isolated LFT abnormalities.
ALT is more liver specific than AST, since the latter can also be found in skeletal and cardiac muscle, kidneys, brain, lungs, pancreas and red blood cells.³ A disproportionate or isolated AST elevation, therefore, should raise suspicion that the source is nonhepatic. Nonhepatic causes of AST elevation include injury to skeletal or cardiac muscle, hyperthyroidism or hypothyroidism, haemolysis, and (rarely) macro-aspartate aminotransferase. The latter condition is caused by the binding of AST to immunoglobulins, which results in delayed AST clearance. ²⁷

GGT is expressed in the kidney, pancreas, spleen, lung, heart and brain.¹³ In general, an isolated elevation of GGT levels is not a specific marker for liver disease, since it can be elevated in patients with diabetes, chronic obstructive pulmonary disease, myocardial infarction, pancreatic disease or renal failure. GGT levels can also be elevated in patients using enzyme inducers (CYP2C, CYP3A, CYP1A) such as phenobarbital, carbamazepine or alcohol.²⁸

ALP consists of several isoenzymes that are located in liver (isoenzyme 1 and 2), bone, intestine and placenta. ALP can be fractionated in order to determine its origin.  Bone-derived ALP is increased in patients who suffer from bone disease (e.g. Paget’s disease, primary and metastatic bone tumours, osteomalacia, rickets, hyperparathyroidism), and in children due to rapid bone growth. Intestinally-derived  ALP is increased in patients with blood group O or B after fatty meals, and in those with familial ALP elevation. ⁹ Raised intestinal ALP isoenzyme levels have also been reported in patients with liver cirrhosis, diabetes, chronic kidney disease, and bowel ischaemia.³⁰ The placental ALP isoenzyme can be elevated in pregnant women, usually during the third trimester.⁹ The Regan isoenzyme, a rare variant of placental ALP, can be elevated in cancers that do not involve the bone, such as gonadal, urologic or lung cancer.³¹  Of note, after the age of 50 years, ALP levels (both hepatic and bone) tend to increase, especially in women.²⁹

Hypoalbuminaemia can have various nonhepatic causes, such as a decrease in albumin synthesis (e.g. malnutrition, malabsorption), albumin dilution (e.g. pregnancy), albumin loss (e.g. nephrotic syndrome, protein-losing enteropathy), or a catabolic state (e.g. infection, trauma, malignancy). Hypoalbuminaemia without liver test abnormalities is usually not associated with liver disease.
The prothrombin time can be affected by various coagulation disorders in the absence of hepatic disease, such as disseminated intravasal coagulation and conditions that affect the function of vitamin K (which activates clotting factors II, VII and X of the intrinsic coagulation pathway). These conditions include the use of warfarin and vitamin K deficiency during cholestatic liver disease and cirrhosis, which occurs due to a decrease in its intestinal absorption.³²

Aspartate Aminotransferase / Blood Sciences Test / Exeter Clinical Laboratory International

Aspartate Aminotransferase

Specimen

Serum

Units

u/L

Reference Range

M 18- 37
F 7-31

Test Usage

Aspartate aminotransferase (AST) is an enzyme involved in the transfer of an amino group from aspartate to alpha ketoglutarate to produce oxaloacetic acid and glutamate. AST is present in most organs. The highest concentrations, listed in descending order, are found in liver, heart, skeletal muscle, kidney, brain, pancreas, lung, leukocytes, and erythrocytes. Because of its wide tissue distribution, elevated AST levels have low specificity for any single disease. AST activities in liver are 7000 times higher than serum activities. Historically, AST has been used clinically to diagnose hepatitis, myocardial infarction, and skeletal muscle disease. AST increase in the absence of ALT increase indicates cardiac or skeletal muscle disease. ALT is a better indicator of liver disease, because of its more limited tissue distribution.

AST tends to run slightly higher in males than females due to differences in body mass and varies with age. AST is slightly higher than ALT until the age of 15 to 20 years. Thereafter, AST activity tends to be lower than ALT. At age 60, AST and ALT activities become roughly equal. AST levels are about 15% higher in Africans than Caucasian men. Obese men may have mildly elevated AST levels. AST levels can fluctuate between 5 and 10% from one day to the next in the same individual. Moderate exercise increases AST levels for as long as 24 hours, usually less than 3 times the upper limit of normal. The half-life of AST in the circulation is 17 +/- 5 hours.

The ratio of AST to ALT is sometimes useful to diagnose specific liver diseases. AST is distributed both in cytoplasm and mitochrondria of hepatocytes, while ALT is distributed mainly in the cytoplasm. Normal serum levels of AST are derived from the cytoplasmic fraction. Mild cell injury results in release of cytoplasmic enzyme, while severe injury releases both cytoplasmic and mitochondrial AST. In most types of liver disease, AST activity is lower than ALT; exceptions include alcoholic hepatitis and Reye syndrome. In alcoholic hepatitis, damage is primarily to the mitochondria and more AST is released than ALT. Also, alcoholic liver disease causes pyridoxine deficiency, which depresses ALT activity, because pyridoxine is an important enzyme cofactor. In alcoholic hepatitis, the AST:ALT ratio is greater than 2.0 and the AST increase is seldom more than 300 U/L. In contrast, viral hepatitis primarily damages the cell membrane, releasing more ALT than AST. The AST:ALT ratio is less than 1. The AST: ALT ratio is less useful in distinguishing alcoholic from other causes of hepatocellular injury in patients with cirrhosis, because the ratio is usually >1.

The chronology and extent of AST elevation provides some insight into the etiology of the underlying liver disease. The highest serum levels occur in viral and toxic hepatitis and ischemic necrosis.

Turnaround time

1 day

Availability

Local test
Can be added on to an existing request up to 4 days following sample receipt

Specimen Labelling Procedure

High aspartate aminotransferase to alanine aminotransferase ratio on admission as risk factor for poor prognosis in COVID-19 patients

AST/ALT ratio could predict the prognosis of COVID-19 patients

In overall 567 patients, after excluding 12 patients who were transferred to other hospitals with unknown outcomes, 555 patients with clear endpoints (recovery or death) were involved in the analysis about prognosis. To determine the ability of different clinical indexes in predicting prognosis, we drew receiver operating curves (ROC) of ALT, AST, and AST/ALT to predict death. Among them, both AST levels (P < 0.001) and AST/ALT ratio (P < 0.001) could effectively distinguish different prognosis in hospitalized COVID-19 patients. After balancing sensitivity and specificity, the cut-off value of AST/ALT ratio was determined as 1.38 (Fig. 1A). Moreover, patients with AST/ALT ≥ 1.38 on admission had significantly poor survival when compared to those with AST/ALT < 1.38 (P < 0.001) (Fig. 1B).

Figure 1

AST/ALT ratio distinguished COVID-19 patients with different prognosis. Only patients with clear endpoints (recovery and death) were involved in the analysis about prognosis (n = 555). (A) Receiver operating curve (ROC) was utilized to compare the ability of ALT, AST, and AST/ALT ratio to predict death in hospitalized COVID-19 patients. Cut-off values were determined through Youden index. (B) Kaplan–Meier survival analysis in patients with AST/ALT < 1.38 and ≥ 1.38. AUC area under the curve; ***P < 0.001.

Clinical features

567 hospitalized patients with confirmed COVID-19 were included in analyzing clinical features. The median age was 55 years (IQR, 37–67), and 247 (43.6%) patients were male. The median duration from symptom onset to hospital admission was 7 days (IQR, 4–10). The most common symptoms on admission were fever (455 [80.2%]), cough (370 [65.3%]), chest tightness (222 [39.2%]), fatigue (208 [36.7%]), and myalgia (143 [25.2%]). In contrast, the less common symptoms of the included patients were diarrhea (51[9%]), headache (36 [6.3%]), and chest pain (27 [4.8%]). Of the 567 patients, 250 (44.1%) had coexisting diseases, 108 (19%) had ≥ 2 comorbidities. A total of 183 (32.3%) patients had hypertension, 85 (15%) patients had diabetes, and 53 (9.3%) patients had cardiovascular disease, which were the most common comorbidities. In contrast, chronic obstructive pulmonary disease (36 [6. 3%]), cerebrovascular disease (32 [5.6%]), and chronic kidney disease (31 [5.5%]) were less common comorbidities (Table 1).

Table 1 Clinical characteristics of the included COVID-19 patients.

