Am Fam Physician. 2005;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.
| 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 |
| 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 |