Liver Health
What Does It Mean If You Have Elevated Liver Enzymes?
Elevated liver enzyme levels can be a sign of serious liver disease. But they can also occur with mild, temporary illnesses.
Symptoms of liver disease may not be present until later stages of severe disease. So sometimes, liver enzyme tests are the first sign of liver damage.
Further testing is often required to determine the cause of elevated liver enzymes.
Annual visits to a healthcare professional often include an order for routine blood tests. A part of those tests includes testing liver enzyme levels. And many times, those values can be elevated.
In fact, up to 1 in 3 people tested will have abnormal liver enzymes. If your liver tests are abnormal, you may wonder: Do I have a serious liver problem? What happens next?
Learn more about the basics of liver enzymes and what the numbers mean for you.
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An enzyme is a special protein in the body. The liver needs enzymes to perform its functions, like making bile for digestion, metabolizing nutrients, and removing toxins from the blood.
Blood tests can measure several different types of liver enzymes, including:
ALT (alanine transaminase)
AST (aspartate aminotransferase)
ALP (alkaline phosphatase)
GGT (gamma-glutamyl transferase)
Liver enzymes are important because they can show if there’s any tissue damage or inflammation in the liver. When they are elevated, this can be a sign of liver disease. It can also be a sign of something else going on in the body that’s affecting the liver.
Elevated liver enzymes are generally a sign of a problem with the liver. But it’s important to know there are also nonliver causes. For example, heart failure, pregnancy, and some cancers can elevate liver enzyme levels.
But elevated liver enzyme levels usually show one of three types of problems with the liver:
Damage or injury to liver cells
Blockage of the bile flow from the liver to the intestine
Impaired function of the liver
Foods that are bad for your liver: Take an in-depth look at the foods that harm the liver, and how you can reverse the damage.
Medications that may cause liver damage: If you’re worried about your liver health, review the list of over-the-counter and prescription medications to avoid.
How do you spot liver damage from alcohol? If you’re worried about your liver health, here are some of the earliest symptoms that could indicate a problem.
Some of the most common causes of elevated liver enzymes include:
Over-the-counter (OTC) medication like Tylenol
Prescribed medications such as anti-seizure medications
Recreational drugs or toxin ingestion
Heavy or frequent alcohol use
Viral hepatitis or other viral infections
Hemochromatosis (genetic disorder of iron overload)
Hemolysis (excessive breakdown of red blood cells)
Blockage of a bile duct, usually from a gallstone
Liver cirrhosis or liver failure
Liver cancer
Liver enzymes are tested through the blood. They are usually part of a broader check of your electrolyte panel (also called a metabolic panel). But they can be tested on their own, if there’s a specific concern about your liver.
The pattern of results — which liver enzymes rise and how high they are — may give a clue to the cause of the problem. For example, elevated AST and ALT point to something injuring the liver cells. And abnormal GGT and alkaline phosphatase may mean your bile duct system is blocked.
Even when a pattern exists, the cause may not be clear. Genetic, dietary, or infectious causes can all lead to liver enzyme elevation. When there are many possible explanations, further testing is usually needed. This may include an ultrasound or MRI of the liver, more blood tests, or in some cases, a liver biopsy.
Many people with elevated liver enzymes have no symptoms at all. Symptoms may not come on until later in liver disease. Symptoms suggesting a problem with the liver include:
Stomach or abdominal pain
Abdominal fullness from enlargement of the liver
Bloating from ascites (fluid in the abdomen)
Yellowing of the skin or eyes (jaundice)
Fever or chills
Vomiting or diarrhea
Itchy skin
Clay-colored stools
Fatigue
If you have had elevated liver enzymes and have any of these symptoms, talk with a healthcare professional as soon as possible. They can work with you to figure out what’s going on.
This depends on what’s causing them to be high in the first place. Your healthcare team will consider your age, medical conditions, and family history when working on a diagnosis.
Once a cause is determined, they can help you decide next steps. The plan could be as simple as stopping a medication or supplement, or retesting in a few weeks. But an underlying medical condition may need treatment.
It’s possible. Some studies have noted worsening liver function after periods of stress in people with existing liver disease. And in animal studies, various types of stress can injure liver cells. But more research is needed to better understand the relationship between stress and liver enzymes in humans.
High liver enzyme levels don’t cause death. But they can be a sign of a deadly underlying disease. Some conditions that cause elevated liver enzymes, like cancer or cirrhosis, can be fatal.
Cancer that starts in the liver or spreads to the liver (metastatic) can cause elevated liver enzymes. Types of cancer that commonly spread to the liver include breast, colorectal, small cell lung, lymphoma, and melanoma.
It’s possible. Some studies have noted worsening liver function after periods of stress in people with existing liver disease. And in animal studies, various types of stress can injure liver cells. But more research is needed to better understand the relationship between stress and liver enzymes in humans.
High liver enzyme levels don’t cause death. But they can be a sign of a deadly underlying disease. Some conditions that cause elevated liver enzymes, like cancer or cirrhosis, can be fatal.
Liver enzymes can be abnormal on blood tests for many different reasons. Some are serious, and some are not. But it’s important to address any abnormalities with a healthcare professional. Many symptoms of liver disease don’t develop until the later stages. So elevated liver enzymes may be the first signal that something isn’t right.
American Cancer Society. (2020). Liver metastases.
Ballotin, V. R., et al. (2021). Herb-induced liver injury: Systematic review and meta-analysis. World Journal of Clinical Cases.
InformedHealth.org. (2023). In brief: How does the liver work? Institute for Quality and Efficiency in Health Care.
Joung, J., et al. (2019). A literature review for the mechanisms of stress‐induced liver injury. Brain and Behavior.
Lala, V., et al. (2023). Liver function tests. StatPearls.
MedlinePlus. (2023). Liver cancer - hepatocellular carcinoma.
Moriles, K. E., et al. (2024). Alanine aminotransferase (ALT) test. StatPearls.
National Institute of Diabetes and Digestive and Kidney Disease. (2023). Symptoms & causes of autoimmune hepatitis. National Institutes of Health.