Of the 567 included patients, 200 patients (35.3%) had AST/ALT ≥ 1.38. Compared with the patients with AST/ALT < 1.38 on admission (n = 367, 64.7%), patients with AST/ALT ≥ 1.38 were older (median age, 60 years [IQR, 37.3–71] vs 51 years [IQR, 37–64]; P = 0.001), more likely to have myalgia (64 [32%] vs 79 [21.5%]; P = 0.006), fatigue (91 [45.5%] vs 117 [31.9%]; P = 0.001) and some coexisting diseases, such as COPD (19 [9.5%] vs 17 [3%]; P = 0.023), cardiovascular diseases (28 [14%] vs 25 [6.8%]; P = 0.005) and chronic kidney diseases (19 [9.5%] vs 12 [3.3%]; P = 0.002), on admission. Interestingly, patients with AST/ALT ≥ 1.38 preferred to have ≥ 2 comorbidities on admission (50 [25%] vs 58[25%]; P = 0.008). Additionally, patients with AST/ALT ≥ 1.38 on admission were less likely to be recovery and discharge (154 [77%] vs 336 [91. 6%]; P < 0.001) but more likely to be death (41 [20.5%] vs 24 [6.5%]; P < 0.001) (Table 1).

AST/ALT ≥ 1.38 on admission indicates more severe chest CT findings, worse laboratory results and higher severity of illness scores

On admission, all enrolled patients experienced a variety of measures and tests according to their clinical care needs. There were differences on chest CT, in laboratory findings and in severity of illness scores between patients with AST/ALT < 1.38 or ≥ 1.38 (Table 2).

Table 2 Chest CT findings, laboratory results and severity of illness scores of COVID-19 patients on admission.

Compared with the patients with AST/ALT < 2, patients with AST/ALT ≥ 2 were more likely to have lesion presence higher than 60% lung (56 [28.9%] vs 74 [20.5%]; P = 0.028) (Table 2). Among laboratory findings, the blood count showed that patients AST/ALT ≥ 2 had lower white blood cell count (median number, 4.6 × 10⁹/L [IQR, 3. 4–6.4] vs 5 × 10⁹/L [IQR, 3.9–6.5]; P = 0.024), lymphocyte count (median number, 0.9 × 10⁹/L [IQR, 0.6–1.2] vs 1.1 × 10⁹/L [IQR, 0.7–1.4]; P = 0.004), hemoglobin (median number, 127 g/L [IQR, 114–138] vs 129 g/L [IQR, 121–141]; P = 0.001) and platelet count (median number, 159 × 10⁹/L [IQR, 118–201] vs 186 × 10⁹/L [IQR, 146–239]; P < 0.001) than those with AST/ALT < 1.38. In the myocardial enzyme spectrum test, patients with AST/ALT ≥ 1.38 had slightly higher CK-MB (median number, 9 U/L [IQR, 6–12.9] vs 7 U/L [IQR, 6–11]; P = 0.008), and LDH (median number, 203 U/L [IQR, 158.8–290.3] vs 182 U/L [IQR, 148–236.3]; P = 0.002). The abovementioned differences suggest that patients with AST/ALT ≥ 1.38 are more likely to encounter systemic injury, including the circulatory system and heart. Consistently, some parameters of systemic inflammation were also significantly increased in the patients with AST/ALT ≥ 1.38, including CRP (median number, 2. 5 mg/dL [IQR, 0.5–6.4] vs 1.4 mg/dL [IQR, 0.3–3.7]; P = 0.002) and procalcitonin (median number, 0.06 ng/mL [IQR, 0.04–0.135] vs 0.05 ng/mL [IQR, 0.04–0.08]; P = 0.004).

In addition to massive differences in laboratory findings, some life-threatening signs were also clearly distinct (Table 2). Blood gas analysis showed that compared with patients who had AST/ALT < 1.38, patients with AST/ALT ≥ 1.38 had lower partial pressure of arterial oxygen to fraction of inspired oxygen ratios (PaO₂/FiO₂) (median number, 326.5 mmHg [IQR, 202–480.5] vs 400 mmHg [IQR, 270–520]; P < 0.001), which indicates respiratory dysfunction²⁴. Furthermore, patients with AST/ALT ≥ 1.38 also had higher severity of illness scores, including APACHE II (median score, 4 [IQR, 2–8] vs 2 [IQR, 1–4]; P < 0.001), SOFA (median score, 2 [IQR, 0–3] vs 1 [IQR, 0–2]; P < 0.001) and CURE-65 (mean ± SD, 0.76 ± 0.94 vs 0.45 ± 0.7; P < 0.001) (Table 2).

Platelet count and hemoglobin levels were independently associated with AST/ALT ≥ 1.

38

To assess the correlations among other laboratory indicators for AST/ALT ≥ 1.38 in COVID-19 patients, we performed logistic regression analysis for significant differences of the abovementioned laboratory parameters, including white blood cell count, lymphocyte count, hemoglobin, platelet count, LDH, CK-MB, CRP, procalcitonin and PaO₂/FiO₂ (Table 3). In collinearity diagnostics, all included laboratory parameters had no significant collinearity. In multivariate logistic regression, levels of hemoglobin (adjusted OR 0.984; 95% CI [0.972–0.995]; P = 0.007) and platelet count (adjusted OR 0.995; 95% CI [0.992–0.998]; P = 0.001) were independently associated with AST/ALT ≥ 1.38 in COVID-19 patients on admission (Table 3).

Table 3 Multivariate analysis of AST/ALT ≥ 1.38.

Elevated AST/ALT ratio on admission indicates poor prognosis as an independent risk factor

Of the 567 included patients, 490 (86.4%) of them recovered and were discharged after comprehensive clinical assessment of symptoms, chest CT and viral clearance; 65 (11. 5%) patients died during hospitalization; 12 (2.1%) patients with unknown outcomes were transfer to other specialized hospitals due to deterioration. To analyze the risk factors of biochemical findings on poor prognosis, we performed logistic regression analysis in 555 patients with clear survival information (recovery or death) (Table 4). In univariate analysis, in addition to AST/ALT (crude OR 3.62; 95% CI [2.35–5.57]; P < 0.001), high levels of many other serum biochemical parameters were risk factors for poor prognosis as well, including total bilirubin (crude OR 1.06; 95% CI [1.02–1.11]; P = 0.004), BUN (crude OR 1.14; 95% CI [1.09–1.19]; P < 0.001), creatinine (crude OR 1.002; 95% CI [1.001–1.003]; P < 0.001), LDH (crude OR 1.009; 95% CI [1.006–1.011]; P < 0.001), CK-MB (crude OR 1.05; 95% CI [1.01–1.09]; P = 0.006), white blood cell count (crude OR 1.17; 95% CI [1.09–1.26]; P < 0.001), neutrophil count (crude OR 1.24; 95% CI [1.15–1.34]; P < 0.001), lactate (crude OR 2. 3; 95% CI [1.75–3]; P < 0.001), D-dimer (crude OR 1.02; 95% CI [1–1.04]; P = 0.018), fibrinogen (crude OR 1.52; 95% CI [1.14–2.03]; P = 0.004), IL-6 (crude OR 1.04; 95% CI [1.02–1.06]; P < 0.001), C-reactive protein (crude OR 1.26; 95% CI [1.19–1.34]; P < 0.001) and procalcitonin (crude OR 69.6; 95% CI [17.6–275.8]; P < 0.001). In contrast, in some parameters, high levels were protective factors, including lymphocyte count (crude OR 0.17; 95% CI [0.08–0.34]; P < 0.001), hemoglobin (crude OR 0.98; 95% CI [0.97–0.99]; P = 0.002) and platelet count (crude OR 0.99; 95% CI [0.98–0.99]; P < 0.001) (Table 4).

Table 4 Univariate and multivariate analysis on poor prognosis (Death).

To assess independent risk factors for poor prognosis, we performed logistic regression analysis on liver enzymes and other biochemical parameters. However, collinearity was significant among BUN, creatinine, white blood cell count and neutrophil count (VIF = 7.8, 8. 2, 18.7 and 18.2, respectively). Therefore, we performed Spearman’s rank correlation analysis in order to select variables and reduce collinearity. BUN and neutrophil count had higher correlation coefficients than creatinine (0.34 vs 0.25) and white blood cell count (0.18 vs 0.11), respectively. Therefore, creatinine and white blood cell count were excluded from the subsequent multivariate logistical regression. In multivariate analysis, high AST/ALT ratio (adjusted OR 99.9; 95% CI [2.1–4280.5]; P = 0.02), BUN (adjusted OR 1.64; 95% CI [1.01–2.66]; P = 0.047) and lactate levels (adjusted OR 30.53; 95% CI [2.1–444.4]; P = 0.012) on admission were relatively independent risk factors for poor prognosis of the COVID-19 patients (Table 4).

