De Ritis ratio (AST:ALT) >2 in a patient with liver disease is MOST suggestive of which condition?

• A Alcoholic liver disease ✓
• B Viral hepatitis A
• C Non-alcoholic fatty liver disease (NAFLD)
• D Autoimmune hepatitis

Explanation

The De Ritis ratio (AST:ALT) >2 is characteristic of alcoholic liver disease. Alcohol and its metabolite acetaldehyde cause mitochondrial damage preferentially releasing mitochondrial AST, while alcohol also depletes pyridoxal phosphate (vitamin B6), a cofactor preferentially needed for ALT synthesis, suppressing ALT levels disproportionately. In viral hepatitis and autoimmune hepatitis, ALT typically exceeds AST (ratio <1). In NAFLD the ratio is usually <1.

Reference: Harper's Illustrated Biochemistry, 32nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.