Liver Function Test (LFT) in Australia

What Is a Liver Function Test?

An LFT measures multiple liver enzymes, proteins, and waste products together, not a single marker, reflecting how your liver is performing and whether there's underlying damage, inflammation, or dysfunction. This liver test is one of the pathology tests most commonly ordered as part of routine blood tests, and elevated liver function tests are one of the more frequent abnormal results doctors see.

This may also be called a liver panel, liver blood tests, or other liver function tests, the same underlying markers regardless of name. We read your LFT results alongside your broader medical history, a physical examination where relevant, and the rest of your Everlab blood panel, not in isolation.

How Is the Sample Taken?

Your LFT is drawn from a vein in your arm as part of your regular Everlab blood draw, the same sample used for the rest of your panel. No separate appointment or extra blood sample is needed.

What Does the Liver Do?

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The liver is your body's largest internal organ, weighing around 1.5kg and performing hundreds of essential functions daily. It acts as your body's biochemical factory, filtering, processing, storing, and producing crucial compounds.

• Detoxification: filters your blood to remove toxins, alcohol, medications, and metabolic by-products, breaking them down and eliminating them through bile or urine.
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• Metabolism: regulates carbohydrate, fat, and protein metabolism, converting excess glucose to glycogen for storage and releasing it when you need energy, through a series of chemical reactions that keep your energy supply steady.
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• Digestion: produces bile, which helps digest fats and fat-soluble vitamins (A, D, E, K).
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• Storage: stores iron, copper, vitamins A, D, and B12, and glycogen.
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• Synthesis: produces key proteins including albumin, which maintains blood volume and pressure, and clotting factors that prevent excessive bleeding.
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• Immune function: houses immune cells that destroy bacteria, viruses, and worn-out blood cells.

Why Liver Health Matters

When liver function declines, the effects can ripple through nearly every system in your body, often well before symptoms appear. Even mildly impaired liver function can contribute to:

• Hormonal imbalance: your liver breaks down oestrogen, cortisol, and thyroid hormones. If it's under strain, hormonal symptoms like low energy or brain fog can follow.
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• Fatty liver and insulin resistance: poor liver health is a key factor in metabolic syndrome and type 2 diabetes.
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• Cardiovascular risk: elevated liver enzymes often coincide with high LDL cholesterol, triglycerides, and inflammation, all of which raise heart disease risk.
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• Toxin overload: a struggling liver can leave your body less able to clear waste, contributing to fatigue, headaches, or skin issues.

Your liver function affects your metabolism, hormones, and cardiovascular health, not just your risk of liver disease specifically.

What's Included in Everlab's Liver Function Test?

Our LFT panel reports 8 markers. These tests measure enzymes released by damaged liver cells, and proteins your liver produces, since your liver produces important proteins like albumin and clotting factors. Select a marker below for a plain-English explanation of what it means.

ALT (Alanine Aminotransferase)

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Also called alanine transaminase, this enzyme is mostly found inside liver cells. When those cells are damaged or inflamed, whether from alcohol, fat buildup, medication, or infection, ALT leaks into your bloodstream. It's one of the most sensitive markers of liver injury.

AST (Aspartate Aminotransferase)

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Also found in liver cells, but less liver-specific than ALT since it's also present in muscle, heart, and kidney tissue, so an elevated AST isn't always of hepatic origin. Comparing your AST and ALT together can add useful context, more on that below.

ALP (Alkaline Phosphatase)

Found in the liver and bile ducts. Elevated ALP can point to bile flow problems, gallstones, or, since it's also found in bone, bone disease rather than a liver issue, so it's always interpreted alongside your other enzymes rather than on its own.

GGT (Gamma-Glutamyl Transferase)

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Highly sensitive to alcohol and certain medications. Elevated GGT alongside ALP suggests a liver or bile duct issue, and GGT is also used to help track alcohol-related liver changes over time.

Albumin

Albumin is a protein made by your liver that keeps fluid from leaking out of your blood vessels. Low levels can indicate liver dysfunction, poor nutrition, chronic disease, or, less commonly, gastrointestinal protein loss unrelated to the liver.

Total Protein

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Total protein combines albumin and globulin into one measure, giving a broader view of your immune and liver function together.

Bilirubin

A byproduct of the breakdown of red blood cells that your liver processes and excretes. High bilirubin can cause jaundice (yellowing of the skin or eyes) and may point to bile obstruction or liver inflammation.

Globulin

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A group of proteins that includes antibodies and enzymes, important for immune function and blood clotting. Abnormal globulin levels can point to chronic inflammation, an immune condition, or liver disease.

What Is FIB-4?

Beyond the 8 markers above, we calculate FIB-4 (the Fibrosis-4 Index) automatically from your results, at no extra cost and no extra sample. FIB-4 combines your age with your AST, ALT, and platelet count (already part of your blood panel) to estimate your risk of liver fibrosis, or scarring, without needing a scan or biopsy.

FIB-4 is endorsed in Australia as the first-line test for assessing fibrosis risk in adults aged 35 and over, particularly relevant given how common metabolic-associated fatty liver disease (MAFLD, formerly called NAFLD) has become. As a general guide:

• Below 1.3 (below 2.0 if you're 65 or older): generally low risk
• 1.3 to 2.7: indeterminate, may need further assessment
• Above 2.7: suggests a higher risk of significant liver scarring

Your Everlab doctor interprets your FIB-4 score alongside your actual liver enzymes and your broader health picture, not as a standalone result.

