In most cases, ALT will be measured in units per liter (U/L) or international units per liter (IU/L)
Interpreting test results
The test report should have a line that shows both your ALT level as well as the reference range that the laboratory uses to categorize ALT levels as normal or abnormal.
When reviewing your results, keep in mind that there is no universal reference range for ALT. There can be variation in laboratory methods that affect what is considered normal. For this reason, it’s important to look at the range provided by the specific lab that analyzed your blood.
Most often, ALT is tested along with other liver enzymes and proteins in a panel test. Your test report will show your levels and the lab’s reference range for each measurement. This is important because your test results are interpreted by looking at these test components together.
High levels of ALT can be a result of damage or injury to cells. Because ALT is most concentrated in the liver, abnormal ALT test results are generally associated with conditions affecting the liver, such as inflammation (hepatitis) and scarring (cirrhosis).
At the same time, ALT can be elevated without any underlying health problem. Multiple factors can affect ALT, and in most cases, high ALT is not a sign of severe liver disease.
In order to interpret your test result, your doctor takes multiple factors into account. These include your current health and health history as well as the levels of other measurements on your test. In addition, your doctor may consider individual factors that can influence your normal level of ALT, including:
- Exercise: Intense or extreme exercise can cause a temporary boost in ALT levels.
- Medications: A number of medications and supplements can alter ALT measurements.
- Sex: Males typically have higher levels of ALT, which is believed to be related to hormonal differences.
- Menstruation: ALT levels can go up or down during the course of the menstrual cycle.
- Age: There is a tendency for ALT levels to decrease with older age, although the exact reason for this is not known.
- Body mass index: Several research studies have found an association between ALT levels and body mass index, which may change the interpretation of test results in people with obesity.
When ALT levels are very high, it may be a sign of an acute liver problem. Mild or moderate elevation, especially if it persists on several tests over time, can be an indicator of a chronic disease. However, the degree of elevation alone is not a reliable predictor of the extent of injury to the liver.
Because many types of liver problems can cause ALT levels to increase, the test alone cannot identify an underlying cause. Although uncommon, ALT can be elevated as a result of disease outside the liver. Looking at how ALT levels relate to other liver enzymes can provide clues that may help the doctor assess your situation and recommend any appropriate follow-up testing.
Your physician can best help you understand the diverse factors that affect the interpretation of your ALT test and what your results mean for your overall health.
Are test results accurate?
Laboratory methods for measuring ALT have been shown to be reliable and reproducible. However, no test is 100% accurate. When errors occur, they are most often related to problems with improperly taking the blood sample.
Do I need follow-up tests?
Follow-up tests are common if an abnormal level of ALT was found on your liver panel or comprehensive metabolic panel test. Further testing may be immediate if you have significantly elevated ALT and/or symptoms of a problem affecting your liver. This follow-up testing may be more thorough and include blood tests, imaging, and in some cases a biopsy.
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