Correction

Am Fam Physician. 2005 Jul 1;72(01):41.

The article “Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient” (March 15, 2005, page 1105) contained an error in the ratio of aspartate transaminase (AST) to alanine transaminase (ALT). In several locations throughout the text, namely on pages 1106, 1107, in the Strength of Recommendations (SOR) table on page 1106, and in Table 3 on page 1108, the ratio was incorrectly listed as the ratio of ALT to AST. The correct ratio is AST to ALT. The corrected SOR table and Table 3 are reprinted below. The online version of this article has been corrected.

Strength of Recommendations

Key clinical recommendation Label References

An algorithmic approach to evaluating mildly abnormal liver functions is recommended.

C

1

In the asymptomatic patient with negative serum testing and mild transaminase elevations, a period of lifestyle modification can be tried.

C

1

If abnormalities persist at the six-month follow-up visit, an ultrasonography of the liver is the recommended imaging modality.

C

1

ALT and AST are not useful screening tests in an otherwise healthy population.

C

1,10

The AST/ALT ratio is only somewhat helpful in diagnosis.

C

5,7


ALT = alanine transaminase; AST = aspartate transaminase.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limitedquality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series.

Strength of Recommendations

View Table

Strength of Recommendations

Key clinical recommendation Label References

An algorithmic approach to evaluating mildly abnormal liver functions is recommended.

C

1

In the asymptomatic patient with negative serum testing and mild transaminase elevations, a period of lifestyle modification can be tried.

C

1

If abnormalities persist at the six-month follow-up visit, an ultrasonography of the liver is the recommended imaging modality.

C

1

ALT and AST are not useful screening tests in an otherwise healthy population.

C

1,10

The AST/ALT ratio is only somewhat helpful in diagnosis.

C

5,7


ALT = alanine transaminase; AST = aspartate transaminase.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limitedquality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series.

TABLE 3

Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels

Clinical clue Suggested diagnosis

Longstanding alcohol abuse

Cirrhosis

Intravenous drug use, history of blood product transfusions, nonsterile needle exposure, AST/ALT ratio < 1.0

Hepatitis B or C

Obesity, diabetes, hyperlipidemia, AST/ALT ratio < 1.0

Steatosis/steatohepatitis

AST/ALT ratio > 2.0

Alcoholic liver disease, Wilson’s disease

Increased iron levels

Hemochromatosis

Polypharmacy, illicit drug use, or certain herbal supplement use

Substance/medication-induced

Frequent, strenuous exercise

Exercise-induced

Intestinal bloating; oily, bulky stools

Celiac sprue

Hypergammaglobulinemia

Autoimmunwe hepatitis

Reduced ceruloplasmin levels, Kayser-Fleischer ring

Wilson’s disease

Depressed thyroid-stimulating hormone levels

Hyperthyroidism


ALT = alanine transaminase; AST = aspartate transaminase.

TABLE 3   Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels

View Table

TABLE 3

Clues in the Evaluation of Mildly Elevated Liver Transaminase Levels

Clinical clue Suggested diagnosis

Longstanding alcohol abuse

Cirrhosis

Intravenous drug use, history of blood product transfusions, nonsterile needle exposure, AST/ALT ratio < 1.0

Hepatitis B or C

Obesity, diabetes, hyperlipidemia, AST/ALT ratio < 1.0

Steatosis/steatohepatitis

AST/ALT ratio > 2.0

Alcoholic liver disease, Wilson’s disease

Increased iron levels

Hemochromatosis

Polypharmacy, illicit drug use, or certain herbal supplement use

Substance/medication-induced

Frequent, strenuous exercise

Exercise-induced

Intestinal bloating; oily, bulky stools

Celiac sprue

Hypergammaglobulinemia

Autoimmunwe hepatitis

Reduced ceruloplasmin levels, Kayser-Fleischer ring

Wilson’s disease

Depressed thyroid-stimulating hormone levels

Hyperthyroidism


ALT = alanine transaminase; AST = aspartate transaminase.


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