The ratio of liver function tests can help to identify a patient with fulminant hepatic failure who has Wilson's Disease.
Patient selection: fulminant hepatic failure
Parameters:
(1) serum alkaline phosphatase in U/L
(2) serum total bilirubin in in mg/dL
(3) serum AST in U/L
(4) serum ALT in U/L
ratio 1 =
= (serum alkaline phosphatase) / (serum total bilirubin)
ratio 2 =
= (serum AST) / (serum ALT)
Rationale:
(1) The serum alkaline phosphatase is low in Wilson's Disease.
(2) The serum total bilirubin tends to be higher in Wilson's Disease than other conditions.
(3) Serum ALT is released from necrotic hepatocytes and hemolyzing erythrocytes.
Interpretation according to Berman et al:
• Ratio 1 < 2 is associated with Wilson Disease.
• Ratio 2 > 4 is associated with Wilson Disease.
Interpretation according to Korman et al:
• Ratio 1 < 4 is associated with Wilson Disease.
• Ratio 2 > 2.2 is associated with Wilson Disease.
