Table 2.

Summary of enzymes patterns in liver disease

	ALP	AST	ALT	GGT	Other Features
Cholestasis	↑↑	↑	↑	↑↑	AST:ALT <1.5 suggests extrahepatic AST:ALT >1.5 suggests intrahepatic
Primary Biliary Cirrhosis	↑↑↑	↑/N	↑/N	↑↑	Raised AST:ALT may indicate cirrhosis
Primary Sclerosing Cholangitis	↑↑	↑/N	↑/N	↑↑	AST:ALT >1 may indicate cirrhosis AST:ALT >1.12 indicates risk of oesophageal varices
Alcoholic liver disease	↑/N	↑	↑	↑↑	AST:ALT > 2
NAFLD/NASH	↑/N	↑	↑	↑	AST:ALT <1 unless cirrhosis present
Wilson’s disease	↑	↑↑	↑↑	↑	ALP:bilirubin < 4 AST:ALT > 2.2
Hepatitis B/C	↑	↑↑/ N	↑↑/N	↑	AST:ALT >1 indicates cirrhosis AST:platelet >1.5 indicates at least moderate fibrosis Enzymes may all be normal
Autoimmune hepatitis	↑	↑↑	↑↑	↑	Persistently high transaminases indicate poor prognosis
Ischaemic injury/shock liver	↑	↑↑↑	↑↑↑	↑
Toxic injury	↑	↑↑↑	↑↑↑	↑