Performance of the AST/ALT Ratio as a Diagnostic Marker for Cholelithiasis: Insights from a Retrospective Study in Peruvian Patients with Biliary Colic

Lara-Gutiérrez T.; Rueda-Torres L.; Bendezu-Quispe G.; Li J.; Rosales-Rimache J. · Revista Colombiana de Gastroenterologia (2026) · DOI: 10.22516/25007440.1439

Resumen

Objective: This study evaluated the association and diagnostic performance of the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio in the detection of cholelithiasis in patients presenting with biliary colic. Methods: A cross-sectional retrospective study was conducted through the analysis of medical records of patients treated for biliary colic in the emergency department of a regional hospital in Peru. Confirmatory diagnosis of cholelithiasis was established based on clinical evaluation and abdominal ultrasonographic findings. Serum AST and ALT activity levels were obtained to calculate the AST/ALT ratio. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: A total of 191 medical records were reviewed, corresponding to 94 patients with cholelithiasis and 97 without. The mean age was 49.6 ± 15.1 years, and 72% of the cohort were women. Elevated ALT and AST levels were observed in 34% and 31.9% of patients, respectively. The area under the curve (AUC) for the AST/ALT ratio was 0.52, indicating minimal diagnostic value, while the AUCs for AST and ALT were 0.67 and 0.65, respectively. In the model adjusted for age and sex, the association between the AST/ ALT ratio and cholelithiasis showed a prevalence ratio of 1.16 (95% confidence interval [CI]: 0.56–2.41). Conclusion: The AST/ALT ratio demonstrated limited efficacy as a diagnostic marker for cholelithiasis in patients with biliary colic. Although individual AST and ALT levels showed moderate diagnostic potential, the AST/ALT ratio did not significantly enhance the identification of cholelithiasis within this clinical context.

Instituciones: Universidad Nacional Agraria La Molina; Universidad Científica del Sur; Universidad Nacional Federico Villarreal; Universidad Señor de Sipán