Likely primary explanations for AST>ALT by 40 units or more and AST/ALT ≥ 2.0 Cause Number of patients % of total patients Alcohol 187 49.3 Hepatitis C 23 6.1 Heart 31 8.2 Skeletal muscle 28 7.4 Trauma 17 4.7 Malignancies 18 4.7 NASH 14 3.7 Hb SS 13 3.4 Med/OD 7 1.8 Gall Stones 6 1.6 Seizures 5 1.3 HIV/AIDS 5 1.3 Sepsis 4 1.1 Pre-eclampsia 3 0.8 Hemolysis 2 0.5 Hematoma 2 0.5 Malnurtion 2 0.5 Myxedema 1 0.3 Primary sclerosing cholangitis 1 0.3 Unresolved 10 2.6   Total =379

Table 3: Most of the patients had multiple pathologies and many had more than one potential explanation for the altered AST-ALT enzyme pattern. The likely dominant etiologic factor was determined from the laboratory data and clinical history. Further breakdown of the various malignancies is presented in table 4. The pathologies present in the ten cases in which the primary cause could not be ascertained with confidence are given in table 5