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HepaticDe Ritis Ratio

De Ritis Ratio Calculator

Calculate the AST-to-ALT ratio from contemporaneous aminotransferase values.

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U/L
U/L

De Ritis ratio (AST/ALT)

Auxiliary biochemical ratio; no liver-disease cause is assigned

About

The De Ritis ratio is serum aspartate aminotransferase (AST) divided by alanine aminotransferase (ALT). It is an auxiliary biochemical ratio that must be interpreted with the absolute enzyme activities, laboratory reference intervals, trends, and clinical context.

Formula

De Ritis ratio = AST (U/L) ÷ ALT (U/L)

Interpretation

What the result represents: A unitless ratio between two aminotransferase activities measured in the same units.

Input units: AST and ALT in U/L from a reasonably contemporaneous laboratory panel.

Worked example: AST 40 U/L and ALT 20 U/L gives a ratio of 2.00.

Applicable population: Biochemical reference contexts in which both AST and ALT are available. Interpretation depends on whether either enzyme is elevated and on the applicable laboratory method and reference interval.

Interpretation limitations: A single threshold does not identify alcohol-associated liver disease, viral hepatitis, fibrosis, or another cause. Muscle injury, exercise, medicines, hemolysis, cardiac injury, sample quality, and laboratory methods can affect AST or ALT. Absolute values and the broader clinical evaluation remain essential.

References

  1. Botros M, Sikaris KA. The De Ritis ratio: the test of time. Clin Biochem Rev. 2013;34:117-130.
  2. Kwo PY, et al. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112:18-35.

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Disclaimer

Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.