The proportion of AST to ALT in hepatocytes is about 2.5:1, but because AST is removed from serum by the
liver sinusoidal cells twice as quickly (serum
half-life t1/2 = 18 hr) compared to ALT (t1/2 = 36 hr), so the resulting serum levels of AST and ALT are about equal in healthy individuals, resulting in a normal AST/ALT ratio around 1. An AST/ALT ratio >5 necessarily involves extrahepatic tissue, as death of hepatocytes alone would produce an AST/ALT ratio no greater than 2.5. Because the primary cause is extrahepatic, typically an isolated elevated AST is seen, with no change in ALT. Common causes include bone disease, chronic renal failure, lymphoma, and congestive heart failure. When hepatocellular death is increased beyond the usual "background" levels, the serum levels of AST compared to ALT tend to reflect the cellular proportions, yielding AST that is over twice as prevalent as ALT (AST/ALT >2) in conditions with chronic, constant hepatocyte damage (such as alcoholic hepatitis, hepatocellular carcinoma) and during early-stage acute liver damage (such as viral hepatitis). In late-stage acute liver damage, the body has had adequate time to clear AST, but not ALT, often resulting in an AST/ALT <1. Since testing typically occurs late in acute viral hepatitis, it is conventionally associated with an AST/ALT ratio <1, though early in the disease, the AST/ALT ratio is often elevated. As the acute liver damage resolves, the body has more time to clear ALT, so in the absence of chronic liver disease, the AST/ALT ratio gradually returns to baseline levels. ==See also==