Some laboratory findings and indexes are helpful in distinguishing WD with acute liver failure (ALF) from non-WD ALF, including increased aspartate aminotransferase: alanine aminotransferase (AST : ALT) ratios, low serum alkaline phosphatase (AP) activity, and decreased AP to total bilirubin (TB) ratios [13, 16, 17]. The gene discussed is GPT; the disease is Wilson disease.