The AST/ALT ratio as an indicator of cirrhosis in patients with PBC

Nyblom, Helena
Björnsson, Einar
Simrén, Magnus
Aldenborg, Frank
Almer, Sven
Olsson, Rolf

¹Department of Internal Medicine, Sahlgrenska University Hospital, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
²Department of Pathology, Sahlgrenska University Hospital, Göteborg, Sweden
³Department of Gastroenterology and Hepatology/IMK, University Hospital, Linköping, Sweden

Rolf Olsson, Department of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden. Tel: +46 31 342 1830 Fax: +46 31 822152 e-mail: [email protected]

Abbreviations: AST, aspartate aminotransferase; ALT, alanine aminotransferase; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis; UDCA, ursodeoxycholic acid; LT, liver transplantation; ALD, alcoholic liver disease.

Received 1 February 2006, accepted 8 May 2006

Liver International 26(7):p 840-845, September 2006.

Objectives

A non-invasive, simple and non-expensive test to predict cirrhosis would be highly desirable. The aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio has been proven to be such an indicator of cirrhosis in alcoholic liver disease, hepatitis C.

Aim

To test whether the AST/ALT ratio is a marker of cirrhosis also in patients with primary biliary cirrhosis (PBC).

Methods

The study consisted of 160 patients. In 126 patients, we had clinical and laboratory data at the time of diagnosis and follow-up with outcome: liver-related death, liver transplantation and survival. In 121 patients, we had laboratory data and liver histology.

Results

We found that the AST/ALT ratio was significantly higher in cirrhotic patients than in non-cirrhotic patients. A high AST/ALT ratio was significantly associated with esophageal varices and ascites. In a multivariate analysis, bilirubin and ALP were predictors of poor prognosis.

Conclusion

The AST/ALT ratio seems to be of clinical value as a hint to the diagnosis of cirrhosis in patients with PBC but not as a prognostic factor.