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Sample

Precaution

Purpose of the test

  1. This is done in suspected liver diseases.
  2. This also helps in heart diseases to diagnose acute myocardial infarction.

Pathophysiology

  1. This enzyme is distributed in all tissues but primarily found in the liver, heart and skeletal muscles in high concentration.
    1. SGOT is found in the plasma, bile, CSF, and saliva.
    2. It is not found in urine unless there is kidney lesion.
    3. Minimal activity occurs in skin, kidneys, pancreas, and RBCs.
  2. In the liver, it is present in cytosolic and mitochondrial forms.

 

SGOT catalyze the reaction.

  1. This is also called as GOT (glutamate oxaloacetate transaminase).
  2. It is released into circulation:
    1. in liver diseases.
    2. In myocardial infarction, there is a rise after 6 to 8 hours of the damage or chest pain. Abnormal values are seen almost in more than 97% of the cases. 
    3. Renal infarction.
    4. Brain infarction.
    5. Skeletal diseases.
  3. This test is advised in hepatocellular diseases and coronary occlusive diseases leading to muscle necrosis.
  4. The amount of the SGOT is directly related to the number of cells affected by the disease or injury.
  5. After the cell injury:
    1. It appears in blood after 6 to 8 hours.
    2. Peak level is in 24 to 36 hours.
    3. It returns to normal in 3 to 7 days.
  6. In chronic injury, the elevated level will persist.
  7. In Acute hepatitis, the level may increase 20 times to the normal.
  8. SGOT >8 to 10 time more than the normal indicates:
    1. Acute viral hepatitis.
  9. SGOT >30 times more than the normal seen in:
    1. Alcoholic patient taking acetaminophen.
  10. In acute extrahepatic obstruction like gallstones, the SGOT level rises to 10 times the normal value and it returns normally quickly when the obstruction is relieved.
  11. AST/ALT ratio is usually greater than 1 in:
    1. The patient with alcoholic cirrhosis.
    2. Liver congestion.
    3. Metastatic tumor of the liver.
    4. The ratio of less than 1 is seen in:
      1. Acute hepatitis.
      2. Viral hepatitis.
      3. Infectious mononucleosis.
        1. The ratio will be less accurate if the AST level is more than 10 times the normal.
  12. The SGOT level as compared to serum is 7800 times in the heart, 7100 times in liver, skeletal muscles 5000 times, kidney 4500 times, pancreas 1400 times, spleen 700 times, lungs 500 times,  and RBCs 15 times.

Normal

Source 1

Age U/L
Newborn  25 to 75
Infants 15 to 60
Adult 8 to 20
>60 years  Male = 11 to 60
  Female = 10 to 20

Source 2

Another source

Increased SGOT level seen in:

  1. Fulminant type of hepatitis especially viral type.
  2. In liver cell necrosis or injury like chronic hepatitis,
  3. Alcoholic hepatitis.
  4. liver metastasis and Hepatoma (increase may be 5 to 10 folds and is of both enzymes).
  5. In necrosis of heart muscle or skeletal muscle e.g acute myocardial infarction.
  6. Severe exercise.
  7. Severe burn.
  8. Hypothyroidism ( in 40 to 90% of cases).
  9. In cholestatic and obstructive jaundice.
  10. May see a transient increase in acute pancreatitis, acute renal diseases, musculoskeletal diseases, or trauma.
  11. Other diseases than liver and heart which can increase the level:
    1. Hypothyroidism.
    2. Dermatomyositis.
    3. polymyositis.
    4. Gangrene.
    5. Toxic shock syndrome.
    6. Shock.
    7. Mushroom poisoning.
    8. Pulmonary embolism and infarction.
    9. Hemolytic anemia.
    10. malignant hyperthermia.

Decreased SGOT level seen in:

  1. Chronic renal dialysis.
  2. Acute renal diseases leading to Azotemia.
  3. Vit.B6 deficiency.
  4. Beriberi.
  5. Pregnancy.

Myocardial infarction (MI) SGOT pattern:

  1. The SGOT level will be raised but this is not a specific test but useful when there is raised the level of Creatine phosphokinase(CPK) and Lactic dehydrogenase(LDH).
  2. In Myocardial Infarction:
    1. SGOT appears in 6 to 8 hours. This rise is 3 to 5 times of the normal.
    2. Peak level is between 18 to 24 hours.
    3. Returns to normal in 4 to 5 days.
      1. The average increase in MI is 4 to 5 times the normal.
      2. The increase of 10 to 15 times indicates massive MI.
      3. The abnormal level is seen in >97% of the patient if it is done on right time.

                               

  1. The Myocardial injury like Angina, pericarditis and rheumatic carditis does not lead to rising in the level.

Liver diseases SGOT pattern:

  1. There is raised the level of SGOT in liver cell necrosis. This may be 10 to 100 times increase.
  2. The SGOT level may be compared with SGPT.
  3. SGOT/SGPT ratio is usually greater than 1 in a patient with alcoholic cirrhosis, liver congestion, and metastatic tumors of the liver.
    1. The ratio of less than 1 may be seen in acute hepatitis and viral hepatitis.
  4. Acute viral hepatitis:
    1. The rise of SGOT seen before the onset of jaundice.
    2. Peak level has seen during 7 to 12 days after onset of jaundice.
    3. The normal level has seen  3 to 4 weeks after the onset of jaundice.
    4. Characteristically SGPT is greater than SGOT.

Table showing the increase of SGOT in various conditions:
Clinical condition
The rise in SGOT level with reference to the normal value
Viral hepatitis and liver diseases  may reach 100 times
Infectious hepatitis  ALT > AST
Toxic hepatitis Extremely high level
Infectious mononucleosis 20 times
Intrahepatic cholestasis lower values
Extrahepatic cholestasis Increased value
Cirrhosis Normal to 4 to 5 times
Metastatic carcinoma 5 to 10 times
 Acute myocardial infarction 4 to 5 times 
Fatal myocardial infarction 10 to 15 times
Progressive muscular dystrophy May reach 8 times
Dermatomyositis May reach 8 times
Pulmonary emboli 2 to 3 times
Acute pancreatitis 2 to 5 times
Crushed muscular injury, Gangrene   2 to 5 times
Hemolytic diseases 2 to 5 times

Possible References Used

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