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To detect liver damage and/or to help diagnose liver disease
When a healthcare practitioner thinks that you have symptoms of a liver disorder, such as abdominal pain, nausea and vomiting, jaundice (yellow skin), or potential exposure to a hepatitis virus; as part of a comprehensive metabolic panel when you have a routine health exam
A blood sample drawn from a vein in your arm
Aspartate aminotransferase (AST) is an enzyme found in cells throughout the body but mostly in the heart and liver and, to a lesser extent, in the kidneys and muscles. In healthy individuals, levels of AST in the blood are low. When liver or muscle cells are injured, they release AST into the blood. This makes AST a useful test for detecting or monitoring liver damage.
The liver is a vital organ located in the upper right-hand side of the abdominal area just beneath the rib cage. It is involved in many important functions in the body. The liver helps to process the body's nutrients, manufactures bile to help digest fats, produces many important proteins such as blood clotting factors, and breaks down potentially toxic substances into harmless ones that the body can use or excrete.
A number of conditions can cause injury to liver cells and may cause increases in AST. The test is most useful in detecting liver damage due to hepatitis, drugs toxic to the liver, cirrhosis, or alcoholism. AST, however, is not specific for the liver and may be increased in conditions affecting other parts of the body.
An AST test is often performed along with an alanine aminotransferase (ALT) test. Both are enzymes found in the liver that become elevated in the blood when the liver is damaged. A calculated AST/ALT ratio is useful for differentiating between different causes of liver injury and in recognizing when the increased levels may be coming from another source, such as heart or muscle injury.
A blood sample is drawn by needle from a vein in the arm.
No test preparation is needed.
The blood test for aspartate aminotransferase (AST) is usually used to detect liver damage. It is often ordered in conjunction with another liver enzyme, alanine aminotransferase (ALT), or as part of a liver panel or comprehensive metabolic panel (CMP) to screen for and/or help diagnose liver disorders.
AST and ALT are considered to be two of the most important tests to detect liver injury, although ALT is more specific for the liver than is AST and is more commonly increased than is AST. Sometimes AST is compared directly to ALT and an AST/ALT ratio is calculated. This ratio may be used to distinguish between different causes of liver damage and to distinguish liver injury from damage to heart or muscle.
AST is often measured to monitor treatment of persons with liver disease and may be ordered either by itself or along with other tests for this purpose.
Sometimes AST may be used to monitor people who are taking medications that are potentially toxic to the liver. If AST levels increase, then the person may be switched to another medication.
AST may be ordered as part of a comprehensive metabolic panel (CMP) when someone has a routine health examination.
An AST test may be ordered along with several other tests when a person has signs and symptoms of a liver disorder. Some of these may include:
AST may also be ordered, either by itself or with other tests, for people who are at an increased risk for liver disease since many people with mild liver damage will have no signs or symptoms. Some examples include:
When AST is used to monitor treatment of persons with liver disease, it may be ordered on a regular basis during the course of treatment to determine whether the therapy is effective.
Low levels of AST in the blood are expected and are normal.
Very high levels of AST (more than 10 times normal) are usually due to acute hepatitis, sometimes due to a viral infection. With acute hepatitis, AST levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. Levels of AST may also be markedly elevated (often over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver as well as in conditions that cause decreased blood flow (ischemia) to the liver.
With chronic hepatitis, AST levels are usually not as high, often less than 4 times normal, and are more likely to be normal than are ALT levels. AST often varies between normal and slightly increased with chronic hepatitis, so the test may be ordered frequently to determine the pattern. Such moderate increases may also be seen in other diseases of the liver, especially when the bile ducts are blocked, or with cirrhosis or certain cancers of the liver. AST may also increase after heart attacks and with muscle injury, usually to a much greater degree than ALT.
AST is often performed together with the ALT test or as part of a liver panel. For more about AST results in relation to other liver tests, see the Liver Panel article.
In most types of liver disease, the ALT level is higher than AST and the AST/ALT ratio will be low (less than 1). There are a few exceptions; the AST/ALT ratio is usually increased in alcoholic hepatitis, cirrhosis, hepatitis C virus-related chronic liver disease, and in the first day or two of acute hepatitis or injury from bile duct obstruction. With heart or muscle injury, AST is often much higher than ALT (often 3-5 times as high) and levels tend to stay higher than ALT for longer than with liver injury.
Pregnancy, a shot or injection of medicine into muscle tissue, or even strenuous exercise may increase AST levels. Acute burns, surgery, and seizures may raise AST levels as well.
In rare instances, some drugs can damage the liver or muscle, increasing AST levels. This is true of both prescription drugs and some "natural" health products. Be sure to tell your healthcare practitioner about all of the drugs and/or health supplements that you are taking.
Conditions that affect other organs, such as the heart and skeletal muscle, can cause elevations of AST. Mild to moderate increases may be seen with vigorous exercise and skeletal muscle injury or in conditions such as acute pancreatitis and heart attacks.
After a thorough physical exam and evaluation of a person's medical history, there are several other tests that may be performed as follow up depending on what is suspected to be the cause of liver damage. Some of these include:
A liver biopsy may be performed to help determine the cause of liver injury and to evaluate the extent of liver damage.
For more information, see the article on Liver Disease.
Sources Used in Current Review
2016 review performed by Beth A. O'Donnell, MLS (ASCP) CM and the Editorial Review Board.
(Updated Feb. 8, 2015) MedlinePlus Medical Encyclopedia. AST. Available online at https://medlineplus.gov/ency/article/003472.htm. Accessed 8/15/2016.
(Updated Jul. 15, 2014.) Mayo Clinic. Liver disease. Available online at http://www.mayoclinic.org/diseases-conditions/liver-problems/basics/definition/con-20025300. Accessed 8/15/2016.
(January 2015) Karim, S. et. al. Correlation between Aminotransferase Ratio (AST/ALT) and Other Biochemical Parameters in Chronic Liver Disease of Viral Origin. Delta Medical College Journal. Available online at http://imsear.hellis.org/handle/123456789/172619. Accessed 8/15/2016.
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Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC Pp 270-271.
Carey, W (January 1, 2009) Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests, Cleveland Clinic. Available online at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/. Accessed February 2010.
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(Feb 23 2009) MedlinePlus Medical Encyclopedia: AST. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm. Accessed February 2010.
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