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Liver Cell Markers – Meaning and Normal Values

Liver cell markers are laboratory values that provide information about the condition of liver cells. Elevated levels may indicate damage or disease of the liver.

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Things worth knowing about "Liver Cell Markers"

Liver cell markers are laboratory values that provide information about the condition of liver cells. Elevated levels may indicate damage or disease of the liver.

What Are Liver Cell Markers?

Liver cell markers are specific enzymes and proteins found in liver cells (hepatocytes) that are released into the bloodstream in elevated concentrations when liver tissue is damaged or inflamed. By measuring these markers in blood serum, physicians can draw conclusions about the condition and function of the liver. Liver cell markers are a central component of liver diagnostics and are routinely determined as part of blood tests.

Key Liver Cell Markers at a Glance

ALT (Alanine Aminotransferase)

Alanine aminotransferase (ALT), also known as GPT (glutamate pyruvate transaminase), is the most specific marker for liver cell damage. It is found mainly in liver cells and rises sharply in cases of inflammation, fatty liver, or toxic injury. Elevated ALT levels are considered a sensitive indicator of acute or chronic liver disease.

AST (Aspartate Aminotransferase)

Aspartate aminotransferase (AST), also called GOT (glutamate oxaloacetate transaminase), is present not only in the liver but also in heart muscle, skeletal muscle, and kidney cells. An elevated AST level can therefore indicate not just liver damage, but also myocardial infarction or muscle disorders. The ratio of AST to ALT (the De Ritis ratio) helps differentiate between various liver conditions.

GGT (Gamma-Glutamyltransferase)

Gamma-glutamyltransferase (GGT) is a sensitive marker for liver disease, particularly alcohol-related liver damage and bile duct disorders. Elevated GGT levels also commonly occur with the use of certain medications.

GLDH (Glutamate Dehydrogenase)

Glutamate dehydrogenase (GLDH) is located almost exclusively in the mitochondria of liver cells and is considered a specific marker for severe liver cell damage, particularly in the deeper zones of the liver lobule (zone 3). Elevated values indicate toxic or hypoxic liver injury.

LDH (Lactate Dehydrogenase)

Lactate dehydrogenase (LDH) is less liver-specific, as it is found in many tissues throughout the body. In the context of liver disease, elevated LDH levels may indicate extensive cell damage.

Causes of Elevated Liver Cell Markers

Viral hepatitis (Hepatitis A, B, C, D, E)
Alcoholic liver disease (alcoholic hepatitis, liver cirrhosis)
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
Drug- or toxin-induced liver damage
Autoimmune hepatitis
Bile duct disorders (e.g., gallstones, primary biliary cholangitis)
Heart failure with hepatic congestion
Liver metastases or liver tumors

Diagnosis and Interpretation

Liver cell markers are determined through a simple blood test, in which venous blood is drawn and analyzed in a laboratory. Reference ranges may vary slightly depending on the laboratory and measurement method. Typical normal values are:

ALT (GPT): up to 35 U/l (women), up to 45 U/l (men)
AST (GOT): up to 35 U/l (women), up to 50 U/l (men)
GGT: up to 40 U/l (women), up to 60 U/l (men)
GLDH: up to 5 U/l (women), up to 7 U/l (men)

Elevated liver values alone do not constitute a conclusive diagnosis. For an accurate assessment, additional investigations are performed, including liver ultrasound, further laboratory parameters (e.g., bilirubin, alkaline phosphatase, albumin), and if necessary, a liver biopsy.

Treatment for Elevated Liver Cell Markers

Treatment is always directed at the underlying cause. General measures include:

Abstaining from alcohol in cases of alcohol-related liver damage
Weight loss and dietary changes for fatty liver disease
Discontinuing or adjusting medications in cases of drug-induced liver damage
Antiviral therapy for viral hepatitis (e.g., direct-acting antivirals for Hepatitis C)
Immunosuppressive therapy for autoimmune hepatitis
Regular follow-up blood tests to monitor liver values and treatment response

References

European Association for the Study of the Liver (EASL): EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 2021.
Kwo, P.Y., Cohen, S.M., Lim, J.K.: ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology, 2017.
Lala, V., Zubair, M., Minter, D.A.: Liver Function Tests. StatPearls Publishing, 2023. Available at: www.ncbi.nlm.nih.gov/books/NBK482489/

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