ALANINE AMINOTRANSFERASE/ASPARTATE AMINOTRANSFERASE RATIO REVERSAL AND PROLONGED PROTHROMBIN TIME: A SPECIFIC INDICATOR OF HEPATIC CIRRHOSIS

Background: Both ALT/AST ratio reversal (AST/ALT>1) and prolonged prothrombin time are separately related to hepatic cirrhosis. Ratio reversal means that in normal individuals ALT is more than AST and thus ALT/AST> 1 but with development of cirrhosis AST becomes › ALT and so AST/ALT>1 or ALT/AST<1. This study was conducted with the idea that prolonged prothrombin time and reversed (AST/ALT>1) ratio together can prove a more specific indicator with a high positive predictive value for the detection of hepatic cirrhosis in patients of chronic liver disease than either of the two alone. Method: This is a comparative cross sectional study. The data of hepatitis B & C patients was collected from the general medical ward and medical out patient department. Clinical and Ultrasonographic features, detected by a single ultrasonologist, were used to diagnose cirrhosis. Patients who were alcoholic were excluded from the study as alcohol itself causes ALT/AST ratio reversal. To avoid laboratory errors and variations the facilities of only a single specific laboratory were used for this study. The sensitivity and specificity of ALT/AST ratio reversal along with positive predictive value were calculated. Then prolonged prothrombin time (PT) and reversed ratio together were used and the results of these two groups were compared. Results: It was found that the reversal of ratio alone is 88 % specifi