S2356 Missed Opportunities: Disparities in Follow-Up and Diagnostic Completion for Low Ceruloplasmin Levels in Hospitalized Patients

Introduction: Ceruloplasmin evaluation is commonly performed in patients presenting with liver pathologies, including acute liver injury, acute liver failure, cirrhosis, and transaminitis. While low ceruloplasmin levels prompt further workup for conditions such as Wilson’s disease, disparities in follow-up care may hinder timely diagnosis. Understanding the influence of sociodemographic factors on completing this diagnostic evaluation is critical to improving outcomes. Methods: We conducted a retrospective cohort study of hospitalized patients from 5/2023 to 5/2024 with liver pathology and low ceruloplasmin levels. Liver pathologies included acute liver injury, acute liver failure, cirrhosis, and transaminitis. Patients who died during hospitalization or lacked sequelae of liver injury or transaminitis were excluded. Data collected included hepatology clinic follow-up, urinary copper testing, and liver biopsy completion. Demographic variables analyzed included age, gender, race, and Social Vulnerability Index (SVI), and their associations with workup completion. Results: A total of 403 patients were included (240 men, 163 women). Hepatology follow-up was completed by 47% of patients, while 20% completed urine copper testing. Liver biopsy was performed in 24 patients (6.0%), with only 1 biopsy yielding a diagnosis of Wilson’s disease. By race, 14/48 (29%) of African American patients completed hepatology follow-up compared to 153/287 (53%) of White patients (P = 0.006). Completion of urine copper quantification was lower in patients aged 60–90 (21/135, 16%) compared to those aged 0–30 (13/41, 32%, P = 0.038). No significant differences in follow-up or testing were observed across other SVI strata or demographic variables. Conclusion: Completion rates for follow-up after identification of low ceruloplasmin levels were suboptimal. Notably, only 6% underwent liver biopsy with 1 case yielding a diagnosis of Wilson’s disease. Racial and age disparities were observed, with African American patients less likely to receive hepatology follow-up and older patients less likely to undergo urine copper testing. These disparities may delay diagnosis and contribute to inequities in care. Efforts to improve diagnostic adherence and address barriers in vulnerable populations are urgently needed.