High aspartate to alanine aminotransferase ratio is an indicator of cirrhosis and poor outcome in patients with primary sclerosing cholangitis

Liver Int. 2007 Jun;27(5):694-9. doi: 10.1111/j.1478-3231.2007.01471.x.


Objectives: A liver biopsy is performed mainly to stage primary sclerosing cholangitis (PSC). In viral hepatitis, alcoholic liver disease and in primary biliary cirrhosis, the ratio of aspartate to alanine aminotransferase (AST/ALT) has been proven to be an indicator of liver cirrhosis. We wanted to test whether or not an AST/ALT ratio >/=1 is an indicator of cirrhosis also in patients with PSC.

Methods: A cohort of 154 patients diagnosed with PSC was studied retrospectively. Laboratory tests and the histological stage were scored.

Results: The mean AST/ALT ratio in the cirrhotic patients at the time of the first (n=117) as well as the last (n=72) histological examination was higher (1.3+/-0.5 and 1.6+/-0.7, respectively) than in the non-cirrhotic patients (0.7+/-0.4 and 1.0 +/-0.4, respectively) (P<0.0001 and P=0.0002, respectively). An AST/ALT ratio >/=1 was a strong predictor for liver-related death/orthotopic liver transplantation and liver-related death, being associated with a double and an almost fourfold higher risk, respectively.

Conclusion: An AST/ALT ratio >/=1 is significantly associated with the presence of cirrhosis and poor outcome in PSC. It may therefore be a valuable non-invasive method for indicating cirrhosis in patients with PSC.

MeSH terms

  • Adult
  • Alanine Transaminase / metabolism*
  • Aspartate Aminotransferases / metabolism*
  • Biomarkers / metabolism
  • Cholangitis, Sclerosing / complications
  • Cholangitis, Sclerosing / diagnosis
  • Cholangitis, Sclerosing / enzymology*
  • Female
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / enzymology*
  • Liver Cirrhosis / etiology
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies


  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase