What is the typical AST/ALT ratio in alcoholic hepatitis?

In alcoholic hepatitis, the typical AST (aspartate aminotransferase) to ALT (alanine aminotransferase) ratio is greater than 2. This elevated ratio is significant and is often greater than 2:1. This finding is primarily due to the fact that alcohol metabolism affects the liver's enzyme levels differential, with AST rising higher relative to ALT.

This pattern occurs because AST is found in higher concentrations in the mitochondria, and alcohol-related liver injury can cause mitochondrial damage, leading to an increased release of AST from liver cells. In contrast, ALT primarily exists in the cytoplasm of hepatocytes, and its elevation is not as pronounced in alcoholic liver disease when compared to AST.

When assessing liver function tests in the context of alcoholic liver disease, clinicians often use this AST/ALT ratio as an important diagnostic criterion. A ratio of greater than 2 should prompt considerations for alcohol-related liver issues, guiding clinical decisions and management strategies.