In which liver disease is the DeRitis ratio (ALT:AST) usually greater than 1.0?

The DeRitis ratio, which compares the levels of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), is a useful diagnostic parameter in various liver diseases. In acute hepatitis, the ALT levels are often significantly elevated compared to AST levels, leading to a DeRitis ratio greater than 1.0.

This is important because in acute liver damage, particularly due to viral hepatitis, hepatocellular injury primarily elevates ALT, with AST generally increasing but not to the same extent. Therefore, the pronounced rise in ALT contributes to the ratio exceeding 1.0.

In contrast, other liver diseases such as chronic hepatitis, hepatic cirrhosis, and hepatic carcinoma may present with different patterns. For instance, in chronic hepatitis or cirrhosis, the ALT and AST levels may remain elevated, but the ratio can be closer to or less than 1.0 due to the relative levels of both enzymes being more balanced. In hepatic carcinoma, AST can be elevated due to tumor effects and underlying liver conditions, often leading to a ratio less than or around 1. Therefore, acute hepatitis is the condition most reliably associated with a DeRitis ratio greater than 1.0.