AST

The blood test for aspartate aminotransferase (AST) is usually used to detect liver damage. It is often ordered in conjunction with another liver enzyme, alanine aminotransferase (ALT), or as part of a liver panel or comprehensive metabolic panel (CMP) to screen for and/or help diagnose liver disorders.

AST and ALT are considered to be two of the most important tests to detect liver injury, although ALT is more specific for the liver than is AST and is more commonly increased than is AST. Sometimes AST is compared directly to ALT and an AST/ALT ratio is calculated. This ratio may be used to distinguish between different causes of liver damage and to distinguish liver injury from damage to heart or muscle.

AST levels are often compared with results of other tests such as alkaline phosphatase (ALP), total protein, and bilirubin to help determine which form of liver disease is present.

AST is often measured to monitor treatment of persons with liver disease and may be ordered either by itself or along with other tests for this purpose.

Sometimes AST may be used to monitor people who are taking medications that are potentially toxic to the liver. If AST levels increase, then the person may be switched to another medication.

AST may be ordered as part of a comprehensive metabolic panel (CMP) when someone has a routine health examination.

An AST test may be ordered along with several other tests when a person has signs and symptoms of a liver disorder. Some of these may include:

• Weakness, fatigue
• Loss of appetite
• Nausea, vomiting
• Abdominal swelling and/or pain
• Jaundice
• Dark urine, light-colored stool
• Itching (pruritus)
• Swelling in the legs and ankles
• Tendency to bruise easily

AST may also be ordered, either by itself or with other tests, for people who are at an increased risk for liver disease since many people with mild liver damage will have no signs or symptoms. Some examples include:

• Persons who might have been exposed to hepatitis viruses
• Persons who are heavy drinkers
• Persons who have a history of liver disease in their family
• Persons taking drugs that can damage the liver
• Persons who are overweight and/or have diabetes

When AST is used to monitor treatment of persons with liver disease, it may be ordered on a regular basis during the course of treatment to determine whether the therapy is effective.

Low levels of AST in the blood are expected and are normal.

Very high levels of AST (more than 10 times normal) are usually due to acute hepatitis, sometimes due to a viral infection. With acute hepatitis, AST levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. Levels of AST may also be markedly elevated (often over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver.

With chronic hepatitis, AST levels are usually not as high, often less than 4 times normal, and are more likely to be normal than are ALT levels. AST often varies between normal and slightly increased with chronic hepatitis, so the test may be ordered frequently to determine the pattern. Such moderate increases may also be seen in other diseases of the liver, especially when the bile ducts are blocked, or with cirrhosis or certain cancers of the liver. AST may also increase after heart attacks and with muscle injury, usually to a much greater degree than ALT.

AST is often performed together with the ALT test or as part of a liver panel. For more about AST results in relation to other liver tests, see the Liver Panel article.

In most types of liver disease, the ALT level is higher than AST and the AST/ALT ratio will be low (less than 1). There are a few exceptions; the AST/ALT ratio is usually increased in alcoholic hepatitis, cirrhosis, hepatitis C virus-related chronic liver disease, and in the first day or two of acute hepatitis or injury from bile duct obstruction. With heart or muscle injury, AST is often much higher than ALT (often 3-5 times as high) and levels tend to stay higher than ALT for longer than with liver injury.

Pregnancy, a shot or injection of medicine into muscle tissue, or even strenuous exercise may increase AST levels. Acute burns, surgery, and seizures may raise AST levels as well.

In rare instances, some drugs can damage the liver or muscle, increasing AST levels. This is true of both prescription drugs and some "natural" health products. Be sure to tell your healthcare practitioner about all of the drugs and/or health supplements that you are taking.