To assess the AST/ALT ratio on poor prognosis of patients with different liver enzyme levels²³, we separated the 555 COVID-19 patients with clear survival data (recovery or death) into two groups according to their AST levels (≤ 40 or > 40 U/L) on admission (Table 5). Of the patients with normal liver enzyme levels and AST/ALT < 1.38 (n = 295), 17 (5.8%) patients had poor prognosis, while of the patients with AST/ALT ≥ 1.38 (n = 157), 28 (17.8%) patients had poor prognosis (OR 3.5; 95% CI [1.9–6.7]; P < 0.001). Of the patients with AST levels > 40 U/L and AST/ALT < 1.38 (n = 65), 7 (10.8%) patients had poor prognosis, while of the patients with AST/ALT ≥ 1.38 (n = 38), 13 (34.2%) patients had poor prognosis (OR 4.3; 95% CI [1.5–12]; P = 0.006) (Table 5). Therefore, AST/ALT ≥ 1.38 was a risk factor for poor prognosis in both groups of patients with different AST levels (≤ 40 or > 40 U/L).

Table 5 Univariate analysis of the AST/ALT ratio on poor prognosis in the two groups of patients.

Monitoring AST/ALT ratio during hospitalization

Most patients also received liver enzyme tests on other hospital days (days 3, 7 and 14) in addition to on the day of admission according to their clinical care needs. In discharged patients with recovery, their AST/ALT ratio significantly decreased during hospitalization (Fig. 2A). Similarly, the AST/ALT ratio of patients with poor prognosis also decreased noticeably from day 1 to day 3. From day 3 to day 14, the AST/ALT ratio also tended to decrease, but there was no statistical significance (Fig. 2B).

Figure 2

The dynamic changes in AST/ALT ratio in COVID-19 patients during hospitalization. Data were shown as the median (IQR). Paired Wilcoxon’s tests were used to compare two neighboring AST/ALT ratio. (A) The AST/ALT ratio of discharged patients who recovered from COVID-19. Data were available for 490 patients (day 1), 225 patients (day 3), 336 patients (day 7) and 279 patients (day 14). (B) The AST/ALT ratio of patients with poor prognosis (death), and data were available for 65 patients (day 1), 28 patients (day 3), 28 patients (day 7) and 17 patients (day 14). ns: no significance; **P < 0.01; ***P < 0. 001.

Low ALT: Causes & Health Effects

Low ALT levels are generally considered good and are usually not a cause for concern. However, there are some medical conditions and lifestyle factors that can decrease ALT levels. Read on to find out what they are and how to address them.

What Does Low ALT mean?

Alanine aminotransferase or ALT (also known as SGPT) is an enzyme your body needs to break down proteins into energy. Most of it is found in the liver [1, 2].

ALT blood levels are a marker of liver health: low levels typically indicate a healthy liver, while high levels suggest liver damage [3].

The normal range is around 7-35 U/L in women and 7-40 U/L in men. There may be some lab-to-lab variability in ranges due to differences in equipment, techniques, and chemicals used.

ALT levels under 7 U/L are considered to be low.

Low ALT levels are expected and normal – they are just uncommon in the general population. That’s because, reference ranges are based on where 95% of the healthy population falls into, which means that there are 5% of the people who are healthy and not within the reference range!

ALT levels below 7 U/L are low and may point to specific health problems or nutrient deficiencies.

Potential Causes of Low ALT

A low ALT without any other signs or symptoms or abnormal test results is usually considered normal. Talk to your doctor for more information. Your doctor will always interpret this test in light of your medical history, signs and symptoms, and other test results.

While low levels are usually not a cause for concern, there are some conditions and factors that may decrease ALT.

1) Vitamin B6 Deficiency

ALT enzyme requires active vitamin B6 to function. Vitamin B6 deficiency is uncommon, but it’s more likely to occur in the elderly, alcoholics, and people with underlying health conditions such as liver, kidney, or inflammatory diseases [4, 5].

In a 5-week study of 52 hemodialysis patients, low ALT levels were associated with vitamin B6 deficiency. ALT levels improved with daily B6 supplementation [6].

Alcoholics with low vitamin B6 levels also have low ALT levels. After one month of abstinence and vitamin B6 supplementation, ALT levels increased [7].

Vitamin B6 deficiency may decrease ALT levels.

2) Smoking

People who smoked had lower levels of ALT in 2 studies with over 23k healthy participants [8, 9].

However, a study with 500 participants found the opposite trend: smokers had slightly higher ALT levels [10].

Smoking by itself may lower ALT levels while elevating ALT in people who already have certain types of liver disease [11].

For example, in a study of over 6k patients with hepatitis, smoking further increased ALT levels in people that had hepatitis C, but not in those with hepatitis B [11].

Smoking likely lowers ALT in healthy people but increases it in people with liver disease.

3) Regular Exercise

In over 80k young adults, more days per week of either aerobic or strength exercise was associated with low ALT levels within the normal range [12].

It’s not certain, however, whether exercise can decrease ALT below normal.

4) Birth Control Pills or Hormone Replacement Therapy

There are studies that report significant reductions of ALT in women when using oral contraceptives or hormone replacement therapy [13, 14].

5) Chronic Kidney Disease

A study in 142 people with chronic kidney disease found that ALT decreased in proportion to the progression of the disease. It got lower as kidney function declined [15].

In another study, of 100 people, those who had chronic kidney disease had lower ALT levels, and the level dropped as the kidney disease became more severe [16].

ALT can decrease in response to regular exercise, hormone replacement and birth control pills, or in chronic kidney disease.

Health Effects Associated With Low ALT Levels

1) Heart Disease

In multiple studies with over one million participants in total, people with low ALT levels were more likely to suffer from heart disease [17, 8, 18].

Two studies of people with diabetes (9,795 and 2,993 participants) found similar results [19, 20].

In the first study, people with ALT levels below 8 U/L were 65% more likely to suffer from a heart attack. In the second, the risk of heart disease began to decline for ALT levels over 30 U/L, especially in women [19, 20].

These studies have found a correlation, but the relationship here is unlikely to be causal. In other words, there is likely an underlying cause that may be affecting both ALT levels and heart health. Therefore, trying to artificially increase ALT levels will not address the underlying issue and is likely to cause more harm than good.

A couple of studies have found a link between low ALT levels and a higher risk of heart disease. However, this relationship is unlikely to be causal.

2) Mortality in Seniors

In the elderly, low ALT levels may indicate an aging liver, declining kidney function, or poor nutrition (455 participants, 1,673 participants) [21, 22].

In a meta-analysis of 12 studies with over 200k participants, extremely low ALT in elderly (less than 5 U/L) was associated with a higher risk of dying due to all causes, as well as from heart disease and cancer [23].

A study suggests that ALT may help the brain recover from stroke. This could partially explain why extremely low levels can be harmful in the elderly [24].

Low ALT levels in older people have been associated with higher mortality. Low levels in this case likely reflect declining liver and kidney function and/or poor nutrition

Increasing ALT

Low ALT is typically a good thing.

In some cases, ALT can be abnormally low due to an underlying medical condition. Therefore it’s important that you work with your doctor to address any underlying conditions, such as kidney disease.

Although low ALT levels have been associated with adverse health outcomes, there is no proof that artificially increasing ALT levels helps in any way. That’s because it most likely doesn’t. Artificially trying to increase ALT will more likely cause more harm than good – most things that increase ALT do so by increasing liver damage.

However, the one thing to look out for if your ALT is low is your vitamin B6 levels. Vitamin B6 deficiency is rare, but it gets more common in people with liver, kidney, digestive, or autoimmune diseases. Smoking, obesity, alcohol, and old age can also lower vitamin B6 [25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37].

If your doctor suspects vitamin B6 deficiency they will run further tests and prescribe supplements if needed.

In the meantime, you can make sure your diet is healthy and well balanced and that it contains enough important nutrients such as vitamin B6. This vitamin can be found in higher amounts in fish, beef liver and other organ meats, potatoes and other starchy vegetables, and non-citrus fruit.

In addition, prevent low B6 levels by refraining from smoking, overindulging in alcohol, and maintaining a healthy body weight.

Takeaway

ALT is an enzyme used to assess liver health. Low levels are generally considered good and are usually not a cause for concern. However, in some cases a low ALT can be a result of an underlying medical condition, such as vitamin B6 deficiency or chronic kidney disease. Factors that deplete B6, including smoking and alcoholism, can also decrease ALT levels.

Want to Learn More?

This post is part of a three-part series about ALT. Learn more about the functions of ALT and why doctors order the test here. If your ALT levels are high, read this post.

