Increased SGPT and SGOT — What that really means

SGOT and SGPT blood tests are performed as a part of liver function tests.

This article will help you find answers to all your questions around this routinely performed lab test. Both these enzymes are present in your liver and when there is any damage in the liver, there is an increase in the level of these enzymes in your blood circulation. These tests measure levels of these enzymes in your blood sample. These tests can help in early diagnosis of liver disease. Don’t get confused if your lab reports show values of ALT and AST, as these are just other names of SGPT and SGOT tests, respectively. Your lab test report will show your SGPT and SGOT values in units per liter (U/L) or international units per liter (IU/L). Normal range may vary from lab to lab and is also dependent on your age and gender. Both SGOT and SGPT normal values are higher in males than in females. Their levels are commonly higher for people with higher BMI than that for people with lesser BMI.

Reference: NCBI-Books, NCBI-Books

Magnitude and pattern of enzyme elevation

Based on the magnitude of SGPT and SGOT elevation above the normal, elevation in abnormal test results are classified into mild, moderate and marked. This helps in better interpretation and better diagnosis by the healthcare physician. Similarly, the pattern of enzyme elevation i.e. the rate of change in enzyme levels with time, helps distinguish between sudden increase and gradual increase, and between mild fluctuation and progressive increase/decrease. These details can help your doctor distinguish between acute hepatitis (sudden liver damage caused by virus, drugs etc. and which generally resolves within 6 months) and chronic hepatitis (long term and progressive deterioration of liver function)NCBI. Acute hepatitis is generally characterized by temporary and sudden increase to moderately/markedly high levels while chronic hepatitis and cirrhosis is generally characterized by persistently elevated to mildly/moderately high levels (NCBI-articles)

Commonly accepted reference range for classifying magnitude of SGOT and SGPT elevation are as follows:

Mild — < 5 times the upper reference limit

Moderate — 5–10 times the upper limit of normal/upper reference limit

Marked — > 10 times the upper limit of normal

Reference: NCBI-articles, NCBI-Books, NCBI

When are these tests recommended

1. These tests are done as a part of a normal routine exam. You should get these tests done more frequently if you are at a higher risk of liver disease. Having diabetes, drinking heavy alcohol and taking certain medicines that might affect your liver, are some of the risk factors of developing liver disease.
2. These tests are specifically ordered when liver disease is suspected, i.e. when you have some symptoms of liver problems; such as, loss of appetite, nausea and vomiting, yellowing of skin and eyes as in jaundice, abdominal pain, dark urine, weakness, extreme weight loss and unusual itching, light color of stool etc.

Reference: Medlineplus, Medlineplus

Some important facts

1. Intense exercise, muscle injury, polymyositis (inflammatory disease of muscles), hypothyroidism, acute myocardial infarction and pancreatitis can also increase the level of SGOT and SGPT in your blood.NCBI-articles, NCBI-articles
2. Non-alcoholic fatty liver disease is usually a silent disease with few or no symptoms. NIDDK-NIH
3. Non-alcoholic steatohepatitis (NASH) is a type of non-alcoholic fatty liver disease and is characterized by fatty acid deposition, inflammation and fibrosis (damage) in the liver. Obesity, insulin resistance and type-2 diabetes increases your risk of developing (NASH). Mild and fluctuating elevation of SGOT and SGPT is seen in people with NASH FDA.gov. NIDDK-NIH recommends eating a healthy diet and maintaining a healthy weight to prevent any type of fatty liver disease.
4. Drugs such as aspirin, acetaminophen, anti-tuberculosis drugs and statin can cause mild increase in your SGPT and SGOT levels. NCBI-articles, NCBI-Books
5. In chronic viral hepatitis, the degree of SGOT and SGPT elevation may not correlate well with the degree of liver damage. In other words, if your SGPT and SGOT levels have come down from your past results, but are still abnormally high, then that does not necessarily mean that your liver health is improving. WHO
6. Sometimes patients with severe liver disease can still have normal SGOT and SGPT values. NCBI-articles

