What is the AST:ALT ratio in alcoholic hepatitis?

In alcoholic hepatitis, the AST:ALT ratio is typically 2:1 or higher. This distinctive ratio is a key diagnostic criterion that helps differentiate alcoholic liver disease from other types of liver disease.

The reason for this specific elevation stems from the pattern of enzyme release in the liver. As liver cells are damaged due to alcohol, aspartate aminotransferase (AST) tends to rise more significantly than alanine aminotransferase (ALT). This is attributed to AST being present in higher concentrations in the mitochondria of liver cells, where damage is more pronounced in the context of alcohol-related injury, while ALT is more cytosolic.

Thus, seeing a ratio of at least 2:1 aids clinicians in strongly suspecting alcoholic hepatitis and taking appropriate steps for management and treatment. This information is particularly useful as part of a wider clinical picture that includes a patient's history and other laboratory findings.