De Ritis ratio as diagnostic marker of alcoholic liver disease

Abstract

Patients suffering from Alcoholic Liver Diseases (ALD) are often diagnosed by spectrum of physical manifestations and laboratories abnormalities. Among biochemical abnormalities De Ritis Ratio (AST/ALT ratio) is more sensitive during any phase of the disease. This ratio is based on common tests of liver function test and can be investigated in any laboratory and is more relevant in countries like Nepal where alcohol abuse is a major cause of liver disease. Clinically diagnosed 103 ALD cases and 73 healthy controls were enrolled for the study. Selected parameters of liver function tests were analyzed by Vitalab Selectra-2 autoanalyser using Merck diagnostic kits and statistically analyzed by student "t" test. The De Ritis ratio was calculated from serum AST and ALT values and was found 2. 30:1 in patients compared to of 1.10:1 in control group. AST and ALT value showed mild to moderate elevation as it was 124.80 +/- 86.24 IU/L and 54.21 +/- 39.72 IU/L in patients compared to 35.00 +/- 23.49 IU/L and 31.48 +/- 17.79 IU/L in controls. The increase in AST and ALT level in patients was statistically significant (p < 0.001) and (p < 0.01) respectively. > or = - Glutamyl Transferase showed 425.26 +/- 36.40 IU in alcoholics compared to 70.55 +/- 27.35 IU/L in controls, a significant increase observed (p<0.001) However Alkaline Phosphatase activity was observed within normal limit. Serum Total Protein (TPR) and Albumin (ALB) showed 6.86 +/- 1.01 g/dl and 2.71 +/- 0.78 g/dl in patients with Albumin: Globulin ratio of 0.61:1 compared to 7.51 +/- 1.74 g/dl and 4.03 +/- 0.61 g/dl in controls with the ration of 1.15:1, a significant decrease in albumin (p < 0.001) without alteration of Total Protein in patients. Total and Direct bilirubin showed 2.32 +/- 1.10 mg/dl and 1.26 +/- 0.88 mg/dl in alcoholics higher than the control of 1.06 +/- 0.60 mg/dl 0.38 +/- 0.31 mg/dl (p<0.001). Diagnosis of ALD is straight forward with history-and compatible clinical features but alcoholic's denial and under estimation of alcohol abuse becomes an obstacle in confirmation. A mild to moderate disproportionate elevation of AST than ALT activity making De Ritis Ratio > 2:1, supported by reversal of Albumin/globulin ratio facilitates the diagnosis.