ALT is a biomarker of liver function, increased ALT usually indicated liver dysfunction, in our study, we found that the DIBIL ratio is related to ALT and albumin after multiple regression analysis, this finding revealed that in ACS patients, especially those with extremely high-risk ASCVD, many patients also suffer liver dysfunction, which inferred that we should pay attention to the liver protection while we used bilirubin to predict patients’ prognosis. Here, ALB is linked to Decreased liver function.