A research study on the utility of GGT level and AST/ALT ratio in alcoholic liver diseases

Alcoholic liver disease covers a spectrum of disorders, beginning from the fatty liver, progressing at times to alcoholic hepatitis and culminating in alcoholic cirrhosis, which is the most advanced and irreversible form of liver injury related to the consumption of alcohol. There are three histologic stages of alcoholic liver disease: 1. Alcoholic Fatty Liver or Steatosis: At this stage, fat accumulates in the liver parenchyma. 2. Alcoholic Hepatitis: Inflammation of liver cells takes place at this stage, and the outcome depends on the severity of the damage. Alcohol abstinence, nutritional support, treatment of infection, and prednisolone therapy in severe cases can help in the treatment of alcoholic hepatitis, but more severe cases lead to liver failure. 3. Alcoholic Cirrhosis: Liver damage at this stage is irreversible and leads to complications of cirrhosis and portal hypertension. 1. Summarize the conditions and factors that aggravate alcoholic liver disease. 2. Outline strategies for decreasing alcohol dependency and/or abuse in patients with alcoholic liver disease. 3. Review the treatment options available for alcoholic liver disease. 4. Describe interprofessional team strategies for improving care coordination and communication to ameliorate outcomes in patients with alcoholic liver disease. To assess the value of enzymes Gamma-glutamyl transferase (GGT), Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) as diagnostic indicators of alcoholic liver diseases. Our study group comprised of 25 normal healthy controls, 50 patients with advanced alcoholic liver disease (ALD), 15 patients with acute viral hepatitis (AVH) and 10 patients with nonalcoholic cirrhosis (NALD). We analyzed GGT, AST, ALT, Total bilirubin, Total protein, Albumin, and Prothrombin time. AST/ALT ratio and discriminant function were calculated. GGT values were significantly high (6-8 times upper limit of the mean of normal controls) among ALD patients in comparison with all other groups. The mean AST/ALT ratio among ALD patients was >2. 88% of patients with ALD had an AST/ALT ratio of ≥1.5. The ratio was<2 among all the other diseased groups, with a value of 1.15 among normal healthy controls. A discriminant function score of ≥32 was found in 9 among 50 ALD patients. GGT and AST/ALT ratio of ≥1.5 together are good indicators of alcohol as the cause of liver disease. AST/ALT ratio >2 indicates advanced liver disease in alcoholics. Bilirubin and prothrombin time can be used to know the severity of liver disease as a part of discriminant function. A discriminant function of ≥32 has a poor prognosis. Our study shows that 6-8 times elevations in GGT and AST/ALT ratio of ≥1.5 together can be used as diagnostic indicators for alcohol-induced liver damage. Bilirubin and MDF score have their utility as prognostic indicators as well as in selecting patients.