Editorial commentary on the Indian Journal of Gastroenterology—May–June 2022

Abstract

Ratio of aspartate aminotransferase to alanine aminotransferase and alkaline phosphatase to total bilirubin in Wilsonian acute liver failure in children Acute liver failure (ALF) secondary to Wilson's disease (WD) is invariably fatal without emergency liver transplantation, and requires a prompt diagnosis [1]. Although reduced ceruloplasmin and elevated copper levels support a diagnosis of WD, they are less reliable in a fulminant setting [1]. Laboratory findings associated with fulminant WD include Coombs negative hemolytic anemia, low serum uric acid levels, low serum alkaline phosphatase (ALP) activity and increased aspartate amino transferase (AST):alanine amino transferase (ALT) ratios [2].Yasmin and colleagues from Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, report on a series of 60 children with ALF, of whom 40 had WDassociated ALF (WALF) [3]. The median AST/ALT ratio was higher in WALF than in non-WALF patients with sensitivity and specificity of 70% and 95% and a positive and negative predictive value of 96.5% and 61.3%, respectively. At a cut-off value of ≥1.85, AST/ALT ratio had a sensitivity of 77.5% and specificity of 95%. An ALP/total bilirubin ratio <4 had sensitivity and specificity of 32.5% and 100% and a positive and negative predictive value of 100% and 42.5%, respectively. The authors suggest that using these routinely available tests, patients with fulminant WD may be identified promptly, enabling emergency listing for liver transplantation for this rare but near uniformly fatal disorder.