Your doctor knows the best

Relying on these tests alone will give only an unrefined and rudimentary information about your health. If your ALT and AST are high, then your doctor will interpret the lab results by considering many other factors. For example, your doctor will take into account your medical history, any liver disease history among your close relatives and presence or absence of symptoms which are indicative of a liver problem. Analyzing both these tests together, along with other tests, will give a better picture of your health. ALT (SGPT) is an enzyme which is very specific to the liver, i.e. it is predominantly present in the liver; whereas, AST (SGOT) is not that specific and is also present in organs other than the liver. Some SGOT is also present in your heart, your kidney, your brain, and your muscles. If levels of both these enzymes are high then that indicates a problem with your liver. If only AST (SGOT) is high and ALT (SGPT) is normal, then it indicates that the problem is not with your liver but with some other organ. The study of the pattern of these tests can help your doctor differentiate between liver problems which are intrinsic to the liver (i.e. originate inside your liver itself) from the liver related problems whose source is outside the liver (for example liver injury caused by biliary tract diseases) NCBI.

Understanding SGOT/SGPT Ratio

This parameter can give additional information in patients with abnormally high SGOT and SGPT levels. Analyzing ratio helps in determining the specific type of liver disease in patients already diagnosed with some liver problem.

1. Ratio less than or equal to 1 is indicative of non-alcoholic fatty liver disease, acute viral hepatitis and drug induced viral toxicity.NCBI-Books, NCBI-articles
2. Ratio equal to or greater than 2 is highly suggestive of alcoholic hepatitis and cirrhosis. NCBI, NCBI-articles, NCBI-articles

Note: Referring ratio values as mentioned above to diagnose the specific type of liver disease is more relevant in early stages of liver disease as ratio tends to shift and may reverse as liver disease reaches a very advanced stage. NCBI-articles, NCBI-articles

Final take away

1. Statistically speaking, abnormally high SGOT and SGPT is one of the most common abnormal results one encounters in medical lab reports. If your results are abnormal, then that does not necessarily mean that you have some medical condition needing treatment. It is advisable that you get retested after a gap of sometime. High ALT and AST can be temporary and levels might come down naturally. Medlineplus
2. Hepatitis A, B and C viruses cause hepatitis (a liver disease). It is advisable to get hepatitis A and B vaccination and get regular screening for viruses known to cause liver diseases (especially if you are immunosuppressed). NCBI-Books
3. You should be aware of the side effects of medicines and supplements that you take. Continuous use of some medicines, including paracetamol and some herbal medicines, can damage your liver. If you are taking prescriptions which might affect your liver, you should get liver function tests more frequently. This will help in monitoring the effect of that prescribed medicine in your liver and may help your doctor adjust the dose and prescribe the medicine which is more suitable in your case. Modern lab tests reports that have started showing historical analysis of patient’s lab test data makes it easier for doctors to follow the change of these enzyme levels with time. NCBI-Books, FDA.gov
4. Avoid iron supplements unless there is an iron deficiency. Overdose of iron-supplements can cause liver injury. NCBI-Books, NCBI-Books
5. If your SGOT and SGPT test results are abnormal then your doctor can recommend you to get some other tests like platelet count, bilirubin test, glucose test, liver ultrasound, viral testing, LDH (lactate dehydrogenase), albumin, total protein, ALP (alkaline phosphatase), GGT (gamma glutamyl transferase), PT (prothrombin time) etc. You may also be recommended to a hepatologist (liver specialist).
6. Exercise regularly and maintain a good lipid profile. Obesity increases your risk of developing liver disease. NCBI-Books
7. If your SGPT and SGOT are persistently high then that may indicate fatty liver/non fatty chronic liver disease, inflammation of liver etc. If you are diagnosed with chronic hepatitis then you should take it seriously. Chronic hepatitis can lead to fibrosis in the liver. Proper treatment can reverse fibrosis in its initial stages. Untreated fibrosis can progress into irreversible fibrosis and the end stage is development of cirrhosis liver. NCBI-Books

Abbreviations used: SGOT-serum glutamic-oxaloacetic transaminase, AST-aspartate aminotransferase, SGPT-Serum glutamic pyruvic transaminase, ALT-Alanine Aminotransferase

Smart Health Reports are essential. We are sure you knew that before, and if not, COVID-19 or this article must have done that by now.

At NIROGGYAN, we know how important your health is. Our products in the form of user-friendly lab test reports are meant to improve health awareness & better living. All so that you can live a great life!

Visit us at niroggyan.com or call Shweta @ +91–7678277891 to know more.