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Ast Alt Ratio Calculator

Created by Łucja Zaborowska, MD, PhD candidate
Reviewed by Bogna Szyk and Jack Bowater
Based on research by
Nyblom H, Berggren U, Balldin J, Olsson R. High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking.; Alcohol and Alcoholism; August 2004See 1 more source
Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease.; American Journal of Gastroenterology; April 1999
Last updated: Mar 21, 2024

Our AST ALT ratio calculator is a simple tool that assesses the well-being of your liver. Don't worry - we'll do the calculations for you and provide you with all the necessary information to interpret your results.

In the article below, we will focus on alcoholic hepatitis in AST vs ALT calculations. We'll talk about different functions of the liver and the effects of exceeding your daily standard drink limit. 🍺

You'll also find some additional information about different liver diseases, such as cirrhosis, and their influence on the AST ALT ratio.

What are AST and ALT?

Both AST and ALT are enzymes - proteins that accelerate chemical reactions.

  • AST is non-specific to the liver; this means it can be found in other organs of the body, and its levels can be elevated for a number of different reasons, such as a myocardial infarction, acute pancreatitis or some muscle diseases - myopathies.

  • ALT is also a non-specific enzyme. It can be elevated in clinical situations, such as liver disease, celiac disease, or drugs and toxins.

How to calculate AST ALT ratio?

It's as easy as it seems! Divide your level of AST by the level of ALT:

AST / ALT = ratio

You should also answer the following questions:

  1. Is my AST elevated?
  2. Is my ALT elevated?
  3. Do I have any symptoms I should be worried about?

Remember, we shouldn't treat the result itself, we should treat the actual patient - always consider their overall clinical picture.

How to use the AST ALT ratio calculator?

You'll need to know your AST and ALT levels, as determined by a bloodtest.

Your physician may include these tests in your regular check-ups, regardless of the presence any liver insufficiency symptoms.

  • Aspartate transaminase (AspAT/SGOT/ASAT/AAT/GOT); and
  • Alanine transaminase / alanine aminotransferase (ALT/SGPT).

💡 You shouldn't be intimidated with the ubiquity of different names and abbreviations: "AST ALT ratio calculator" means precisely the same thing as the "SGOT SGPT ratio calculator".

Our calculator will provide you with a simple AST ALT ratio chart, containing the necessary interpretation of your results. This way, you can quickly find out if your ratio is elevated, if you have high AST or normal ALT, or if all these enzymes are within their correct levels. All of these pieces of information may alter your physician's definitive diagnosis.

Interpretation of the AST ALT ratio

Too high of an AST ALT ratio and high levels of AST and ALT.

  • A ratio of AST ALT greater than 1 can be indicative of cirrhosis - a scar tissue transformation of the liver that eventually results in a loss of its function.
  • AST ALT ratio > 2 strongly suggests alcoholic hepatitis - an inflammation caused by the consumption of too many units of alcohol for a regular period of time.

Too high AST ALT ratio with low levels of AST and ALT.

  • Can be caused by factors located outside of the liver, such as hemolysis (the breakdown of the red blood cells), and muscle or thyroid gland diseases.

Too Low AST ALT ratio - check the section below.

The interpretation of an elevated and normal AST ALT ratio is based on many factors. We need to evaluate the value of the ratio and the value of its singular components. Your physicians will also check for other signs or symptoms of liver disease and will run some additional tests to verify their diagnosis:

  • APTT, PT, or INR - measure the ability of your blood to clot. The time needed for your blood to clot will be prolonged if liver disease is present;
  • In the case of ascites: serum ascites and albumin gradient - this simple test allows doctors to differentiate between the reasons pathological fluid may accumulate in your abdomen; and
  • Levels of albumin and proteins in your blood (while taking into consideration your protein intake).

When ALT's higher than AST - what does it mean?

Let's talk about the situation when both AST and ALT are elevated, but the level of ALT is higher than that for AST. This results in a low value of the AST ALT ratio. What are the causes of such a finding?

  • Destruction of the liver caused by drugs/toxins (e.g. paracetamol; use our paracetamol dosage calculator to find the proper amount of medicine to administer);
  • Hepatitis B, C or other viral diseases that may affect the liver;
  • Haemochromatosis;
  • Nonalcoholic steatohepatitis - inflammation of the liver that was not caused by an excess amount of alcohol; and
  • Autoimmune hepatitis - where your body attacks its cells and organs.

Liver functions

The liver is a big, triangular organ found under your right ribcage, right at the bottom. It's where detoxication happens, which is why it's so easily damaged by various toxins. This organ has an incredible ability to regenerate, yet years of damage will inevitably cause irreversible, lasting damage. Other important functions of the liver include:

  • Glycogen storage;
  • Processing aminoacids or lactate from the muscles;
  • Synthesis of clotting factors;
  • Production of blood proteins;
  • Production of bile; and
  • Storage of vitamins A, D, K.

AST ALT and alcohol

The result obtained via the AST ALT ratio calculator may provide you with a confirmation that your liver insufficiency was caused by alcohol. A high ratio and elevated levels of AST and ALT help the clinicians to make the correct diagnosis, discover the cause, and implement proper treatment.

The more alcohol consumed, or the higher the level of alcohol in the blood, the more damage is done. The most important factor is the frequency, and the number of years spent drinking. The following are how the destruction of the liver progresses:

  1. Fatty liver disease - the accumulation of fat within the liver may not cause any signs or symptoms. It can be reversible when treated with total alcohol abstinence.

  2. Alcoholic hepatitis and AST ALT are found together - the elevated ratio of these enzymes is highly indicative of this disease.

  3. Cirrhosis of the liver - the irreversible, final stage of liver damage. The organ cannot perform its functions anymore - the only known treatment method is a liver transplant.

Don't hesitate to look for professional help! If you think you may need counseling, try the alcohol-dependency tools, such as Audit-c calculator, Audit test calculator (longer, more complex version), and CAGE questionnaire calculator.


Why do we need the AST/ALT ratio?

AST, ALT, and their ratio help us screen for liver diseases and detect possible liver damage.

  • AST and ALT might be elevated during a heart attack, infections, inflammations, and while taking certain drugs.
  • AST/ALT ratio helps us differentiate between alcoholic and non-alcoholic hepatitis (liver inflammation).

What factors elevate the AST/ALT ratio?

The AST/ALT ratio usually increases along with the level of liver destruction; the amount of alcohol consumed by the patient fuel the progress of the disease.

Since diseases outside the liver can also cause the AST/ALT ratio to elevate, we always need to assess all biochemical results available and not the ratio alone.

How can we distinguish alcoholic hepatitis using AST/ALT?

  1. ⬆️ The AST/ALT ratio of more than 2, combined with elevated AST and ALT enzymes, tells us that a patient probably has alcoholic hepatitis.

  2. ⬆️ The high AST/ALT ratio and low enzyme levels inform us about a process that occurs outside the liver, e.g., hemolysis.

  3. ⬇️ The low AST/ALT ratio with elevated enzymes is usually a sign of liver destruction caused by other reasons, e.g., drugs, viruses, or an autoimmune disease.

What is SGOT/SGPT ratio?

SGOT/SGPT ratio is also called the AST/ALT ratio.

  • Aspartate transaminase can be written as both AST and SGOT; and
  • Alanine transaminase/alanine aminotransferase is known as ALT, ALAT, or SGPT.

Physicians use this ratio to confirm or rule out different liver diseases.

Łucja Zaborowska, MD, PhD candidate
The AST/ALT ratio can be tricky - for a more detailed interpretation, check the article on the right ➡️
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