Alkaline phosphatase (ALP) as a diagnostic biomarker

  • ALP is a simple marker that can be used to monitor response to therapy1-4
  • The first indicator of primary biliary cholangitis (PBC) may be elevated ALP levels as measured by routine blood tests1
  • Elevated ALP is an indication of continual bile duct destruction, which leads to inflammation and damage3,4
  • Liver biopsy may be used to confirm staging during the diagnosis of PBC1

Serum ALP levels may vary by age, gender, and blood type5

  • Elevated ALP concentration is usually attributed to either liver or bone disease5
  • However, for certain groups of patients:
    • A gradual increase in ALP is seen between the ages of 40 and 65 years, especially in women5,6
    • African Americans may have a 10% to 15% higher serum ALP5
    • Patients with blood types O and B may have elevated ALP following a fatty meal due to influx of intestinal ALP5
    • Smokers may have up to 10% higher ALP compared with nonsmokers5

aAmerican Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL).

References:  1. European Association for the Study of the Liver. EASL clinical practice guidelines: management of cholestatic liver diseases. J Hepatol. 2009;51(2):237-267. doi:10.1016/j.jhep.2009.04.009.  2. Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ. Primary biliary cirrhosis. Hepatology. 2009;50(1):291-308. doi:10.1002/hep.22906. (AASLD guidelines)  3. Corpechot C, Poujol-Robert A, Wendum D, et al. Biochemical markers of liver fibrosis and lymphocytic piecemeal necrosis in UDCA-treated patients with primary biliary cirrhosis. Liver Int. 2004;24(3):187-193.  4. Poupon R, Chazouillères O, Balkau B, Poupon RE. Clinical and biochemical expression of the histopathological lesions of primary biliary cirrhosis. UDCA-PBC Group. J Hepatol. 1999;30(3):408-412.  5. Siddique A, Kowdley KV. Approach to a patient with elevated serum alkaline phosphatase. Clin Liver Dis. 2012;16(2):199-229. doi:10.1016/j.cld.2012.03.012.  6. Schiele F, Henny J, Hitz J, Petitclerc C, Gueguen R, Siest G. Total bone and liver alkaline phosphatases in plasma: biological variations and reference limits. Clin Chem. 1983;29(4):634-641.