Why 2:1 Ratio of AST/ALT in Alcoholic Hepatitis?

Alcoholic hepatitis lab findings classically reveal serum AST/ ALT >2. (Although rarely above 300 IU per milliliter). Although this finding is neither specific nor sensitive.

WHY??? The proposed mechanisms accounting for this high ratio are reduced hepatic alanine aminotransferase activity, alcohol-induced depletion of hepatic pyridoxal 5′-phosphate (B6), and increased hepatic mitochondrial aspartate.

REFERENCES

1. Vech RL, Lumeng L, Li TK. VitaminB6 metabolism in chronic alcohol abuse:the effect of ethanol oxidation on hepaticpyridoxal 5′-phosphate metabolism. J ClinInvest 1975;55:1026-32.
2. Matloff DS, Selinger MJ, Kaplan MM. Hepatic transaminase activity in alcoholic liver disease. Gastroenterology 1980;78: 1389-92.
3. Cohen JA, Kaplan MM. The SGOT/SGPT ratio — an indicator of alcoholic liver disease. Dig Dis Sci 1979;24:835-8.