Isolated Rise in ALT in Asymptomatic Adults

ALT is a sensitive marker of hepatocyte injury.

• However considerable liver injury may be present with normal transaminase levels.
• Serum ALT activity varies with age, sex, race, body mass index, acute illness and exercise.
• There is poor correlation between the level of rise of ALT and biopsy findings. A persistently abnormal ALT should have some investigation performed.
• If ALT
  remains abnormal after a period of observation and first line
  investigation reveals no clear cause then a referral (biopsy) threshold
  of >200 can be used.