Influence of gender on the ratio of serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) in patients with and without hyperbilirubinemia
ABSTRACT The serum asparate aminotransferase (AST)/alanine aminotransferase (ALT) ratio is widely used in the differential diagnosis of icteric and non-icteric hepatic disorders. Our objective was to determine whether there are gender related-differences in the serum AST/ALT ratio. We used sera from 3,618 unselected patients sent to our laboratory for an automated chemistry panel, which included measurements of AST, ALT, alkaline phosphatase, and total bilirubin. Effects of gender on serum AST, ALT, and AST/ALT were examined in different age groups. Among patients with normal total serum bilirubin concentrations, serum AST and ALT concentrations were significantly lower in the females than in the males (P < 0.0001). However, the serum AST/ALT ratio was higher in the females than the males (median values of 0.90 and 0.81, respectively; P < 0.0001). AST and ALT were also lower in the 54 hyperbilirubinemic females than in the 102 hyperbilirubinemic males. Serum AST/ALT ratios were considerably higher in these 156 hyperbilirubinemic patients than in the normobilirubinemic group, with median ratios of 1.09 in females and 0.92 in males (P = 0.02). Significantly higher serum AST/ALT ratios in females were first evident in the 3rd age decade and remained significantly higher than ratios in males through the 8th decade. We conclude that serum AST/ALT ratios are higher in women than men. When clinicians utilize serum AST/ALT ratios to assess the etiology or chronicity of liver disease, the patient's gender also should be taken into consideration.
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ABSTRACT: De Ritis described the ratio between the serum levels of aspartate transaminase (AST) and alanine transaminase (ALT) almost 50 years ago. While initially described as a characteristic of acute viral hepatitis where ALT was usually higher than AST, other authors have subsequently found it useful in alcoholic hepatitis, where AST is usually higher than ALT. These interpretations are far too simplistic however as acute viral hepatitis can have AST greater than ALT, and this can be a sign of fulminant disease, while alcoholic hepatitis can have ALT greater than AST when several days have elapsed since alcohol exposure. The ratio therefore represents the time course and aggressiveness of disease that would be predicted from the relatively short half-life of AST (18 h) compared to ALT (36 h). In chronic viral illnesses such as chronic viral hepatitis and chronic alcoholism as well as non-alcoholic fatty liver disease, an elevated AST/ALT ratio is predictive of long terms complications including fibrosis and cirrhosis. There are methodological issues, particularly whether or not pyridoxal phosphate is used in the transaminase assays, and although this can have specific effects when patient samples are deficient in this vitamin, these method differences generally have mild effects on the usefulness of the assays or the ratio. Ideally laboratories should be using pyridoxal phosphate supplemented assays in alcoholic, elderly and cancer patients who may be pyridoxine deplete. Ideally all laboratories reporting abnormal ALT should also report AST and calculate the De Ritis ratio because it provides useful diagnostic and prognostic information.The Clinical biochemist. Reviews / Australian Association of Clinical Biochemists 11/2013; 34(3):117-130.
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ABSTRACT: This study examined gender differences in heroin users who first received MMT. Compared with men, female heroin users were younger and more likely to be unemployed, to have family members using illicit substances, to initiate heroin use at a younger age, to begin MMT earlier after starting heroin use, to have methamphetamine use, to initiate methamphetamine use at a younger age, and to report a child-raising burden and a prior history of traumatic experiences. Men were more likely to have use of betel quid, and to initiate alcohol, nicotine and betel quid use at a younger age than women.Journal of Addictive Diseases 04/2013; 32(2):140-149. DOI:10.1080/10550887.2013.795466 · 1.46 Impact Factor
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ABSTRACT: This research investigates the intermediate mechanism that translates brand communities into brand relationships. Using a sample of online brand communities from China, the study finds that consumer brand attachment plays a full mediating role between brand community commitment and brand commitment and exerts partial mediation between brand identification and brand commitment. Perceived community–brand similarity moderates both brand community identification's effect on brand identification and brand community commitment's effect on brand attachment. The findings contribute to the brand literature and provide implications for brand community management.Research highlights► We investigate how brand communities generate brand relationships. ► Consumer brand attachment plays a mediating role. ► Perceived community-brand similarity plays a moderating role.Journal of Business Research 07/2012; 65(7):890-895. DOI:10.1016/j.jbusres.2011.06.034 · 1.48 Impact Factor