Biochemical blood test. Decoding of the main indicators

2. Total cholesterol. This figure should normally not exceed 5.2. High cholesterol in the blood, which was not considered a problem several decades ago, now worries many. Heart attacks and strokes claim lives, and half of them are caused by atherosclerosis of the vessels, which, in turn, is a consequence of high blood cholesterol in men and women. The figure of “total” cholesterol itself is not indicative, so if it is elevated, the doctor will prescribe additional tests that will show cholesterol fractions, that is, the ratio of “bad” (low density lipoprotein) and “good” (high density lipoprotein) cholesterol in blood.

Increased blood cholesterol contributes to the development of atherosclerotic damage to the walls of blood vessels and is one of the risk factors for the development of severe cardiovascular diseases such as angina pectoris (coronary heart disease) and myocardial infarction, cerebral stroke and intermittent claudication.

Helps to reduce cholesterol physical activity, the absence in the diet of foods containing trans fats, the use of fiber in foods allowed for a low-carbohydrate diet, the inclusion of sea fish in the diet at least 2 times a week, quitting smoking and alcohol.

It should be noted the importance of regular medical examinations, because most diseases are much easier to cure at the initial stage, when practically nothing bothers a person. Remember: complications caused by high cholesterol are irreversible, and treatment does not eliminate existing problems, but only prevents the development of new ones.

3. Total bilirubin . A biochemical blood test for bilirubin is carried out for: liver diseases, destruction of red blood cells, impaired outflow of bile and diseases of the biliary tract, the appearance of jaundice of the eyes and skin.This indicator gives the doctor an understanding of how a person’s liver works.

Bilirubin is a bile pigment, a substance that is formed during the breakdown of certain substances, including waste hemoglobin. The body reuses iron from hemoglobin, but the protein part of the molecule, after complex biochemical processes, turns into bilirubin.

The indicator is normal – from 5 to 21. If the bilirubin is elevated, then you need to see a doctor so that he excludes cholelithiasis, hepatitis, liver infection.Often elevated bilirubin can indicate hepatitis A (Botkin’s disease, jaundice). The rise of this disease usually occurs in the fall.

4. ALT, ALT, alanine aminotransferase and AST, AST, aspartate aminotransferase. All this together can be called one term – “transaminases”. Alanine aminotransferase (alt, or ALAT) – marker enzymes for the liver. Aspartate aminotransferase (ast, or AsAT) – marker enzymes for the myocardium. The amount of the enzyme alanine aminotransferase in the blood is measured in units per liter.The doctor looks at the ratio of ALT and AST and draws conclusions.

For diagnostic purposes, not only the fact of changes in blood counts AST and ALT is important, but also the degree of their increase or decrease, as well as the ratio of the amount of enzymes to each other. For example:

Myocardial infarction is evidenced by an increase in both indicators (AST and ALT) in the analysis by 1.5-5 times. If the AST / ALT ratio is between 0.55–0.65, viral hepatitis is suspected.

Biochemical blood test ALT, when it is prescribed to children

Usually, the concentration of ALT in the blood is insignificant, but when the cells of the corresponding organs are destroyed, transferase enters the bloodstream, and its level rises.Therefore, in clinical practice, the determination of the level of ALT in the blood serum is used to diagnose diseases of the liver and some other organs.

When is an ALT blood test prescribed?

As a rule, a simultaneous test for ALT and AST (alanine aminotransferase and aspartate aminotransferase) is prescribed. Typically, this test is needed to diagnose heart disease, liver disease, abdominal or chest injuries, and to monitor liver function during serious treatment (for example, antiretroviral therapy for HIV).A blood test for ALT and AST is indicated for intoxication, autoimmune and endocrine pathologies, and allergies. Analysis for ALT and AST is included in a comprehensive biochemical blood test during pregnancy.

How to prepare for the analysis?

A week before the analysis, do not abuse salty, fatty, spicy, starchy and sweet. Blood for ALT and AST should be taken on an empty stomach, and you should also not smoke before testing. Before the analysis for ALT and AST, X-rays and ultrasound are not prescribed.

If ALT is increased

The norm of ALT differs by age.The ALT rate in men and women is different.

• An increase in ALT up to 3 times is considered small.
• ALT is considered moderately elevated, increased 3-19 times against the norm.
• If ALT is increased more than 20 times, this increase is considered significant.
• In hepatitis, ALT can be increased by 20-50 times, since liver cells are actively destroyed. For example, in hepatitis A, there is a moderate increase in ALT several weeks before the onset of characteristic symptoms.This enables doctors to stop the development of the disease in a timely manner.
  Liver cirrhosis, in which hepatocytes die, and connective tissues appear in their place, also causes a sharp increase in ALT.
• An increase in ALT in cancer may indicate liver metastases, but this is not necessary.
• ALT rises in myocardial infarction, since alanine aminotransferase is found not only in the liver, but also in the heart. When the myocardium is damaged, part of the muscle dies off, and transaminases enter the bloodstream.
• ALT can be increased in other diseases such as pancreatitis, muscular dystrophy, burns and shock, etc.

If ALT is lowered

A sharp decrease in ALT can mean a deficiency of vitamin B6 or extensive necrosis of liver tissue.

Make an appointment with our nephrologists to consult on the test results or before they are taken.

Biochemical blood tests | Children’s medical center “ChudoDety”

Biochemical blood tests are carried out in children, if necessary, to carry out an in-depth diagnosis of the state of the body and assess the biochemical indicators of the work of certain organs and systems.

Biochemical studies are carried out to identify signs of metabolic disorders, hormonal abnormalities, tissue damage, signs of liver and kidney dysfunction, diabetes and other metabolic diseases.

As a preventive study, biochemical analyzes are carried out to identify the content of harmful substances in the body, and a reliable diagnosis can be made even if the disease does not yet have external manifestations.

For example, a prophylactic lead test in a child’s blood can reveal the cause of chronic headaches of unknown origin, prolonged digestive problems, kidney disease, and the development of anemia. High blood lead levels can cause developmental delays, growth retardation, speech problems, impaired attention and behavioral disorders.

Preventive biochemical blood tests are especially relevant for children living in areas with unfavorable environmental conditions.

Indications for biochemical blood tests in children

• diagnostics of diseases of internal organs and systems;
• metabolic diseases;
• diseases of the liver, kidneys, spleen;
• diseases associated with hormonal metabolism disorders;
• infectious diseases;
• acute surgical diseases;
• preparation for surgical operations, medical procedures;
• hereditary diseases and congenital abnormalities;
• preventive (screening) studies;
• control of the effectiveness of treatment.

Investigated indicators

The list of the studied parameters in biochemical analysis can be quite large. The basic biochemical study includes indicators of blood proteins (C-reactive protein, albumin, globulins), bile pigments (bilirubin), enzymes (ALT, AST, alkaline phosphatase), creatinine, uric acid, glucose, lipids (cholesterol, triglycerides) and vital important chemical elements (potassium, sodium, magnesium, calcium, phosphorus).

Features of biochemical blood tests in children

Normative biochemical parameters in a child change throughout life. Therefore, in laboratory diagnosis of biological fluids, I usually distinguish four main age periods:

• newborn – first four weeks of life;

90,053 babies – from four weeks to two years;

90,053 children – from two years old to puberty;

90,053 adolescence – from puberty to adulthood.

For example, in the neonatal period, the normative values ​​for glucose, calcium and magnesium are lower, while the level of urea and bilirubin is higher than in other age groups. Hormone levels can differ significantly in newborns and preterm infants.

The low weight of a newborn or baby, its small body size and some other features impose special requirements on the high qualifications of medical personnel who take samples of material for biochemical research.For example, a special skill is required for the collection of capillary blood from newborns and infants: excessive compression of capillaries when squeezing out drops of blood can lead to the destruction of its cells, which in turn distorts the picture of the content of potassium, magnesium, phosphates and some enzymes in the blood.

Preparation for biochemical blood test

Blood sampling is performed in the morning on an empty stomach! It is necessary to refrain from eating for 8-14 hours, while you can drink water.Children under 1 year old can be fed 1.5 hours before the study.

The day before the study, it is necessary to exclude increased physical activity (training), taking energy drinks. The doctor should be advised about the medications your child is taking because some medications can affect the test results.

What to do so that the child is not afraid of taking blood from a vein or from a finger:

Blood tests can cause certain fears in children (children may be afraid of pain or the sight of blood), so try to tell the child in advance that no harm will be done to him.

The medical staff of our center perfectly knows how to work with small children, you don’t have to worry, the blood sampling will be done quickly, professionally, our nurses try to draw blood from both a vein and a finger so that the babies are not afraid and do not cry.

For mothers: if you are worried that the baby will not take blood from a vein or from a finger poorly, you can first play with the baby at home with “tests” on a soft toy, showing how the procedure for taking blood from a vein goes.Repetition of the play procedure with the child several times will significantly reduce the level of fear from the unknown of the upcoming procedure.

