In adults, clues to the level of liver fibrosis can be gleaned from the use of non-invasive algorithms such as the AST to ALT ratio.12 An AST:ALT ratio of >1 indicates advanced fibrosis/cirrhosis,38 hence the inclusion of this ratio in algorithms has the potential to assess the risk of significant fibrosis in adults with abnormal liver blood tests. The gene discussed is GPT; the disease is Cirrhosis.