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Wilson disease is an uncommon cause of acute liver failure (ALF), but, without emergency liver transplantation, patient mortality is nearly 100%. Therefore, rapid diagnosis of Wilson disease is essential in ALF management. Low serum ceruloplasmin levels are used as a marker for this disorder, although other candidate markers include low serum uric acid and alkaline phosphatase levels as well as elevated aspartate aminotransferase:alanine aminotransferase (AST:ALT) liver enzyme ratios. However, the ability of each of these markers to differentiate Wilson disease from other causes of ALF has been questioned (Hepatology 1992; 16:1206).
To identify the best method for diagnosing ALF due to Wilson disease, researchers performed a nested, case-con…