In alcoholic hepatitis, which is more elevated in liver function tests?

In alcoholic hepatitis, the elevation of liver enzymes is characterized by a specific pattern, primarily showcasing a significantly higher level of aspartate aminotransferase (AST) compared to alanine aminotransferase (ALT). This is particularly notable because the AST elevation is typically about two to three times higher than that of ALT, which fits the classic laboratory findings associated with alcoholic liver disease.

The reason for this pattern is multifactorial. Alcohol metabolism can induce the production of certain enzymes, and the metabolism of ethanol leads to accompanying cellular damage that preferentially raises AST levels. Additionally, the presence of mitochondrial injury in alcoholic liver disease can contribute to an increase in AST, which is present in the mitochondria, while ALT, predominantly cytosolic, may not rise as dramatically.

Alkaline phosphatase, which is often associated with cholestatic liver disease or biliary obstruction, would not be typically elevated in alcoholic hepatitis, making it less relevant in this scenario. The differentiation between elevations in AST and ALT is crucial for diagnosis and management, providing clinicians with insights into the underlying pathophysiology of the liver disease in question.