Dr. Prabhat AryaMD · Internal Medicine
ConditionsKnow your condition

Your liver tests, value by value.

A slightly high SGPT is one of the commonest findings on an Indian health check, and it is usually fatty liver, not liver failure. Here is what each line on your LFT means and when it needs a doctor.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed · Next review · Sources: MedlinePlus, NHS

Send your report for ₹199See every value

Read this first.

Go by the range printed on your own report. Labs use different machines, so the top of the normal range for SGPT can be 35 on one report and 45 on another. The ranges below are typical adult ranges only.

The liver enzymes (SGPT, SGOT, ALP, GGT) show whether liver cells are irritated or bile flow is slowed. They do not show how well the liver is working. That is shown by albumin and bilirubin (and by a clotting test, INR, when it is done).

A rise of less than about three times the top of the range, with no symptoms, is very common. The usual causes are fatty liver, alcohol and medicines. It needs the cause found and a repeat test in a few weeks, not panic.

The direction matters more than one number. Put this report next to your last one: falling, steady or rising tells Dr. Arya far more than a single “H”.

Every value, one by one.

Bilirubin, total

The yellow pigment made when old red cells are broken down; the liver clears it into bile

Typical adult range about 0.2–1.2 mg/dL

High usually means
Too much bilirubin in the blood. Above about 2.5–3 mg/dL the eyes look yellow (jaundice). The split into direct and indirect bilirubin (below) shows where the problem lies.
Usually nothing to worry about when
It is only slightly high (up to about 2–3 mg/dL), the rise is all indirect bilirubin, and the other liver tests and blood count are normal. This is usually Gilbert’s syndrome: harmless, lifelong, and often higher after fasting, illness or poor sleep.
See a doctor when
Your eyes or urine turn yellow, your stools turn pale, or your total bilirubin is above about 3 mg/dL: see a doctor within a day or two. Mostly direct bilirubin raised: this week, with an ultrasound of the abdomen.

Bilirubin, direct (conjugated)

Bilirubin the liver has already processed and is trying to pass into bile

Typical adult range up to about 0.3 mg/dL

High usually means
Bile is not flowing out of the liver properly: hepatitis (viral, alcohol, medicines), or something blocking the bile ducts, most often a gallstone.
Usually nothing to worry about when
It is just above the line (for example 0.4 against 0.3) and every other liver test is normal. A repeat in a few weeks is reasonable.
See a doctor when
It is clearly raised, especially with a high ALP or GGT, itching, pale stools or dark urine: see a doctor this week for an ultrasound. With fever, shivering and pain under the right ribs: the same day.

Bilirubin, indirect (unconjugated)

Bilirubin not yet processed by the liver; usually worked out as total minus direct

Typical adult range about 0.1–1.0 mg/dL

High usually means
Most often Gilbert’s syndrome, a harmless inherited quirk in how the liver handles bilirubin. Less often, red cells breaking down faster than usual (haemolysis), which shows as anaemia on the blood count.
Usually nothing to worry about when
Your blood count is normal, the liver enzymes are normal, and the bilirubin goes up and down with fasting (including religious fasts), illness or lack of sleep.
See a doctor when
It is raised together with a low haemoglobin, or with dark urine and tiredness: see a doctor this week to check for red cells breaking down.

SGPT (ALT)

Alanine aminotransferase: an enzyme found mainly inside liver cells; it leaks into the blood when they are irritated

Typical adult range up to about 40 U/L (labs print 35–45; healthy women run lower than men)

High usually means
Liver cells are irritated. In India the commonest cause by far is fatty liver, which goes with weight around the waist, high sugar and high triglycerides. Others: alcohol, viral hepatitis (A and E pass in weeks; B and C can last years), medicines (TB medicines, some antibiotics, too much paracetamol; statins can raise it slightly), and herbal, ayurvedic or body-building products.
Low usually means
A low SGPT has no meaning and needs no action.
Usually nothing to worry about when
It is under about three times the top of the range (under about 120 U/L), you feel well, and there is an obvious likely cause such as weight gain, alcohol or a new medicine. Repeat it in 6–12 weeks after dealing with the cause.
See a doctor when
It stays raised on two reports a few months apart: see a doctor within the next few weeks for the cause (hepatitis B and C test, ultrasound, sugar and cholesterol). More than five times the top of the range (about 200 U/L or more): this week. In the thousands, or with yellow eyes, vomiting or drowsiness: the same day.

