The De Ritis ratio represents the relative activities of which two liver enzymes?

• A. AST to ALT
• B. ALT to AST
• C. AST to ALP
• D. ALT to CK

Answer: (A)

The De Ritis ratio compares the activities of two liver enzymes, AST and ALT. It is calculated as AST divided by ALT. This matters because ALT is more liver-specific, while AST is also found in heart and muscle, so the ratio helps indicate the pattern of liver injury. In alcoholic liver disease, AST tends to be higher than ALT, giving a ratio greater than 1 and often over 2. In many other liver conditions like viral hepatitis or fatty liver disease, ALT is higher, yielding a ratio less than 1. The De Ritis ratio involves these two enzymes, not ALP or CK.