Biochemical Tests

Serum biochemical tests are useful for the diagnosis of alcoholic liver disease:

Aspartate aminotransferase/alanine aminotransferase

Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio >2 differentiates between ALD and other liver pathology. Impaired ALT rise results from a hepatic deficiency of pyridoxal-6-phosphate required for ALT enzyme activity in the liver [5].


Gamma-glutamyltransferase (GGT) is often found to be raised. These markers assess alcohol abuse indirectly by testing liver damage and therefore have a low sensitivity and specificity of less than 70%.

Mean corpuscular volume

Mean corpuscular volume (MCV) is also found to be raised in most cases due to toxic effects of alcohol on bone marrow. This marker also has low sensitivity in the region of 50%.

Prolongation of the prothrombin time

Prolongation of the prothrombin time (PT) and low albumin levels suggest poor synthetic liver function [5].

The emerging tests below are sometimes used in conjunction with the tests above:

Carbohydrate-deficient transferrin test

Carbohydrate-deficient transferrin test shows the desialylation of transferrin which occurs in the presence of high alcohol intake independent of liver damage. This is thought to be specific for ALD, although it has relatively low sensitivity.

Mitochondrial aminotransferase

Mitochondrial aminotransferase (AFT) is released from hepatocytes with sustained alcohol abuse.

Ratio of AST/ALT 1.5:2

Low albumin

High PT

High MCV

Low platelets