Transaminitis refers to elevated levels of specific liver enzymes called transaminases.
- When the liver is damaged, cells release more of the two major enzymes, ALT and AST, into the bloodstream.
- Several blood tests will be performed to determine the type and amount of liver enzymes in the blood to determine if the liver is damaged.
- Because these enzymes are normally only found in the liver, the presence of elevated abnormal liver enzymes may indicate liver damage.
- In most cases, liver enzyme levels are only mildly or temporarily elevated and do not indicate a serious liver problem.
However, abnormal liver enzymes can be a sign of:
- Chronic and acute alcohol use
- Chronic hepatitis B and C
- Drug overdose
- Possibly liver cancer
- Transaminitis can be caused by high cholesterol, certain medications, and herbal supplements (as a common side effect, the statin family of cholesterol-lowering drugs causes elevated transaminases)
Even if the tests do not reveal liver disease, elevated transaminases are always a cause for concern because they either indicate liver damage or other condition that may be of great concern (e.g., elevated AST is a sign of heart disease).
Even if the cause is a medication side effect, the effect may indicate that the medication or dosage should be changed.
What are the common symptoms of transaminitis?
Liver disease is always a cause for concern even if there are no obvious symptoms in some cases and the early stages of progressive diseases.
Mild to moderate elevations in liver enzymes may cause the following symptoms:
Which conditions commonly elevate liver enzymes levels?
Higher levels of alanine transaminase (ALT) than aspartate transaminase (AST) are found in most types of liver diseases.
Extremely high levels of AST (more than 10 times the normal level) are usually caused by:
- Acute hepatitis or, sometimes, a viral infection: In acute hepatitis, AST levels typically remain elevated for one to two months but can take up to three to six months to return to normal.
- AST levels can be significantly elevated (often more than 100 times the normal) as a result of exposure to toxic drugs or other substances, as well as conditions that cause decreased blood flow (ischemia) to the liver.
- AST levels are typically lower in chronic hepatitis, often less than four times the normal, and are more likely to be normal than ALT levels. With chronic hepatitis, AST frequently varies between normal and slightly elevated, so the test may be ordered regularly to determine the pattern.
- Moderate increases could be seen in other liver diseases, particularly when the bile ducts are blocked, such as cirrhosis or certain liver cancers.
- AST can rise after a heart attack or a muscle injury, and it is usually higher than ALT.
AST and ALT ratio
- In most liver diseases, it is usually low (less than one).
- In alcoholic hepatitis, cirrhosis, or injury from bile duct obstruction, the AST and ALT ratio is usually elevated.
- When there is a heart or muscle injury, AST levels are often much higher than ALT (often three to five times higher) and levels tend to stay higher than ALT for a longer period than when there is a liver injury.
What are the treatment options for transaminitis?
Because transaminitis is not a disease, there is no treatment pattern for it. It is a good diagnostic for the success of treatments aimed at reversing the underlying diseases.
Transaminitis treatment will vary depending on the cause but may include:
- Abstaining from alcohol
- Losing weight if needed
- Eliminating red meat, trans fats, high fructose corn syrup, and processed carbohydrates from the diet
- Monitoring liver functions
- Liver transplant
Additional testing is sometimes required. These tests may include ultrasound imaging or a check for blood antibody levels. If transaminase levels remain elevated for six months, the doctor may recommend a biopsy.
What is the significance of transaminitis in COVID-19 patients?
Transaminitis has been linked to mortality in COVID-19 patients according to research. Coronavirus disease has been well described in terms of gastrointestinal symptoms. Transaminitis has been observed in COVID-19 patients in recent studies.
Several studies have been conducted to compare the characteristics of patients with transaminitis and those who do not have transaminitis.
- Transaminitis at presentation is associated with a higher mortality rate in COVID-19 patients.
- Identifying transaminitis in COVID-19 patients is important. It will aid clinicians in prognosis based on the presence or absence of transaminitis at the time of initial presentation.
- Transaminases may act as a surrogate marker for disease severity and a predictor of mortality.
- This could be due to the virus' ability to bind to the angiotensin-converting enzyme 2 receptor. During the early stages, this binding would allow for viral entry and replication within the hepatocytes.
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WebMD. What Is Transaminitis? https://www.webmd.com/a-to-z-guides/what-is-transaminitis
Oh RC, Hustead TR. Causes and Evaluation of Mildly Elevated Liver Transaminase Levels. Am Fam Physician. 2011 Nov 1;84(9):1003-1008. https://www.aafp.org/afp/2011/1101/p1003.html
Stellpflug SJ. Transaminitis: the lab test that has inflammation…. J Med Toxicol. 2011;7(3):252-253. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550201/