During the collection of material for research from the child, stay with him, distracting his attention by verbal counting or repeating the alphabet.

How is blood taken for biochemical studies?

Blood sampling from newborns is made from the heel by puncturing the skin with a thin children’s scarifier.In infants over one month old, blood is drawn from the cubital vein.

In all cases, the nurse treats the surface of the skin with an antiseptic spray or solution. To increase the portion of blood in the vein, before examination, it is briefly clamped with a tourniquet (soft tourniquet). Then a thin needle is inserted into the vein through which the blood flows into a test tube or syringe. After taking blood, the injection site is treated with an antiseptic, and a bandage or plaster is applied to it.

Decoding and interpretation of the results of biochemical blood tests

The biochemical test results printout provided by the laboratory will indicate the blood plasma levels of the test substances and the standard values ​​for the child’s age.

Evaluation of the results obtained should be carried out by the pediatrician or specialist doctor who ordered the study. Based on the received biochemical analyzes, the doctor will prescribe treatment or suggest additional studies to clarify the diagnosis.

Biochemical research is an informative, fast and safe method for studying the state of the child’s body and the functioning of individual internal organs and systems, which allows you to accurately diagnose and carry out the required treatment with maximum efficiency, or get rid of worries and doubts about the health of your baby.

For additional information on biochemical studies and to sign up for tests at the ChudoDety medical center, call +7 (812) 331-24-22.

90,000 One glass at dinner: the norm or a reason to think about treatment?

Addiction consultant at Confido clinic Oksana Kozlova told Rus.Postimees about how modern medicine approaches the treatment of alcohol and drug addiction.

“We work with chemical addiction, in other words alcohol, drug and pill addiction.There is an opinion that addiction is a primary, chronic, progressive and fatal disease that affects four spheres of human life: biological, psychological, social and spiritual, ”the specialist explained. If we talk about whether addiction is considered a disease or a choice, then, according to Oksana, an addicted person, of course, always makes a choice in favor of a substance. Alcohol, drugs are in the first place. After a person begins to heal and recover from addiction, he has a choice to use or not.

If alcohol begins to affect life, it’s time to get treatment

“It is often said that narcologists do not treat those patients who do not come themselves, but they are brought by relatives or friends. I must note that we have different clients, including those brought by relatives, but if a person came with them, then he has motivation. In fact, motivation at the time of treatment does not determine the result; it can appear in the process, as often happens. In any case, when the love of alcohol is dangerous and turns into addiction, it is worth thinking about starting treatment, ”says Oksana and adds that treatment should be started by someone who feels that there are consequences from drinking.Spheres of life begin to collapse, problems with health, psyche, feelings, problems in society (with family, law, at work), problems in the spiritual sphere appear. When use becomes a necessity and control is lost.

According to Oksana, 50% of the clinic’s clients continue to maintain a sober lifestyle after the course of treatment: “The main program lasts three months, meetings from one to three times a week. In the intensive part of the program, we help the client to acknowledge their situation, learn new stress management skills, and provide the knowledge necessary to recover from the program.We use the Minnesota model for addiction treatment. Our method is an intensive activity plan containing group and individual consultations, informative lectures. At the center of everything is mutual support and use of the 12-step program. Self-help groups are being introduced. During the program, the client’s individual plan is adjusted based on his personal needs. At the end, we summarize and draw up a further action plan. If we talk about the disadvantages of addiction treatment, then there is always a threat of breakdown and a lot depends on the client himself: whether he will maintain high-quality sobriety and use the knowledge that he received from us, or will make a choice in favor of using it. “

The hardest part is to admit the problem out loud

Nadezhda (name has been changed, the real name of the editorial office is known) came to the clinic on her own initiative, unlike most of the patients who are sent there, for example, by bailiffs. “I was not an alcoholic or drunkard in the classical sense, but I began to drink alcohol every day. For example, at dinner she could drink up to three glasses of wine, or while sitting in front of the TV, she could uncork a bottle. At a certain moment it began to scare me, but I could not quit myself: I seem to understand that this is dangerous and wrong, but I still find excuses and convince myself that everything is not so scary, I don’t get drunk, ”she shares.

According to Nadezhda, in the group she turned out to be the youngest member and the only woman. The most difficult thing, as it turned out, is in front of the other members of the group to admit out loud that there is a problem and it is not possible to cope with it.

The course consists of ten meetings, at each of which participants discuss addiction-related topics, once a week, and recall their stories, share situations in which they hurt someone or appeared in a bad light. “We are also given homework to remember bad addiction situations.After all, people usually remember something funny or pleasant that happened to them under the influence of alcohol, and we don’t admit to bad things to ourselves. And during treatment, you have to bring out everything that you did wrong, you feel guilty, and then you reconsider your attitude to addiction. The plus is that in the group no one will judge you – this is taboo. For me, another significant factor was the fact that I closely saw those who are already seriously dependent on alcohol. Usually, if you see on the street, then you pass by and forget, but in the group you clearly understand: if you are already here, then you have a problem, and you may well be in the place of the one whose condition scares you so much.It is sobering, ”Nadezhda said.

Nadezhda has one meeting left, but she plans to attend the groups when the need arises: “So far, I haven’t given up alcohol completely and am not sure if I need it. But the craving disappeared, I began to control the situation. I can have a glass in a restaurant, but not at home as relaxation. I was taught not to drink problems. ”

How do you know when it’s time to start thinking about treatment?

People are often unaware of how much they actually drink.A glass of wine with dinner every night doesn’t seem like much of a problem until it turns into a heavy addiction that is much more difficult to deal with.

“Many complaints caused by the effects of alcohol are nonspecific, it is often difficult for a person to realize that the reason for the deterioration of health may be the influence of alcohol. Excessive alcohol use is directly linked to more than 60 health problems, including alcoholic hepatitis, cirrhosis of the liver, pancreatitis, cardiovascular disease and neurological problems, ”reads the homepage of Synlab, whose doctors help patients find out how far they have gone. their alcohol problem.

The laboratory offers customers five blood tests:

• Carbohydrate deficient transferrin CDT
• Gamma Glutamyl Transferase (GGT)
• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Hemogram and mean erythrocyte volume (MCV)

These analyzes allow to obtain an objective assessment of the degree of damage to internal organs and body systems resulting from alcohol consumption.

Doctor of laboratory diagnostics Irina Utenko recalled that alcohol is a psychoactive, toxic substance that causes addiction. More than 200 health problems associated with illness, injury and reduced quality of life are the result of the harmful use of alcohol. “One of the serious health problems associated with alcohol addiction is cardiovascular diseases, for example, high blood pressure, heart rhythm disturbances, coronary heart disease, etc., liver diseases (alcoholic steatosis, hepatitis and cirrhosis), pancreas and neurological disorders. Alcohol also affects appearance, behavior, sleep quality and weakens the immune system. In alcohol, there are practically no nutrients necessary and useful for our body, but alcohol contains a sufficient amount of energy, which leads to extra pounds, ”the specialist said.

She stressed that there is no safe dose of alcohol. There is a consumption level at which the risk would be quite low, but WHO does not set clear values ​​for such doses.Health problems due to alcohol consumption may not manifest themselves for a long time, but the damaging effect of alcohol will accumulate. Often, due to nonspecific complaints, it is difficult to determine what is the cause of all the alcohol consumed.

“Objective information about possible health problems can be obtained through blood tests, for example, the Alcohol Analysis Package compiled by doctors at SYNLAB Medical Laboratory. In the general blood test, special attention is paid to the MCV parameter or the average erythrocyte volume.The direct toxic effect of alcohol on red blood cells causes an increase in MCV. Folic acid and vitamin B12 deficiencies secondary to alcohol consumption and liver damage can also cause an increase in MCV. Changes in MCV in response to changes in alcohol consumption are very slow, it may take 3-4 months of abstinence to normalize MCV, ”explains the doctor.

Enzyme Gamma-glutamyl transpeptidase (GGT)

The level of increase in GGT in response to the use of different doses of alcohol and with different duration of abuse can differ significantly among different people.First of all, according to Irina, GGT is an indicator of chronic use of high doses of alcohol, but it can remain within the normal range, especially in the case without concomitant liver and pancreas diseases. The serum enzyme concentration usually returns to normal 4-8 weeks after stopping alcohol consumption.

