Table 5. Biochemical features of common causes of moderate to marked increase in aminotransferase levels27.

Cause	Aminotransferase level increase (value × URL)	Bilirubin level increase (value × URL)	Comments
Ischemic injury	>10 to >50	<5	AST > ALT; rapid rise and fall of aminotransferase levels; ALT/LDH ratio <1; presence of comorbid conditions
Toxic injury	>10	<5	AST > ALT; rapid rise and fall of aminotransferase levels; history indicative of toxic injury
Acute viral hepatitis	5–10 to >10	5–10	Slow decrease of aminotransferase levels; presence of risk factors
Acute biliary obstruction	5–10	5–10 to >10	Aminotransferase increase may precede cholestasis; Charcot’s triad
Alcoholic hepatitis	5–10	5–10 to >10	AST/ALT ratio >2; may occur as both acute and acute-on-chronic injury