Abnormal liver enzymes: A review for clinicians

Table 3 Common condition with abnormal liver biochemical tests

Condition	AST/ALT	ALP	GGT	Bilirubin	Other
Alcoholic hepatitis	↑↑ AST:ALT > 2	↑	↑	↑	AST/ALT < 500
NAFLD	-/↑ ALT > AST	-/Mild ↑	-/Mild ↑	↑ If progress to cirrhosis	-
Viral hepatitis	↑↑ In acute/↑ in chronic	↑	↑	↑ In chronic	AST:ALT > 1 suggestive of cirrhosis
Hemochromatosis	↑ ALT > AST	↑	↑	↑ Higher levels = higher iron load	↑ Ferritin and transferrin saturation
Wilson’s disease	↑/↑↑↑ AST:ALT > 2.2 in ALF	↑	↑	↑	ALP:Bilirubin < 4
AATD	↑ AST > ALT	-	-	-	-
Celiac disease	↑ ALT > AST	-	-	-	-
Autoimmune hepatitis	↑↑	↑	↑	↑	ALP:AST/ALT < 3
DILI	↑↑/↑↑	↑	↑	↑	↑ PT/INR
Cholestasis	↑	↑↑	↑↑	↑	AST:ALT < 1.5 – ExtrahepaticAST:ALT > 1.5 - Intrahepatic

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; NAFLD: Non-alcohol fatty liver disease; AATD: Alpha-1 antitrypsin deficiency; DILI: Drug induced liver injury; PT: Prothrombin time; INR: International normalized ratio.