De Ritis ratio (AST/ALT)

The ratio of AST and ALT, also known as De Ritis ratio, is very valuable diagnostic purposes, too.

For a healthy human, this ratio should not be higher than 1.2±0,42.

Usually, it reduces in the patients with viral hepatitis and rises in the patients with acute myocardial infarction.

In addition to the magnitude of AST and ALT elevations (described above), the ratio of AST to ALT may be useful in determining the etiology of abnormal liver tests. Typically, for most liver conditions including chronic viral hepatitis and NAFLD, ALT levels are higher than AST levels. ^177,178

However, ~90% of patients with alcoholic liver disease have AST>ALT, and >70% have an AST/ALT ratio>2.^1,2 AST>ALT can also be seen in patients with cirrhosis of any etiology, although the AST:ALT ratio is typically not >2:1.

In one study examining hepatitis C virus (HCV) patients, non-cirrhotics had an AST/ALT ratio of 0.60, while the mean ratio in cirrhotics was 1.05.³

1.        Cohen JA, Kaplan MM. Th e SGOT/SGPT ratio--an indicator of alcoholic liver disease. Dig Dis Sci 1979; 24: 835 – 8.

2.        Correia JP, Alves PS, Camilo EA. SGOT-SGPT ratios. Dig Dis Sci 1981; 26: 284.

3.        Sheth SG, Flamm SL, Gordon FD et al. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol 1998;93:44-8.