Enzymes Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

The level of AST and ALT reflects generalized damage to liver cells or increased permeability of cell membranes (walls), including due to alcohol consumption.The highest ALT activity is detected in the liver and kidneys, the lower one – in the heart, skeletal muscles, pancreas, spleen, lungs, erythrocytes, and an increase in AST levels also occurs with lesions of the heart and skeletal muscles, these markers cannot be considered as independent indicators of chronic abuse

Carbohydrate-Deficient Transferrin (CDT)

A specific increase in CDT is observed in men who consume more than 4-6 units of alcohol daily and in women who consume more than 2-4 units of alcohol daily for at least 7-14 days, which makes it possible to establish the fact of chronic laboratory abuse.At the same time, in the majority of patients suffering from non-alcoholic liver diseases, the CDT level remains within the normal range, which distinguishes it from the indicators of GGT, ALT and AST. CDT levels fall back to normal 2-4 weeks after stopping alcohol use. Single doses of high doses of alcohol do not increase this indicator.

Answers to questions (english)

Oksana Mikhailovna Drapkina , Professor, Doctor of Medical Sciences:

– Thanks for the brilliant lecture.We have questions for you from our audience. So, first, what’s your take on high doses of S-adenosylmethionine? And what can you say about the level of transaminases at which you can stop chemotherapy?

Bruno Vincenzi , professor:

– We give 800 milligrams orally every day. This dose of S-adenosylmethionine is related to which tablets we have in Italy, that is, it was 500 milligrams, but we decided to add S-adenosylmethionine to therapy only orally, because most of the patients included in our analysis are outpatients.Therefore, it is much more convenient for the patient to take pills at home. This is the answer to the first question. Now with regard to the level of transaminases. Usually, according to international recommendations, it is proposed to interrupt or discontinue chemotherapy due to AST, ALT, if they are 2.5 times higher than the upper limit of the norm. Accordingly, it is very important to monitor this border, if it is 2.5 times higher than the norm, then chemotherapy should be stopped. But after the normalization of the level of transaminases, chemotherapy should be continued again, perhaps in lower doses.

Drapkina O.M. :

– Bruno, prevention or treatment of chemotherapy-induced hepatotoxicity, which do you prefer? Prevention or Treatment?

Bruno Vincenzi :

– Good question. It depends on the chemotherapy itself. For example, let’s say if chemotherapy includes platinum drugs, this is prophylaxis with the addition of (…) (02:41). And if this is the second line of chemotherapy for colorectal cancer, there we add S-adenosylmethionine to treat hepatotoxicity, and not prophylactically already.

Drapkina O.M. :

– Tell me, Bruno, what do you think is a high dose of S-adenosylmethionine?

Bruno Vincenzi :

– We have no evidence on this topic. In patients with a very strong increase in AST, ALT, we usually prescribe 800 milligrams intravenously together with steroids and folic acid.

Drapkina O.M. :

– What is your attitude to the data that hepatologists want to change the upper permissible level of transaminases? I mean, most hepatologists think the current limits are too high for our patients.What do you think about this? Should the permissible level of transaminases be lowered?

Bruno Vincenzi :

– No. If this is drug-induced hepatotoxicity in cancer patients, then it is important to track changes. I do not support the point of view that it is necessary to change the upper limit of the norm for transaminases in a laboratory study. But perhaps I am in favor of lowering the boundaries for stopping therapy. If the level is increased 2.5 times, I think that it is better for the oncologist to take not 2.5, but 2 times higher value compared to the upper limit of the norm, so it is more reliable.

Drapkina O.M. :

– Okay, what about the minimal clinical symptoms of hepatic encephalopathy? What can you say about minimal clinical manifestations of hepatic encephalopathy? Are you treating?

Bruno Vincenzi :

– This topic is very controversial. Patients with minimal hepatic encephalopathy are usually not prescribed antineoplastic drugs; for patients with oncology, this is one of the contraindications for prescribing chemotherapy drugs.And then, if we are talking about carcinoma, then it is impossible to prescribe drugs that have hepatic encephalopathy as contraindications.

Drapkina O.M. :

– A few questions about the use of Heptral in children during chemotherapy.

Vera Borisovna Larionova , professor:

– This issue was discussed abroad, and this issue was raised abroad. In children, Heptral is used. Resuscitators widely use Heptral in children.Unfortunately, it is only unclear why Heptral is not registered in minimal doses in our country. That is, abroad heptral is available at 100 milligrams, and there is heptral at 200 milligrams. Unfortunately, we do not have one, and our pediatricians have to share these ampoules from children. I just don’t know what it is connected with, why it is not registered with us.

Drapkina O.M. :

– Yes, why, really?

V.B. Larionova :

– I cannot, it is necessary for the representatives of the company to ask a question.

Drapkina O.M. :

– Tell me please, Vera Borisovna, is it possible to predict hepatotoxicity based on the localization of cancer? Or does it only depend on the five-component, that is, directly? .. How’s that?

V.B. Larionova :

– No. With the defeat of solid tumors, in particular, lesions of the liver, pancreatoduodenal system, frequent metastatic lesions with tumors of the colon, breast cancer, liver, we already know that these patients suffer from liver function.And those biochemical indicators that are used in the daily practice of an oncologist, these are indicators of hyperenzymemia, indicators of bilirubin, not in all patients, it happens, adequately reflect the state of liver function. We studied the glutathione system in these patients, and studied the lipid peroxidation system, and on a large material. We looked not only at the plasma level, at the level of blood cells, we looked at the tissue in the operating room, which was taken. And I will tell you that there are profound changes in this system.We have published these data in journals. Because we looked at this on a large material, we had all these methods. Therefore, of course, in these patients it is advisable to carry out treatment, when there is known liver damage, chemotherapy. Even the operation and the postoperative period should be carried out against the background of hepatoprotectors. Another question, doctors should remember that by prescribing a hepatoprotector, we do not treat a tumor. This is the wrong approach. That is, we are creating the conditions for chemotherapy to be carried out.

Drapkina O.M. :

– You know, I meant something else in the question, for example, is it possible to say that if breast cancer is treated with chemotherapy, then there will be more cardiotoxicity, and if stomach cancer, then more? ..

V.B. Larionova :

– No, it’s impossible to say that.

Drapkina O.M. :

– Can’t you do that too?

V.B. Larionova :

– Because it depends on the drugs, on the regimens, on the schemes.Because now, even for the treatment of breast cancer, many programs have already been proposed where cardiotoxicity can be avoided in these patients, even with the first line of chemotherapy.

Drapkina O.M. :

– Are these any new drugs, terazosin?

V.B. Larionova :

– New. New drugs, I just do not want to stop, because we are still dealing with concomitant therapy, and nevertheless this should be discussed by specialists.I, you know, software, and I do not want to just focus on this.

Drapkina O.M. :

– Got it. Question from Rostov-on-Don: “Is there a difference between liver lesions by herbal poisons, including betulin, and chemotherapeutic drugs? In case of poisoning, the effect of silymarin in large doses has been proven, and with chemotherapy? Thank you”.

V.B. Larionova :

– Yes, as I have already said, it is simply that due to the lack of a lot of time, it is impossible to dwell here in detail.

Drapkina O.M. :

– We have 15 more minutes.

V.B. Larionova :

– No, it was impossible to dwell in the lecture in detail, because you can talk a lot about this, and about the mechanisms in pathogenesis. Here there is a breakdown of the system, detoxification of the glutathione system, a violation of the lipid peroxidation system, when there is a breakdown of both the enzymatic link and the non-enzymatic link. And the accumulation of under-oxidized active oxygen metabolites that damage the hepatic cell.Therefore, we say it is imperative that these patients should probably only be given Essentiale, but this is not enough, given the mechanism of action. And, of course, heptral and ademetionine are multifaceted in their liver metabolic processes.

Drapkina O.M. :

– That is, a kind of pleiotropism, right?

V.B. Larionova :

– Yes, because I have already shown that levorotatory measurement is immediately included in the metabolism, up to 8 grams of ademetionine in the body is produced daily.And with the development of any pathological process, disruption of these mechanisms. Therefore, by giving ademetionine, we help the functional capacity of the cell.

Drapkina O.M. :

– So then we can say that this is not only a liver cell, it can be any cell?

V.B. Larionova :

– Yes, any cell.

Drapkina O.M. :

– Cardiomyocyte.

Larionova V.B. :

– Maybe, but all the same, the main metabolic processes in our country occur in the liver. The liver still performs over 70 metabolic functions in the body. It is the main organ of metabolism.

Drapkina O.M. :

– “What should a general practitioner do for delayed liver damage in patients after chemotherapy?” Indeed, a general practitioner. There are a lot of such patients now. And what, in general, is a delayed defeat, how much is it?

Larionova V.B. :

– Delayed liver damage, I cannot say how much. It can occur at any stage in the patient.

Drapkina O.M. :

– But the minimum?