SGOT (AST)

Aspartate aminotransferase: an enzyme in liver cells, but also in muscle and heart

Typical adult range up to about 40 U/L

High usually means
Usually the same causes as a raised SGPT. Because it also comes from muscle, it can rise after heavy exercise, gym work or a muscle injury. Alcohol tends to raise SGOT more than SGPT. In dengue, SGOT is often higher than SGPT and settles as you recover.
Low usually means
A low SGOT has no meaning and needs no action.
Usually nothing to worry about when
It is only mildly raised, SGPT is similar, and you had a hard workout, a fall or a fever in the days before the test.
See a doctor when
Same timings as SGPT. If SGOT is clearly higher than SGPT and you drink alcohol regularly, say so honestly at your visit: it changes what is tested next.

SGOT/SGPT ratio (AST:ALT)

SGOT divided by SGPT; some labs print it, some don’t

Typical adult range usually around 1 or below

High usually means
A ratio of 2 or more suggests alcohol is the cause. A ratio above 1 in someone with fatty liver can be a sign of scarring building up, and is a reason to check for it (a FibroScan or a FIB-4 score).
Low usually means
Below 1 is the usual pattern in fatty liver and most viral hepatitis.
Usually nothing to worry about when
Both SGOT and SGPT are normal. The ratio only means something when the enzymes themselves are raised.
See a doctor when
The ratio is above 1 with long-standing fatty liver, diabetes or a low platelet count, or above 2 with regular drinking: see a doctor at your next check-up for a liver scarring check.

Alkaline phosphatase (ALP)

An enzyme from the bile ducts of the liver and from bone

Typical adult range about 40–130 U/L (higher in teenagers and in pregnancy)

High usually means
Either bile flow is slowed (a gallstone in the duct, a liver problem, some medicines), or bone is busy: growth in teenagers, a healing fracture, pregnancy, or vitamin D deficiency, which is very common in India. The GGT tells which: high GGT points to the liver, normal GGT points to bone.
Low usually means
Mildly low ALP is rarely important. It can be seen with poor nutrition, low zinc or magnesium, and after some medicines.
Usually nothing to worry about when
It is only slightly high, GGT is normal, and you are pregnant, still growing, recovering from a fracture, or known to be low in vitamin D.
See a doctor when
ALP and GGT are both raised, especially with a raised direct bilirubin or itching: see a doctor this week for an ultrasound. ALP alone is raised with bone pain: at your next check-up, with a vitamin D and calcium test.

GGT (gamma-GT)

Gamma-glutamyl transferase: a liver enzyme that is sensitive to alcohol and bile flow

Typical adult range men up to about 60 U/L, women up to about 40 U/L

High usually means
Alcohol (even moderate regular drinking), fatty liver, slowed bile flow, and some medicines (for example some epilepsy medicines). It is very sensitive but not specific: it rises easily.
Low usually means
A low GGT has no meaning.
Usually nothing to worry about when
It is the only raised value, it is mildly high, and you drink alcohol or have fatty liver. Stopping alcohol for 4–8 weeks and repeating it usually shows a fall.
See a doctor when
It is raised with a high ALP or direct bilirubin (bile flow problem): this week. It stays high even after stopping alcohol: at your next check-up.

Total protein

All the protein in the blood: albumin plus globulins

Typical adult range about 6.0–8.3 g/dL

High usually means
Usually mild dehydration at the time of the test. A truly high total protein comes from high globulins (see below).
Low usually means
Usually low albumin: poor nutrition, long illness, liver disease, or protein lost through the kidneys or gut.
Usually nothing to worry about when
It is slightly outside the range and albumin and globulin are both normal.
See a doctor when
It is low with swelling of the legs, face or tummy: see a doctor this week. High because of a high globulin: see the globulin line.

Albumin

The main protein the liver makes; it holds fluid inside the blood vessels

Typical adult range about 3.5–5.0 g/dL

High usually means
Almost always mild dehydration at the time of the test. Not harmful in itself.
Low usually means
Long illness or infection (including TB), poor nutrition, a liver that is not making enough (cirrhosis), or protein leaking into the urine (kidney disease). Low albumin also makes the calcium on a kidney test look falsely low.
Usually nothing to worry about when
It is just below the line (for example 3.3–3.4 g/dL) during or soon after an illness, and the liver enzymes and urine are normal. Repeat it once you are well.
See a doctor when
It is below about 3.0 g/dL, or low with swollen legs or tummy, frothy urine, or a known liver problem: see a doctor this week.

