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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 recommendationLabelReferences
An algorithmic approach to evaluating mildly abnormal liver functions is recommended.C1
In the asymptomatic patient with negative serum testing and mild transaminase elevations, a period of lifestyle modification can be tried.C1
If abnormalities persist at the six-month follow-up visit, an ultrasonography of the liver is the recommended imaging modality.C1
ALT and AST are not useful screening tests in an otherwise healthy population.C1,10
The AST/ALT ratio is only somewhat helpful in diagnosis.C5,7
Clinical clueSuggested diagnosis
Longstanding alcohol abuseCirrhosis
Intravenous drug use, history of blood product transfusions, nonsterile needle exposure, AST/ALT ratio < 1.0Hepatitis B or C
Obesity, diabetes, hyperlipidemia, AST/ALT ratio < 1.0Steatosis/steatohepatitis
AST/ALT ratio > 2.0Alcoholic liver disease, Wilson’s disease
Increased iron levelsHemochromatosis
Polypharmacy, illicit drug use, or certain herbal supplement useSubstance/medication-induced
Frequent, strenuous exerciseExercise-induced
Intestinal bloating; oily, bulky stoolsCeliac sprue
HypergammaglobulinemiaAutoimmunwe hepatitis
Reduced ceruloplasmin levels, Kayser-Fleischer ringWilson’s disease
Depressed thyroid-stimulating hormone levelsHyperthyroidism

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