A Comparative Analysis of Liver Function Test Profiles in Alcoholic Versus Metabolic-Associated Steatotic Liver Disease.

Introduction Liver function tests (LFTs) are essential for evaluating hepatic injury in steatotic liver disease. Alcoholic fatty liver disease (AFLD) and metabolic-associated steatotic liver disease (MASLD) share steatosis but differ in pathogenesis. This study aimed to compare LFT profiles between AFLD and MASLD to identify potentially distinct biochemical patterns. Methods This cross‑sectional study included 90 participants (30 AFLD, 30 MASLD, 30 healthy controls) at Krishna Institute of Medical Sciences, Karad, India. A comprehensive LFT panel was analyzed, including transaminases (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), alkaline phosphatase (ALP), bilirubin fractions, total protein, albumin, and globulin. AST/ALT and albumin/globulin (A/G) ratios were derived. Statistical analyses included analysis of variance (ANOVA) with post‑hoc Tukey honestly significant difference (HSD), chi‑square tests, and exploratory receiver operating characteristic (ROC) analysis. Given the small sample size, multivariable regression was not performed. Results Both disease groups showed significant LFT abnormalities compared to controls (p < 0.001). Mean total bilirubin was 0.88 mg/dL (15.0 μmol/L) in AFLD and 0.79 mg/dL (13.5 μmol/L) in MASLD, within normal limits. MASLD demonstrated higher ALT elevations (70 ± 25 U/L vs. 45 ± 15 U/L in AFLD, p < 0.05). The AST/ALT ratio >1.5 was present in 62% of AFLD versus 28% of MASLD (p < 0.001). Hypoalbuminemia was mild and likely multifactorial. Exploratory ROC analysis of the AST/ALT ratio yielded an area under the curve (AUC) of 0.88 (95% CI 0.82-0.94), suggesting potential discriminative value that requires external validation. Conclusion AFLD and MASLD exhibit suggestive LFT trends: MASLD shows a predominant hepatocellular injury pattern (high ALT and low AST/ALT ratio), while AFLD more often shows an elevated AST/ALT ratio with mild hypoalbuminemia. However, these patterns are not diagnostic, overlap exists, and validation in larger cohorts with objective alcohol biomarkers and fibrosis assessment is needed before clinical application.