In alcoholic hepatitis, which is typically higher in lab values?

In alcoholic hepatitis, AST (aspartate aminotransferase) levels are typically higher than ALT (alanine aminotransferase) levels. This is a notable characteristic of liver injury associated with alcohol consumption. A common pattern seen in alcoholic liver disease is that the ratio of AST to ALT can be greater than 2:1, often used as a diagnostic clue for alcohol-related liver disease.

AST is found in various tissues, including the liver, heart, skeletal muscle, and kidneys, and thus can reflect damage occurring in these areas. In contrast, ALT is more specific to the liver. The predominance of AST elevation in alcoholic hepatitis is thought to result from the toxic effects of alcohol on mitochondrial metabolism and its impact on hepatocyte integrity.

While bilirubin and alkaline phosphatase may also be elevated in the context of liver disease, they do not specifically reflect the severity or presence of alcoholic hepatitis in the same manner as AST and ALT do. Bilirubin levels can be elevated due to hepatic dysfunction but are not a defining feature of alcoholic hepatitis. Alkaline phosphatase can be altered in cholestatic liver disease but does not correlate directly with alcoholic liver damage.