Ahmed Imran Siddiqi, Musfireh Siddiqeh, Asif Mehmood, Arif Mahmood Siddiqui


Background: Both ALT/AST ratio reversal (AST/ALT>1) and prolonged prothrombin time are
separately related to hepatic cirrhosis. Ratio reversal means that in normal individuals ALT is
more than AST and thus ALT/AST> 1 but with development of cirrhosis AST becomes › ALT and
so AST/ALT>1 or ALT/AST<1. This study was conducted with the idea that prolonged
prothrombin time and reversed (AST/ALT >1) ratio together can prove a more specific indicator
with a high positive predictive value for the detection of hepatic cirrhosis in patients of chronic
liver disease than either of the two alone. Method: This is a comparative cross sectional study.
The data of hepatitis B & C patients was collected from the general medical ward and medical out
patient department. Clinical and Ultrasonographic features, detected by a single ultrasonologist,
were used to diagnose cirrhosis. Patients who were alcoholic were excluded from the study as
alcohol itself causes ALT/AST ratio reversal. To avoid laboratory errors and variations the
facilities of only a single specific laboratory were used for this study. The sensitivity and
specificity of ALT/AST ratio reversal along with positive predictive value were calculated. Then
prolonged prothrombin time (PT) and reversed ratio together were used and the results of these
two groups were compared. Results: It was found that the reversal of ratio alone is 88% specific
as an indicator of hepatic cirrhosis and almost 70% sensitive and have a positive predictive value
of 94.5%. The statistical significance test based on z -test for difference of proportion yields:
z=6.96 with a p value=0.0000. On the other hand, the prolonged PT and ratio reversal are 98%
specific and 53.9% sensitive with a positive predictive value of 98.2%. z -test for difference of
proportion yields here: z=6.23 with a p value=0.0000. Conclusion: ALT/AST ratio reversal alone
has a high sensitivity and the combined effect of these two parameters increases the specificity as
compared to either of the two alone. The high positive predictive value here shows that almost all
the patients with reversed ratio and prolonged PT will have cirrhosis.
Key Words : ALT/AST ratio reversal, Prolonged PT, Hepatic Cirrhosis.

Full Text:



Sheth SG, Flamm SL, Gordon FD, Chopra S. AST/ALT ratio

predicts cirrhosis in patients with chronic hepatitis C virus

infection. Am J Gastroenterol 1998; 93(1): 44-8.

Pohl A, Behling C, Oliver D, Kilani M, Monson P, Hassanein

T. Serum aminotransferase levels and platelet counts as

predictors of degree of fibrosis in chronic hepatitis C virus

infection. Am J Gastroenterol 2001; 96(11): 3142-6.

Khokhar N. Serum aminotransferase levels and platelet count

as predictive factor of fibrosis and cirrhosis in patients with

chronic hepatitis C infection. J Pak Med Assoc 2003;


Imperiale TF, Said AT, Cummings OW, Born LJ. Need for

validation of clinical decision aids: use of the AST/ALT ratio

in predicting cirrhosis in chronic hepatitis C. Am J

Gastroenterol2000; 95(9):2328-32.

Park GJ, Lin BP, Ngu MC, Jones DB, Katelaris PH.

Aspartate aminotransferase: alanine aminotransferase ratio in

chronic hepatitis C infection: is it a useful predictor of

cirrhosis? J Gastroenterol Hepatol 2000; 15(4):386-90.

Park JH, Park CK, Kim ES, Park SY, Jo CM, Tak WY et al.

The diagnostic value of serum hyaluronic acid, 7S domain of

type IV collagen and AST/ALT ratio as markers of hepatic

fibrosis in chronic hepatitis B and cirrhosis patients. Taehan

Kan Hakhoe Chi. 2003;9(2):79-88.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []