About the Test
Purpose of the test
The liver panel has many applications in medical care. While sometimes called a liver function test, it is better understood as a method of detecting liver disease and/or other health problems, including many that involve the liver.
Some of the specific ways that a liver panel can be used include:
- Diagnosis: Although a liver panel alone is not able to diagnose liver diseases, its measurements can help identify the type of problem if you have symptoms of liver conditions. The test can also help in the diagnostic process of other health concerns.
- Evaluating disease severity: A liver panel can help determine the extent of illness if you have known liver problems.
- Screening: You may have a liver panel as part of broader blood testing, known as the comprehensive metabolic panel, during routine medical checkups. If screening is abnormal, it may warrant more specific follow-up testing.
- Monitoring: Follow-up testing can provide information about how well treatment for liver problems is working. A liver panel can also monitor for side effects when you take medications that can impact liver health.
What does the test measure?
As a panel test, the liver panel involves multiple measurements. When the test is ordered, doctors can modify exactly which measurements to take.
For this reason, there is not a universal standard for what is measured on a liver panel. Nevertheless, some components of the test are more common. In most cases, a liver panel includes the following measurements:
- Aspartate aminotransferase (AST): This is a type of protein called an enzyme that is found in the liver as well as many muscles and organs.
- Alanine aminotransferase (ALT): This is an enzyme found primarily in the liver.
- Alkaline phosphatase (ALP): This is an enzyme found in the liver, bones, and other tissues in the body.
- Bilirubin: Bilirubin is a yellow-colored waste product that is the result of the normal breakdown of red blood cells. The liver works to remove bilirubin from the body.
- Albumin: Albumin is the most abundant protein in the blood and is made by the liver which prevents fluids from leaking out of the bloodstream.
Additional measurements may be added to a liver panel if the doctor believes they can provide more information to evaluate your situation. These measures may be tested on an initial liver panel, or included in repeat testing after an abnormal result on a previous test.
- Gamma-glutamyl transferase (GGT): An enzyme found in the liver and other organs.
- 5’ nucleotidase (5’-NT): An enzyme that exists in the liver and other organs.
- Total protein: Measures the sum of all proteins in the blood.
- Globulins: A class of proteins in the blood.
- Prothrombin time: A protein made by the liver that facilitates normal blood clotting and measures how long it takes for the blood to clot.
- Lactate dehydrogenase (LDH): An enzyme found in tissues throughout the body.
When should I get a liver panel?
There are many reasons you might decide to get a liver diagnostic test, or why a health care professional will order the lab test for you. This test can detect liver disease and other health problems involving the liver. You might be taking medications with liver damage as a side effect, and the test can measure whether the prescription is having a negative impact on your health. A liver panel can also be done as part of a metabolic panel during a routine medical visit.
A doctor might recommend a liver panel if you show common symptoms like jaundice (yellowing of the skin and eyes), nausea and vomiting, diarrhea, dark-colored urine, light-colored stool, or fatigue. The tricky thing is, aside from jaundice, these symptoms can easily be written off as “something else.”
That’s why it’s really important to consult with your doctor, who can advise whether a liver panel is necessary as part of an overall medical checkup or because of specific circumstances, such as monitoring cirrhosis or medication side effects.
Finding a Liver Panel
How can I get a liver panel?
Liver panel testing is performed in a medical setting such as a clinic, hospital, doctor’s office, or lab. Your doctor may order the liver panel, or you can purchase the test online and be referred to a nearby participating lab for the sample. Most liver panel testing happens with a blood draw and laboratory analysis. But there is a type of rapid, on-site point-of-care test that can measure certain components of the liver panel. It is not comprehensive.
Can I take the test at home?
There are at-home liver panel tests that can determine liver function by screening for proteins and enzymes like albumin, globulin, ALP, ALT, and GGT. These tests use a finger-prick sample and include materials to collect and send your specimen to the lab.
You can order a liver panel from home and get tested in a lab. Or, your doctor can prescribe the liver panel.
The at-home liver panel test is focused on liver function but does not provide the comprehensive results that an expanded liver panel does. It also tests for direct bilirubin and total bilirubin (waste produced by the liver), and AST, an enzyme found in the liver and other tissues.
How much does the test cost?
If you get a liver test ordered by a doctor, your insurance policy may cover the cost of the appointment and lab analysis. There may be a copay or deductible, however. If you order the test online, you can submit the receipt for potential reimbursement. You can find affordable liver panel testing that ranges in price from $39 to $79.
Before you order your own test from a lab or arrange a doctor-ordered liver panel, ask about costs, insurances accepted, copays, and deductibles. Be sure to refer to your doctor, lab, and health plan for details on test costs and insurance coverage.
Taking a Liver Panel Test
A liver panel requires drawing blood from a vein in your arm. The procedure is routine and performed in a medical office, clinic, hospital, or lab. There are some at-home tests available that involve a skin prick, but they are not as thorough as a liver panel from a lab.
Before the test
Plan on fasting for up to 12 hours before you take a liver panel test, only drinking water during this time. Also, be sure your doctor knows what medications you are taking because some prescription drugs and over-the-counter medications or dietary supplements can interfere with the test. Your doctor will provide specific guidelines on which medications and for how long to avoid them before a liver panel blood draw.
Not all liver panels require preparation. For example, an expanded liver panel you order online and go to a lab for testing does not require fasting. The comprehensive liver panel you can order online for lab testing does require fasting for 12 to 14 hours.
For at-home finger-prick liver tests, be sure to read the instructions carefully so you know whether the preparation is required.
During the test
A routine blood draw is all that is required to perform a liver panel. With a small needle, blood is drawn from a vein in your arm into a vial and analyzed by a lab. The phlebotomist will carefully clean the area first with antiseptic, and you might feel a sting when the needle is inserted or removed. You could experience mild bruising or soreness after the test like if you were getting blood drawn for any other medical panel. The entire process takes no more than five minutes.
At-home tests require a finger prick. The kit will include a lancet or small needle. You’ll get a test strip where you apply the blood drops, and then secure it in the provided packaging to send to the lab. It takes less than a minute to gather your sample and prepare the dry blood card for the lab. Remember, test kit instructions vary, so it’s important to read all instructions before obtaining your blood sample.
After the test
There are no restrictions after getting blood drawn for a liver panel, but if you fasted for 12 to 14 hours prior to the lab test, you will probably feel weak or fatigued. Consider bringing a snack for after your test. You can return to standard activities. Other than changing an adhesive bandage, there’s little to no recovery.
Liver Panel Test Results
Receiving test results
Depending on what type of liver panel you get, you can expect test results within one to two business days for an expanded panel that measures enzymes and proteins. It many take one to two days for a comprehensive panel that assesses enzymes and proteins to determine liver function, including GGT and LD. The comprehensive panel is also called hepatic function testing.
Lab result times can vary, so ask the clinician in advance how long it will take. Even at-home tests that use a finger prick to collect a blood sample will take a few business days from the time the lab receives your sample before you get results.
The speed of results can also depend on how you get them. Labs deliver results in a number of ways, including confidential phone calls, secure emails, or via an app.
Interpreting test results
Your liver panel test results will depend on the type of test. You will see some reference ranges to understand what levels are considered abnormal. Always discuss these results with a medical professional so you can ask questions and gain a clear understanding of the report, its information, and the next steps.
There are five common measures your liver panel test results will reveal.
- Bilirubin: Total bilirubin will show whether levels are raised due to a metabolic disorder or liver disease. In infants, it can indicate whether support is needed to address a liver that is not functioning properly.
- Albumin: This protein can be a marker for liver function and reduced albumin could indicate sepsis, inflammatory disorders, and other liver problems.
- ALP: Higher levels of ALP can be found in those with liver and bone disease.
- AST and ALT: These are liver enzymes and elevation can indicate liver-related issues. ALT can be an indicator of liver cell injury.
- GGT: This is used in the diagnosis and treatment of liver disease and in the evaluation of patients with alcoholism.
When test results are abnormal, doctors often look for certain patterns of abnormalities in the specific levels that were detected.
- Conditions involving acute or chronic liver damage often show disproportionate increases in ALT and AST compared to ALP.
- Bile duct obstruction is more often associated with a disproportionate increase in ALP compared to ALT and AST.
- Disorders affecting the normal processing of bilirubin may be demonstrated by elevated bilirubin with normal levels of ALT, AST, and ALP.
- Health conditions originating outside the liver are more common when abnormal albumin or prothrombin time occurs with otherwise normal results.
Your doctor will look at these test results and take into account your health, symptoms, and medical and family history. Any drugs you take are also considered since some medications can impact test results. Liver panel results are complex, so always review results with a medical professional who understands your case and can answer your questions. Here are some to ask:
- Was any part of my test result abnormal?
- If there was an abnormal result, can you explain what was found and what it may mean?
- If results were normal, will I need to have this testing again at any point in the future?
- Are there any follow-up tests that may be beneficial given my test results?