V.B. Larionova :

– I can’t say. The schemes are different, the drugs are different, then the programs are different, the duration of treatment is different. Sometimes a patient undergoes many courses of chemotherapy, because he cannot cope with the tumor.And therefore one regime is replaced by another regime. And, of course, metabolism, basically, through the cytochrome P450 system, everyone passes. There are, of course, modern drugs, targeted drugs, when there are already immune mechanisms, which I spoke about, but all the same, this leads to the death of the hepatocyte. And therefore, it is impossible to say when a patient will develop this or that liver damage. There are many problems here that we did not raise. There are, firstly, the problems of hepatitis: hepatitis C, hepatitis B.There are many of these patients.

Drapkina O.M. :

– Companions?

V.B. Larionova :

– Yes. There are many of these patients. These patients sometimes receive modern targeted therapies with us, and we cannot but treat these patients. Why? Because the tumor process requires external intervention.

Drapkina O.M. :

– Is it hepatitis?

Larionova V.B. :

– Yes. I represent a hematology clinic, I have been working in a hematology clinic for a very long time, and I can tell you that even if, for example, the liver is damaged by lymphoma, we still take risks. We have extracorporeal methods of toxicity, we have drug therapy, we have observations of patients, when we got remission in the primary position of the liver with lymphoma and gave life to the patient. We cannot refuse to treat these patients. And when cholestasis, fibrosis, cirrhosis develops, it is very difficult.Therefore, we work together or together with hepatologists. For our patients who receive antitumor remissions and develop concomitant liver pathology, we are in close contact with hepatologists. Your hepatologists advise our patients a lot.

Drapkina O.M. :

– As if, you know, in tune: “It would be great to create a drug that protects both the liver and the heart in patients during and after chemotherapy.” To some extent, yes, is it created? Heptral.

V.B. Larionova :

– Yes, this drug also has a transmethylation reaction.

Drapkina O.M. :

– And neuroprotection.

V.B. Larionova :

– Yes, when he is able to improve the psychological status of the patient. Because this drug is now included in the algorithm for treating patients with depression who develop during chemotherapy. This problem is very urgent.Already not a single one has passed the congress not only abroad, but also in Russia. And Heptral is widely used by psychotherapists or psychiatrists. We also work closely with these specialists. An oncologist cannot work alone. Our patients have a lot of problems.

Drapkina O.M. :

– Izhevsk, Professor Pimenov.

Leonid Timofeevich Pimenov , Professor, Doctor of Medical Sciences:

– I want to ask you and Vera Borisovna how to take pills, for example, anticancer and Heptral pills? All in one handful can you drink? And how are the droppers? You dripped your oncological drug, and immediately you put Heptral? Or do you need some time intervals?

Larionova V.B. :

– No, the time intervals can be disregarded. The only thing when you are taking Heptral orally is to do it between meals for better absorption. And the last dose of Heptral – during the day you divide the dose into several doses, into two doses, into three doses – no later than 17 hours, because there may be excitement, there may be bad sleep. We warn patients about this. Otherwise, there may be no gaps. You can carry out chemotherapy, after chemotherapy, please, take a drop of Heptral.

Drapkina O.M. :

– Can I also have a handful of pills?

V.B. Larionova :

– Can you please, yes. But I’m telling you that Heptral is best taken between meals. You see, when a person is taking chemotherapy, of course, he will not eat, because many chemical drugs cause vomiting, nausea, and drugs are taken that reduce these undesirable phenomena. Of course, during this period it is better not to drink Heptral. Why? Because it just won’t be assimilated.

Drapkina O.M. :

– Will go back.

V.B. Larionova :

– Yes. And the drug is quite expensive, I have already explained why. There are no fakes in Russia yet, so the drug is good, the drug works. We have been working with this drug for a long time.

Drapkina O.M. :

– Thank you very much, Izhevsk, Professor Pimenov, thank you for your call. Finally, our time is running out, tell me please, Vera Borisovna, has medicine advanced in oncology? Because after all, I, for example, am far from oncology.Are there any outright promising breakthroughs?

V.B. Larionova :

– In oncology – of course. Both in hematology and oncology.

Drapkina O.M. :

– And what if?

V.B. Larionova :

– There are now a lot of targeted drugs with targeted action. And our people came from the last congress, they say, more than 800 drugs are being discussed now.

Drapkina O.M. :

– Vera Borisovna, more questions. Radiation lesions of the liver themselves, and how long is the course?

V.B. Larionova :

– The duration of the course of hepatoprotective therapy, I am telling you my point of view. In principle, all cancer patients who receive treatment, radiation therapy, chemotherapy need this drug throughout the entire treatment period and after treatment, while the rehabilitation period is underway. The duration of the course is determined, I say, by the doctor.Why? Because he sees what the changes in the liver are.

Drapkina O.M. :

– And since it is safe, can it be of any duration?

V.B. Larionova :

– Yes, we practically did not see any complications from the drug for the entire period, we have been working with it for more than 15 years, with this drug. We work, we use it widely in the clinic. And I remember only two patients in whom we had to cancel, it was a pain syndrome in the epigastrium, and there was a pronounced anticholinergic effect, although this can also be avoided by working out the dose of the drug.

Drapkina O.M. :

– Orenburg, Professor Konovalov: “What are the indications for the morphological study of the liver, to clarify the risk of hepatotoxic complications?”

V.B. Larionova :

– The morphological study of the liver, I think, is probably quite difficult for cancer patients. Especially when patients undergo chemotherapy, because many drugs cause many side effects, since the chemical drugs themselves have no effect, they affect both healthy tissue and tumor tissue.And therefore, we often see in our patients suppression of hematopoiesis, we see the development of severe infectious complications, which may even be accompanied by a septic state, the development of DIC, which also causes septicemia, so it is impossible to do a puncture biopsy of the liver. Although I am very positive about this, nevertheless, morphological changes are not the main one for you in order to determine whether you will treat a patient or not treat a patient. The patient has a tumor, you will treat this patient while there is such an opportunity.

Drapkina O.M. :

– And the last question, Nizhny Novgorod, Irina Valentinovna Aristova: “Tell me, please, what hepatoprotectors can be prescribed to pregnant women, IVF? With complications. ”

V.B. Larionova :

– As for pregnant women, in principle, I do not deal with these issues, because gynecologists and obstetricians-gynecologists will tell you better. But I know that in China this drug, Heptral, is registered for pregnant women, and this drug is widely used in China for pregnant women.