What Is the AST:ALT (De Ritis) Ratio?

Your results also let your doctor look at the ratio between your AST and ALT levels, sometimes called the De Ritis ratio. This ratio is only genuinely informative once one or both of these enzymes is actually raised, on its own it isn't a diagnosis. When your enzymes are elevated, the pattern can add useful context:

• A ratio below about 0.8 is typically seen with a fatty liver (MAFLD) pattern
• A ratio between about 1.5 and 2.0 can point toward alcohol-related liver injury or more advanced scarring
• A ratio above 2, especially alongside a raised GGT, is a pattern often seen with alcohol-related liver disease

As with FIB-4, your Everlab doctor reads this ratio in the context of your actual enzyme levels and health history, not as a number that means anything by itself.

What Causes Elevated Liver Enzymes?

Raised liver enzymes are a sign your liver is under stress, inflamed, or damaged. When ALT and AST levels rise together, this points to liver damage or hepatocellular injury. Alkaline phosphatase (ALP) rising alongside GGT points more toward a bile duct issue than liver cell damage itself. Common causes of liver disease or damage include:

• Metabolic-associated fatty liver disease (MAFLD): often linked to excess weight, insulin resistance, or high triglycerides, and reflecting broader metabolic dysfunction. This is now the most common cause of elevated liver enzymes globally.
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• Alcohol-related liver disease: excessive drinking can cause alcoholic hepatitis and damage liver cells, raising GGT, ALT, and AST.
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• Medications: painkillers like paracetamol, antibiotics, antidepressants, and cholesterol-lowering statins can all cause drug induced liver injury (drug-induced liver injury).
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• Viral hepatitis: acute viral hepatitis, including hepatitis A, B, or C, can raise enzymes before symptoms appear, and can become chronic hepatitis if untreated.
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• Autoimmune hepatitis: where the immune system mistakenly attacks liver cells.
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• Primary biliary cholangitis and primary sclerosing cholangitis: autoimmune conditions affecting the bile ducts, typically raising ALP and GGT.
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• Genetic liver conditions: such as haemochromatosis or Wilson disease. A family history of these conditions is relevant to your risk.
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• Gallbladder disease: gallstones can cause bile duct damage and obstruction, raising ALP and GGT.
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• Coeliac disease: can be associated with unexplained liver abnormalities.
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• Muscle injury or intense exercise: can also raise AST and ALT, without any liver involvement at all.

Very rarely, a sudden, severe rise in liver enzymes can signal acute liver failure, a medical emergency. This is uncommon and distinct from the gradual, mild elevations most people see on routine testing. Other blood tests, such as lactate dehydrogenase (LDH), are sometimes used alongside LFTs to help build the overall clinical picture.

What Are Normal Liver Function Test Results?

Reference ranges vary between laboratories, so always check the specific range printed on your own results. As a general guide, commonly used Australian adult reference ranges are:

• ALT: under 40 U/L (men), under 35 U/L (women)
• AST: under 40 U/L
• ALP: 30 to 110 U/L
• GGT: under 60 U/L (men), under 40 U/L (women)
• Albumin: 35 to 50 g/L
• Total bilirubin: under 20 micromol/L

What Can Affect Your Test Results?

• Lifestyle factors: alcohol, sugar, processed food, poor sleep, and low physical activity can all affect enzyme levels.
• Body composition: higher visceral fat and waist circumference are strongly linked to MAFLD and elevated ALT and AST.
• Recent activity: heavy exercise or illness can temporarily raise certain enzymes.
• Supplements: even natural products like green tea extract, kava, or high-dose vitamin A can stress the liver.
• Hydration: dehydration can skew albumin or protein readings.

How Do I Prepare for a Liver Function Blood Test?

48 to 72 hours before

• Avoid alcohol.

24 hours before

• Avoid strenuous exercise.

8 to 12 hours before

• Fast from food and drinks other than water.

Before your appointment

• List any medications or supplements you're taking, since some can affect results.
• Stay well hydrated, dehydration can affect your results.

What If My Liver Enzymes Are Elevated?

First, don't panic. Elevated enzymes are like a smoke alarm, they tell us something's going on, but not exactly what. Depending on your result, further tests may include retesting after some lifestyle adjustments, expanding your laboratory tests to check metabolic, inflammatory, or autoimmune markers, imaging tests such as an abdominal ultrasound, a review of your current medications, or a personalised plan covering diet, alcohol intake, or weight. In rare cases where the cause remains unclear, a liver biopsy may be recommended.

Working through the differential diagnosis, and clearing harmful substances like excess alcohol or unnecessary medications where relevant, is part of building a clear underlying cause rather than reacting to a single number.

Your Everlab doctor weighs the clinical significance of your results against your risk factors and overall clinical picture as part of your broader risk assessment, using clinical judgment rather than treating any one marker in isolation, and will help you build a plan tailored to your situation.

References:

1. Jogu P, Zubair M, Minter DA. Liver function tests [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan– [updated 2026 Jun 8; cited 2026 Sep 3]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482489/
2. Coates P. Liver function tests. Aust Fam Physician. 2011 Mar;40(3):113-5.
3. American Liver Foundation. Liver function tests [Internet]. New York: American Liver Foundation; 2022 Jun 7 [updated 2023 Nov 28; cited 2026 Sep 3]. Available from: https://liverfoundation.org/about-your-liver/medical-terms/liver-function-tests/
4. Elsevier. Liver function test [Internet]. ScienceDirect Topics; [cited 2026 Sep 3]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/liver-function-test