Globulin

Antibodies and other proteins; usually worked out as total protein minus albumin

Typical adult range about 2.0–3.5 g/dL

High usually means
The immune system is busy: a long-lasting infection (TB, hepatitis B or C, HIV), a long-standing liver disease, or an autoimmune condition such as rheumatoid arthritis. Occasionally a bone-marrow cause, which a simple extra test (serum protein electrophoresis) checks.
Low usually means
Uncommon. Can be seen with low immunity or protein loss; it matters mainly if you get repeated infections.
Usually nothing to worry about when
It is mildly raised and you have a known reason, such as a recent infection or a joint condition already under care.
See a doctor when
It is above about 4 g/dL, or rising, especially with a high ESR, anaemia, bone pain or weight loss: see a doctor this week for the electrophoresis test.

A:G ratio (albumin/globulin)

Albumin divided by globulin

Typical adult range about 1.0–2.2

High usually means
Usually means globulin is on the low side. Rarely important on its own.
Low usually means
Albumin is low, globulin is high, or both. The two separate lines tell you which, and that is what matters.
Usually nothing to worry about when
It is just below 1.0 and albumin and globulin are each within their own ranges.
See a doctor when
It is low because albumin is low or globulin is high: follow the timing given for those two lines.

Results that go together.

PatternsTypical, not certain
When you seeIt usually means
SGPT higher than SGOT, both mildly raised, with high triglycerides or sugarUsually fatty liver. The ultrasound often says “grade I fatty liver”. Weight loss of 7–10% usually brings the numbers down. See the fatty liver page.
SGOT about twice SGPT or more, with a high GGTPoints to alcohol. The numbers usually fall within weeks of stopping.
High ALP and high GGT, with or without high direct bilirubinBile flow is slowed: a gallstone in the bile duct, fatty liver, alcohol or a medicine. Needs an ultrasound of the abdomen: this week if direct bilirubin is also raised or you have itching or pain, otherwise within a few weeks.
High ALP with normal GGTThe ALP is coming from bone, not liver: growth, a healing fracture, pregnancy or low vitamin D. See the vitamin D page.
Only indirect bilirubin raised, everything else normalAlmost always Gilbert’s syndrome, which is harmless.
SGPT and SGOT in the hundreds or thousands after a feverAcute viral hepatitis (A or E, from water or food), a medicine reaction, or dengue. Needs a doctor within a day, and repeat tests until it settles.

Get help today if

  • Yellow eyes or skin with drowsiness, confusion or unusual behaviour: go to hospital now, or call 112.
  • Yellow eyes with fever, shivering and pain under the right ribs: go to hospital today; this can be an infected, blocked bile duct.
  • Vomiting blood or passing black, tarry stools with a known liver problem: go to hospital now; call 112 if you feel faint.
  • SGPT or SGOT above about 1,000 U/L with vomiting or not keeping food down: go to hospital today.
  • You have taken more paracetamol than the pack allows, even if you feel well and the LFT is normal: go to hospital now, because treatment works best early.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Read more.

Questions people ask.

  1. Is SGPT 60 or 80 dangerous?

    Usually not. A rise to under about three times the top of the range, in someone who feels well, is very common and is most often fatty liver, alcohol or a medicine. It is not dangerous in itself, but it is a reason to find the cause: a hepatitis B and C test, an ultrasound, and checks of sugar and cholesterol. Repeat it in 6–12 weeks.

  2. Can I reduce SGPT naturally?

    If the cause is fatty liver, yes: losing 7–10% of your weight, cutting sugar, sweet drinks and refined flour, walking daily and stopping alcohol usually bring SGPT down within months. Avoid “liver detox” tonics and herbal products: some of them raise SGPT themselves.

  3. My bilirubin is 1.6 but I feel fine. Is it jaundice?

    If the rise is mostly indirect bilirubin and the other liver tests and blood count are normal, it is very likely Gilbert’s syndrome, a harmless family trait seen in many healthy people. It often rises after fasting or illness. If the direct bilirubin is raised, or your eyes or urine turn yellow, see a doctor this week.

  4. Does a normal LFT mean my liver is healthy?

    Mostly, but not always. A scarred liver can have normal enzymes. If you have diabetes, long-standing fatty liver or drink regularly, ask for a FIB-4 score (worked out from your existing tests) or a FibroScan.

  5. Do I need to fast for an LFT?

    Usually no, though many labs ask for it when the LFT is done with sugar or cholesterol. Avoid alcohol for a day or two before, and tell the doctor about every medicine and supplement you take.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

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Dr. Prabhat Arya · MBBS, MD (Internal Medicine)