Utility of gamma glutamyltransferase and AST/ALT (De Ritis) ratio in alcoholic liver diseases

Abstract

Aim: To assess the value of enzymes Gamma glutamyltransferase (GGT), Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) as diagnostic indicators of alcoholic liver diseases. Material and Methods: Our study group comprised of 25 normal healthy controls, 50 patients with advanced alcoholic liver disease (ALD), 15 patients with acute viral hepatitis (AVH) and 10 patients with non alcoholic cirrhosis (NALD). We analysed GGT, AST, ALT, Total bilirubin, Total protein, Albumin and Prothrombin time. AST/ALT ratio and discriminant function were calculated. Results: GGT values were significantly high (6-8 times upper limit of mean of normal controls) among ALD patients in comparison with all other groups. Mean AST/ALT ratio among ALD patients was >2. 88% patients with ALD had AST/ALT ratio of ≥1.5. The ratio was<2 among all the other diseased groups with a value of 1.15 among normal healthy controls. Discriminant function score of ≥32 was found in 9 among 50 ALD patients. Conclusion: GGT and AST/ALT ratio of ≥1.5 together are good indicators of alcohol as the cause of liver disease. AST/ALT ratio >2 indicates advanced liver disease in alcoholics. Bilirubin and prothrombin time can be used to know the severity of liver disease as a part of discriminant function. A discriminant function of ≥32 have poor prognosis and also helps to select patients for steroid therapy.