De Ritis Ratio

• This ratio is particularly valuable in determining the cause of liver enzyme elevations
• Values above 1 suggest more severe liver damage or alcoholic etiology, while values below 1 indicate less severe damage, typically seen in viral hepatitis or NAFLD
• Serial measurements can track disease progression or response to treatment

AST / ALT

• The De Ritis ratio, named after Italian physician Fernando De Ritis, is the ratio of AST to ALT enzymes used to evaluate liver disease etiology and severity

• The ratio itself is asymptomatic
• Underlying conditions may present with: right upper quadrant discomfort, fatigue, nausea, loss of appetite, jaundice, spider angiomas, and ascites in advanced disease

• Elevated ratio: Alcoholic hepatitis, cirrhosis (any cause), cardiac muscle damage
• Normal/low ratio: Acute viral hepatitis, non-alcoholic steatohepatitis (NASH), drug-induced hepatitis