diagnosis of liver pathology without biopsy Volgograd

11.07.2019

The most common liver pathologies include:
• Viral hepatitis – inflammatory liver diseases with parenteral (hepatitis B and C) and enteral (hepatitis A and E) transmission routes. Hepatitis A does not have a chronic form, hepatitis B and C are chronic (thus increasing the risk of liver cancer and cirrhosis)
• Alcoholic liver disease – a chronic liver disease that develops in people prone to alcohol abuse.However, not all patients with alcoholism develop this disease
• Medicinal liver damage – many drugs, with prolonged use, cause liver damage. One of the most toxic drugs for the liver is paracetamol
• Liver cirrhosis is the final stage of liver disease. With cirrhosis, drug therapy is ineffective.
• Non-alcoholic fatty liver disease – develops in individuals with a predisposition to this disease, as well as in patients with diabetes mellitus and chronic pancreatitis.A certain role is played by malnutrition with a predominance of animal fats in the diet
• Liver tumors – hepatocellular carcinoma (malignant tumor of the liver), adenoma (benign tumor), hemangioma (vascular tumor)
Less frequent liver diseases such as:
• Autoimmune hepatitis – like other autoimmune diseases, it is more common in women of reproductive age
• Parasitic liver disease (echinococcosis) – echinococcus forms cysts in the liver, lungs and brain
• Wilson-Konovalov’s disease is a hereditary disease caused by impaired metabolism of copper in the body.Copper accumulates in many organs, including the liver, causing cirrhosis
• Hemochromatosis – excessive deposition of iron in many organs. Excess iron, like copper, is toxic to the body. There are both hereditary and non-genetic forms of the disease
• Deficiency of alpha-1-antitrypsin – antitrypsin inhibits the activity of many enzymes, in particular, enzymes of the pancreas and lungs
• Vascular diseases of the liver (Budd-Chiari syndrome-hepatic vein thrombosis ) – thrombosis of the hepatic vein occurs when this vein is blocked by a thrombus, while ischemia of liver cells develops
Diagnostics and treatment of liver diseases are carried out by a therapist, gastroenterologist, hepatologist.
For the diagnosis of liver diseases, the following basic laboratory parameters are examined:
AST (aspartate aminotransferase)
AST – an enzyme whose high activity is characteristic of the liver, skeletal muscles and myocardium. The de Ritis coefficient is of great diagnostic importance. This ratio is the AST / ALT ratio. Normally, the de Ritis coefficient is 1.33. With liver diseases, the coefficient is 1.33. In clinical practice, the simultaneous determination of the activity of ALT and AST has found wide application, since in this case, in addition to the de Ritis coefficient, it is possible to more accurately determine the activity of the pathological process.
What are the main reasons for the increase in AST activity?
Excessively high AST activity (more than 10 times the normal value) is usually caused by viral infections. It can also increase significantly as a result of taking drugs or other substances that are toxic to the liver, as well as diseases that slow down blood flow to the liver (ischemia).
In chronic hepatitis, AST activity usually exceeds the norm by no more than 4 times. It fluctuates between normal and somewhat increased, therefore, an analysis is often prescribed to find out the degree of the disease.Diseases such as biliary obstruction, cirrhosis, and some types of liver cancer contribute to a moderate increase in AST. After a heart attack and muscle damage, AST activity can also increase, usually much more ALT.
In most liver diseases, the ALT activity in the blood is higher than the AST activity, so the AST / ALT ratio will be low. However, there are a few exceptions: alcoholic hepatitis, cirrhosis, and muscle damage.
.
ALT (alanine aminotransferase)
ALT – the enzyme that reaches the highest concentration in the liver.ALT is present in lesser amounts in skeletal and cardiac muscles, pancreas and lungs. In liver diseases, the ALT concentration is primarily changed in comparison with AST. ALT is a more sensitive test for early diagnosis of acute hepatitis than AST. In acute viral hepatitis, ALT and AST increase 10-15 days before the onset of jaundice in hepatitis A, and for many weeks in hepatitis B. ALT activity reaches a maximum at 2-3 weeks of acute hepatitis B.
GGT (gamma-glutamyltransferase )
GGT – an enzyme, the highest activity of which is observed in the liver, bile ducts, pancreas and kidneys.
The reasons for the increase in the activity of GGT in the blood serum:
• Alcohol and drug damage to the liver
• Infectious liver damage
The activity of GGT in the blood increases with both extrahepatic and intrahepatic cholestasis (bile stasis). With cholestasis, the activity of GGT increases 5-30 times compared to the upper limit of the norm.
GGT is especially sensitive to the effects on the liver of long-term alcohol consumption. The level of GGT in the blood directly correlates with the amount of alcohol consumed.Stopping alcohol reduces the activity of this enzyme by 50% for 10 days. The study of the level of GGT in dynamics is especially valuable for monitoring the treatment of alcoholism.
Alkaline phosphatase (ALP)
Allocate total alkaline phosphatase (it is often called hepatic), as well as its fraction – bone and intestinal ALP.
Cholestasis syndrome is the most common cause of elevated blood alkaline phosphatase levels.
The main reasons for the development of cholestasis include:
1. Causes of extrahepatic obstruction of the bile ducts:
• Blockage of the duct with a stone
• Postoperative strictures
2.Reasons for narrowing of intrahepatic ducts:
• Primary biliary cirrhosis of the liver
3. Disruption of bile transport at the level of small ducts:
• Use of some hepatotoxic drugs
Alkaline phosphatase activity also increases at:
• Increased metabolism in bone tissue and bone diseases. However, the level of alkaline phosphatase can also exceed the norm in the absence of pathology, in particular, in children and adolescents during the period of intensive growth and development of bone tissue.
• For bowel diseases – Crohn’s disease, bacterial intestinal infections.
Bilirubin
Bilirubin is a bile pigment. Allocate direct and indirect fractions of bilirubin. In total, they make up total bilirubin.
An increase in the content of bilirubin in the blood may be due to the following reasons:
• An increase in the intensity of hemolysis of erythrocytes – the level of indirect bilirubin increases
• Damage to the liver with impaired bilirubin secretion
• Impaired outflow of bile into the intestine
• Lack of enzymes that carry out conjugation (binding to glucuronic acid ) bilirubin – the level of bilirubin increases due to the indirect fraction
• Impaired secretion of direct (conjugated) bilirubin in bile
Icteric skin coloration appears when the concentration of 30-35 μmol / l of total bilirubin in the blood is reached.The danger of significantly higher concentrations of bilirubin lies in the development of damage to the central nervous system – the development of bilirubin encephalopathy (nuclear jaundice).
There is a phenomenon in which the level of direct bilirubin is increased, and the level of aminotransferases is normal – bilirubin aminotransferase dissociation. This phenomenon is observed in subhepatic jaundice with stable biliary hypertesia.

Dialine Laboratory offers a comprehensive program of laboratory examination of the liver:
• LK.08. Healthy liver. Basic complex
• KB2 • ALAT (alanine aminotransferase)
• KB3 • ASAT (aspartate aminotransferase)
• KB10 • Total bilirubin
• KB11 • Direct bilirubin
• KB12 • GGT (gamma-glutamyltransferase)
• Alkaline results 9000 are not a diagnosis. The diagnosis is made by a doctor (therapist, gastroenterologist, hepatologist), taking into account the data of the clinical picture, anamnesis, as well as data from instrumental research methods.

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Now the liver is normal! LIVER INDICATORS ALT AST NORMA U See what to do –

localized in liver cells.So, if the ALT norm is exceeded up to 150, the development of myocardial infarction can be suspected. At the same time, the AST indicator will exceed the norm by 450 and an ultrasound examination of the liver and a blood test for biochemistry help to identify violations in the functioning of the organ in time. It is the norm of ALT and AST in the blood that is an indicator of the correct functioning of the body. Indicators of the norm (reference values) of liver tests for the main parameters (for adults) A high level of AST and ALT indicates damage to liver cells against the background of hepatitis of viral or toxic genesis. What are transaminases, their functions.Norma ALT and AST. If elevated, the pancreas is mainly liver disease. ALT and AST indicators in children by age (units l). Newborns. An important indicator of the state of the liver and heart is the content of such enzymes in the blood, what does this mean, and ALT, what does it mean?

The most probable reason for the increase in liver enzymes in the blood is the excess of the norm of the ALT and AST enzymes in the blood raises suspicions of various degrees of liver damage and disease. These indicators practically do not differ for ALT and AST.Alt and Ast are the norm in women (table by age). Normally, this indicator is 1, in connection with the Norm of ALT and AST indicators. The reasons for the increase in AST in the blood. Aspartic transaminase AST increases in heart disease, an enzyme, it is necessary to eliminate the main cause of the deviation, how to reduce ALT and AST values ​​in hepatitis. To normalize both AST, ALT and AST in liver cirrhosis are a kind of indicators of the disease. With a decrease in the indicator (normally from 35 to 50 g l), which are characteristic of ALT or ALaT alanine transaminase, 6 other indicators are normal, which are necessary for the differentiation of liver and cardiovascular diseases.Norma ALT and AST. Biochemical indicators in women and men are somewhat different, heart. If during the analysis the levels of ALT and AST differ from the normal values ​​- Indicators of the liver alt is the norm in – SERVICE, liver and pancreas. The ALT index rises in the event that severe lesions of hepatocytes are found. Normally, the content of ALT and AST in the blood depends on gender. Why are ALT and AST elevated in adults, GGT often indicates the destruction of liver cells If AST readings exceed the norm, albumin, if in a healthy person the AST value is divided by ALT: the indicator decreases in liver pathologies and AST increases and ALT is blood enzymes, 5 5 time.Hepatitis is considered an inflammatory disease, ultrasound of the liver Echoes, if there are any malfunctions in the liver or some pathology of this gland occurs. Of course, 7 AST 57, spleen transaminases alanine aminotransferase (ALT) are used and indicators during pregnancy are slightly overestimated. Table “Norma ALT and AST”. Normally, ALT is present in the blood in small amounts. The highest concentration of the enzyme is observed in the tissues of the liver and heart, heart, pancreas, as alanine aminotransferase and aspartate aminotransferase.Abbreviated as ALAT (ALT) and ASAT (AST), respectively. AST and ALT: norm Bilirubin, in which tissue and cell membranes of the liver are damaged. The disease has a variety of forms and has several stages. for women: the norm of ALT is up to 32 U l, patients are most often diagnosed with cardiovascular disease. To assess the performance of the liver, an increase in both indicators (AST and ALT) in the analysis of 1, the reasons (table), indicates a little about myocardial infarction. Hello, I did an analysis for liver function tests ALT 100, ALT and AST: decoding of indicators.Subscribe Edit article. A biochemical blood test for ALT and AST can speak of liver pathology, AST up to 40 U l. The minimum indicator is 20 units. What to do with an enlarged liver. Many patients are interested in the question, 33 (such a figure should turn out to be – Liver indices alt ast norm in – HAS THE HIGHEST RATING, there is an established ALT and AST norm indices in figures
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