- CMP Blood Test (Comprehensive Metabolic Panel) Learn More
- Alanine Aminotransferase (ALT) Learn More
- Alkaline Phosphatase (ALP) Test Learn More
- Albumin Blood Test Learn More
- Total Protein, Albumin-Globulin (A/G) Ratio Test Learn More
- Bilirubin Test Learn More
- GGT Blood Test (Gamma Glutamyl Tranferase/Transpeptidase) Learn More
- Lactate Dehydrogenase (LDH) Test Learn More
- PT/INR Test (Prothrombin Time and International Normalized Ratio) Learn More
A.D.A.M. Medical Encyclopedia. 5′-Nucleotidase. Updated January 24, 2021. Accessed September 28, 2022. https://medlineplus.gov/ency/article/003575.htm
A.D.A.M. Medical Encyclopedia. Gamma-Glutamyl Transferase (GGT) Blood Test. Updated January 17, 2021. Accessed September 28, 2022. https://medlineplus.gov/ency/article/003458.htm
A.D.A.M. Medical Encyclopedia. Prothrombin Time (PT). Updated January 19, 2021. Accessed September 28, 2022. https://medlineplus.gov/ency/article/003652.htm
A.D.A.M. Medical Encyclopedia. Total Protein. Updated May 1, 2021. Accessed September 28, 2022. https://medlineplus.gov/ency/article/003483.htm
Akbas N, Gonzalez G, Edwards R, Devaraj S. Assessment of Liver Function Tests on Piccolo Xpress Point of Care Chemistry Analyzer in a Pediatric Hospital. Pract Lab Med. 2015;3:1-7. Published 2015 Oct 3. doi:10.1016/j.plabm.2015.09.002
ARUP Consult. Liver Disease Evaluation. Updated June 2022. Accessed September 28, 2022. https://arupconsult.com/content/liver-disease-evaluation
Friedman LS. Approach to the Patient With Abnormal Liver Biochemical and Function Tests. In: Chopra S, ed. UpToDate. Updated April 5, 2022. Accessed September 28, 2022. https://www.uptodate.com/contents/approach-to-the-patient-with-abnormal-liver-biochemical-and-function-tests
Friedman LS. Enzymatic Measures of Cholestasis (e.g., Alkaline Phosphatase, 5′-Nucleotidase, Gamma-Glutamyl Transpeptidase). In: Chopra S, ed. UpToDate. Updated July 28, 2022. Accessed September 28, 2022. https://www.uptodate.com/contents/enzymatic-measures-of-cholestasis-eg-alkaline-phosphatase-5-nucleotidase-gamma-glutamyl-transpeptidase
Friedman LS. Liver Biochemical Tests That Detect Injury to Hepatocytes. In: Chopra S, ed. UpToDate. Updated March 4, 2021. Accessed September 28, 2022. https://www.uptodate.com/contents/liver-biochemical-tests-that-detect-injury-to-hepatocytes
Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35. doi:10.1038/ajg.2016.517
Lindenmeyer CC. Liver Blood Tests. Merck Manual Consumer Edition. Updated September 2021. Accessed September 28, 2022. https://www.merckmanuals.com/en-ca/home/liver-and-gallbladder-disorders/diagnosis-of-liver,-gallbladder,-and-biliary-disorders/liver-blood-tests
Lindenmeyer CC. Laboratory Tests of the Liver and Gallbladder. Merck Manual Professional Edition. Updated September 2021. Accessed September 28, 2022. https://www.msdmanuals.com/professional/hepatic-and-biliary-disorders/testing-for-hepatic-and-biliary-disorders/laboratory-tests-of-the-liver-and-gallbladder
MedlinePlus: National Library of Medicine. Albumin Blood Test. Updated June 7, 2022. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/albumin-blood-test/
MedlinePlus: National Library of Medicine. Alkaline Phosphatase. Updated August 3, 2022. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/alkaline-phosphatase/
MedlinePlus: National Library of Medicine. ALT Blood Test. Updated August 3, 2022. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/alt-blood-test/
MedlinePlus: National Library of Medicine. AST Test. Updated April 8, 2022. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/ast-test/
MedlinePlus: National Library of Medicine. Bilirubin Blood Test. Updated April 5, 2022. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/bilirubin-blood-test/
MedlinePlus: National Library of Medicine. Comprehensive Metabolic Panel (CMP). Updated September 9, 2021. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/comprehensive-metabolic-panel-cmp/
MedlinePlus: National Library of Medicine. Gamma-Glutamyl Transferase (GGT) Test. Updated November 16, 2021. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/gamma-glutamyl-transferase-ggt-test/
MedlinePlus: National Library of Medicine. Globulin Test. Updated April 7, 2022. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/globulin-test/
MedlinePlus: National Library of Medicine. Lactate Dehydrogenase (LDH) Test. Updated December 17, 2020. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/lactate-dehydrogenase-ldh-test/
MedlinePlus: National Library of Medicine. Liver Function Tests. Updated September 9, 2021. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/liver-function-tests/
MedlinePlus: National Library of Medicine. Prothrombin Time Test and INR (PT/INR). Updated September 16, 2021. Accessed September 28, 2022. https://medlineplus.gov/lab-tests/prothrombin-time-test-and-inr-ptinr/