A liver panel may be used to screen for liver damage, especially if someone has a condition or is taking a drug that may affect the liver. A comprehensive metabolic panel (CMP), which is often performed as part of a general health checkup, may be ordered instead of a liver panel for routine screening. This group of tests includes most of the liver panel as well as additional tests that evaluate other organs and systems within the body.

A liver panel or one or more of its component tests may be used to help diagnose liver disease if a person has signs and symptoms that indicate possible liver dysfunction. If a person has a known condition or liver disease, testing may be performed at intervals to monitor the health of the liver and to evaluate the effectiveness of any treatments. A series of bilirubin tests, for instance, may be ordered to evaluate and monitor a jaundiced newborn.

Abnormal tests on a liver panel may prompt a repeat analysis of one or more tests, or of the whole panel, to see if the elevations or decreases persist and/or may indicate the need for additional testing to determine the cause of the liver dysfunction.

The panel usually consists of several tests that are run at the same time on a blood sample. These typically include:

Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best test for detecting hepatitis

Alkaline phosphatase (ALP) – an enzyme related to the bile ducts but also produced by the bones, intestines, and during pregnancy by the placenta (afterbirth); often increased when bile ducts are blocked.

Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other organs, particularly the heart and other muscles in the body

Bilirubin – two different tests of bilirubin often used together (especially if a person has jaundice): total bilirubin measures all the bilirubin in the blood; direct bilirubin measures a form that is conjugated (combined with another compound) in the liver.

Albumin – measures the main protein made by the liver; the level can be affected by liver and kidney function and by decreased production or increased loss.

Total protein (TP) – measures albumin and all other proteins in blood, including antibodies made to help fight off infections

Gamma-glutamyl transferase (GGT) – another enzyme found mainly in liver cells

Lactate dehydrogenase (LD) – an enzyme released with cell damage; found in cells throughout the body

Prothrombin time (PT) – the liver produces proteins involved in the clotting (coagulation) of blood; the PT measures clotting function and, if abnormal, may indicate liver damage.

Alpha-feto protein (AFP) – associated with regeneration or proliferation of liver cell

Autoimmune antibodies (e.g., ANA, SMA, anti-LKM-1) – associated with autoimmune hepatitis

Usually no one single set of liver tests is used to make a diagnosis. Often, several liver panels will be ordered over a few days or weeks to help determine the cause of the liver disorder and evaluate its severity.

This table shows examples of some combinations of results that may be seen in certain types of liver conditions or diseases.

Type of liver condition or disease Bilirubin ALT and AST ALP Albumin PT

Acute liver damage (due, for example, to infection, toxins or drugs, etc.) Normal or increased usually after ALT and AST are already increased Usually greatly increased (> 10 times); ALT is usually higher than AST Normal or only moderately increased Normal Usually normal

Chronic forms of various liver disorders Normal or increased Mildly or moderately increased; ALT is persistently increased Normal to slightly increased Normal Normal

Alcoholic Hepatitis

Normal or increased AST is moderately increased, usually at least twice the level of ALT Normal or moderately increased Normal Normal

Cirrhosis

May be increased but this usually occurs later in the disease AST is usually higher than ALT but levels are usually lower than in alcoholic disease Normal or increased Normal or decreased Usually prolonged

Bile duct obstruction, cholestasis Normal or increased; increased in complete obstruction Normal to moderately increased Increased; often greater than 4 times what is normal Usually normal but if the disease is chronic, levels may decrease Usually normal

Cancer that has spread to the liver (metastasized) Usually normal Normal or slightly increased Usually greatly increased Normal Normal

Cancer originating in the liver (hepatocellular carcinoma, HCC) May be increased, especially if the disease has progressed AST higher than ALT but levels lower than that seen in alcoholic disease Normal or increased Normal or decreased Usually prolonged

Autoimmune

Normal or increased Moderately increased; ALT usually higher than AST Normal or slightly increased Usually decreased Normal