AST to ALT pattern AST/ALT (De Ritis) Ratio
One liver enzyme divided by the other, as a clue to what upset it.
What it measures
The two liver enzymes divided by one another, which turns their absolute values into a pattern.
Points at the cause rather than the amount: above 2 leans alcohol-related, below 1 leans fatty liver, and either changes what is done next.
Why it matters for how long you stay well
It sorts a liver troubled by fat from a liver troubled by alcohol, and those two roads need very different decisions if you want a working liver in your seventies.
How it shows up in daily life
It is arithmetic on two results you already have, and it only carries meaning when at least one of them is actually raised.
High and low readings
When it reads high
A ratio above 2 leans toward alcohol-related liver strain and should be read with GGT.
When it reads low
A ratio below 1 is the usual pattern in fatty liver, or simply normal enzymes.
What moves it
Daily life
- alcohol, which lifts the ratio
- liver fat, which pushes it down
- recent hard exercise
Read it with
Markers that move this one, or that this one moves. One number read alone can mislead.
- AST, a liver and muscle enzymeKnown mechanism
AST is part of its calculation
This pattern divides one liver enzyme by the other. Worked out from two normal enzymes it is noise; it only speaks when one of them is genuinely raised.
- ALT, the liver-specific enzymeKnown mechanism
ALT pulls it down
ALT sits at the bottom of that fraction. A liver holding extra fat lifts ALT the most, which is what pushes the pattern below one.
- GGT, the alcohol-sensitive enzymeObserved association
GGT moves with it
A raised GGT beside a pattern above two is the combination that points at alcohol. Fat in the liver makes a different shape altogether.
Common questions
What does AST/ALT (De Ritis) Ratio measure?
The two liver enzymes divided by one another, which turns their absolute values into a pattern. Points at the cause rather than the amount: above 2 leans alcohol-related, below 1 leans fatty liver, and either changes what is done next.
What does a high AST to ALT pattern result usually mean?
A ratio above 2 leans toward alcohol-related liver strain and should be read with GGT.
What does a low AST to ALT pattern result usually mean?
A ratio below 1 is the usual pattern in fatty liver, or simply normal enzymes.
What is the usual reference range for AST to ALT pattern?
A broad adult reference band is below 2. Labs differ, so read your result against the band printed on your own report.
Educational only, not a diagnosis. A single number means little without your history and the rest of your panel, so discuss your own results with your physician.
Typical adult reference band
- Adults
- below 2
Labs differ. The band printed on your own report is the one that applies to your result.
Reported in Ratio
Worth knowing
Computed from two normal enzymes this ratio is noise; it only speaks when one of them is genuinely high.
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