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CPE-005 · synthetic case LIVER-FX-04

High FIB-4

FIB-4 above 5 in a 63-year-old man with low platelets.

Synthetic · no real patientAuthored by Biod · reviewed by Dr. AmaralLiver engine v1.0.0

Purpose: FIB-4 above 5 in a 63-year-old man with low platelets.

Inputs the engine received

Liver tests and imaging

Hepatic steatosis documented
Yes
AST
76 U/L
ALT
60 U/L
Platelets
120 ×10⁹/L

Patient

Age
63 years
Sex
Male
Alcohol intake
8 g/day

Cardiometabolic criteria

Type 2 diabetes
Yes

Other liver disease and context

Hepatitis B and C testing already done
Yes

What the engine reports

Priority

Advanced fibrosis likely

LV-FIB-05

A high-risk non-invasive result (or known cirrhosis) needs specialist evaluation. Confirmation of stage belongs to hepatology.

Detected clinical pattern

Pattern Meeting the 2023 MASLD Criteria

Steatosis with 1 cardiometabolic criterion/criteria and alcohol in range. Fibrosis risk by non-invasive tests: high.

  • Alcohol: Alcohol 8 g/day · MASLD range
  • Fibrosis risk: Fibrosis risk · high

Why this pattern was identified

  • MASLD criteria. Steatosis is documented and 1 cardiometabolic criterion/criteria are met (type 2 diabetes).

Calculations

FIB-4
5.15

Lower cutoff 1.3; high above 2.67.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Consider referral to hepatology.AASLD 2023.
  2. 2Assess cardiovascular risk: it is the leading cause of death in MASLD.
Evidence and rule trace · 8 rules

LV-ALC-01Alcohol intake category

Inputs: alcohol 8 g/day (male)

Alcohol intake in the MASLD range.

LV-CALC-01Derived value

Inputs: age 63 · AST 76 · ALT 60 · platelets 120

FIB-4 = 5.15

LV-FIB-01FIB-4 and its stratum

Inputs: FIB-4 5.15 · cutoff 1.3

High risk of advanced fibrosis.

LV-01MASLD criteria met

Inputs: steatosis documented · 1 cardiometabolic criterion/criteria: type 2 diabetes · alcohol in MASLD range

Pattern meeting the 2023 MASLD criteria.

LV-CV-01Cardiovascular risk assessment

Inputs: MASLD criteria met

Formal cardiovascular risk assessment is part of the work-up.

LV-04ALT above the AASLD upper limit

Inputs: ALT 60 U/L (limit 33 for male)

ALT above the sex-specific upper limit.

LV-FIB-05Advanced fibrosis likely

Inputs: FIB-4 5.15

High-risk fibrosis result.

LV-REF-01Hepatology referral to consider

Inputs: advanced fibrosis likely

Referral to hepatology is reasonable to consider.

Evidence

  • EV-AASLD-2023 · Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.
  • EV-DELPHI-2023 · Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986.
  • EV-MCPHERSON-2017 · McPherson S, Hardy T, Dufour JF, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol. 2017;112(5):740-751.

Physician adjudication required. Clinical decision support for physician review. This output classifies steatotic liver disease under the 2023 nomenclature and stratifies fibrosis risk. It does not stage fibrosis by itself, diagnose a cause, or recommend a drug. Physician adjudication is required.

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Fibrosis risk by non-invasive tests

  1. ✓ Low

    FIB-4 <1.3 (<2.0 from 65), stiffness <8 kPa

  2. ✓ Indeterminate

    Needs a second-line test

  3. ● High

    FIB-4 >2.67, stiffness ≥12 kPa or ELF ≥9.8

Liver tests and imaging
Patient
Sex

A standard US drink is about 14 g.

Cardiometabolic criteria
Other liver disease and context
Cirrhosis, decompensation and trends

Live result · computed in your browser

Priority

Advanced fibrosis likely

LV-FIB-05

A high-risk non-invasive result (or known cirrhosis) needs specialist evaluation. Confirmation of stage belongs to hepatology.

Detected clinical pattern

Pattern Meeting the 2023 MASLD Criteria

Steatosis with 1 cardiometabolic criterion/criteria and alcohol in range. Fibrosis risk by non-invasive tests: high.

  • Alcohol: Alcohol 8 g/day · MASLD range
  • Fibrosis risk: Fibrosis risk · high

Why this pattern was identified

  • MASLD criteria. Steatosis is documented and 1 cardiometabolic criterion/criteria are met (type 2 diabetes).

Calculations

FIB-4
5.15

Lower cutoff 1.3; high above 2.67.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Consider referral to hepatology.AASLD 2023.
  2. 2Assess cardiovascular risk: it is the leading cause of death in MASLD.
Evidence and rule trace · 8 rules

LV-ALC-01Alcohol intake category

Inputs: alcohol 8 g/day (male)

Alcohol intake in the MASLD range.

LV-CALC-01Derived value

Inputs: age 63 · AST 76 · ALT 60 · platelets 120

FIB-4 = 5.15

LV-FIB-01FIB-4 and its stratum

Inputs: FIB-4 5.15 · cutoff 1.3

High risk of advanced fibrosis.

LV-01MASLD criteria met

Inputs: steatosis documented · 1 cardiometabolic criterion/criteria: type 2 diabetes · alcohol in MASLD range

Pattern meeting the 2023 MASLD criteria.

LV-CV-01Cardiovascular risk assessment

Inputs: MASLD criteria met

Formal cardiovascular risk assessment is part of the work-up.

LV-04ALT above the AASLD upper limit

Inputs: ALT 60 U/L (limit 33 for male)

ALT above the sex-specific upper limit.

LV-FIB-05Advanced fibrosis likely

Inputs: FIB-4 5.15

High-risk fibrosis result.

LV-REF-01Hepatology referral to consider

Inputs: advanced fibrosis likely

Referral to hepatology is reasonable to consider.

Evidence

  • EV-AASLD-2023 · Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835.
  • EV-DELPHI-2023 · Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986.
  • EV-MCPHERSON-2017 · McPherson S, Hardy T, Dufour JF, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol. 2017;112(5):740-751.

Physician adjudication required. Clinical decision support for physician review. This output classifies steatotic liver disease under the 2023 nomenclature and stratifies fibrosis risk. It does not stage fibrosis by itself, diagnose a cause, or recommend a drug. Physician adjudication is required.

More liver cases

LIVER-FX-01

Steatosis with metabolic risk and a low FIB-4

A 52-year-old man with fatty liver on ultrasound, BMI 31 and triglycerides 190.

LIVER-FX-02

Type 2 diabetes, no imaging yet

A 58-year-old with diabetes and normal enzymes: the screening question.

LIVER-FX-03

Indeterminate FIB-4

FIB-4 of 2.0 in a 56-year-old with steatosis.

LIVER-FX-05

FIB-4 of 1.65 at age 70

Low risk under the age-adjusted cutoff of 2.0.

LIVER-FX-06

Stiffness 14 kPa with a low FIB-4

Discordant tests: the elastography result prevails as a warning.

LIVER-FX-07

ELF 10.1

A high ELF with FIB-4 in the indeterminate range.

All liver cases

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