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CPE-005 · synthetic case LIVER-FX-06
Stiffness 14 kPa with a low FIB-4
Discordant tests: the elastography result prevails as a warning.
Purpose: Discordant tests: the elastography result prevails as a warning.
Inputs the engine received
Liver tests and imaging
- Hepatic steatosis documented
- Yes
- AST
- 24 U/L
- ALT
- 30 U/L
- Platelets
- 260 ×10⁹/L
- Liver stiffness (VCTE)
- 14 kPa
Patient
- Age
- 44 years
- Sex
- Male
- Alcohol intake
- 6 g/day
Cardiometabolic criteria
- BMI
- 32 kg/m²
Other liver disease and context
- Hepatitis B and C testing already done
- Yes
What the engine reports
A high-risk non-invasive result (or known cirrhosis) needs specialist evaluation. Confirmation of stage belongs to hepatology.
FIB-4 and the second-line test point in different directions, so the result is not reassuring. Consider repeating or adding another test.
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 6 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 (BMI 32).
Calculations
- FIB-4
- 0.74
- Liver stiffness stratum
- High (≥12 kPa)
Lower cutoff 1.3; high above 2.67.
Device-specific cutoffs.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Consider referral to hepatology.AASLD 2023.
- 2Consider repeating or adding another non-invasive test (ELF, or elastography at a specialist center).
- 3Assess cardiovascular risk: it is the leading cause of death in MASLD.
Evidence and rule trace · 9 rules
LV-FIB-02Elastography or ELF stratum
Inputs: liver stiffness 14 kPa
Second-line fibrosis stratum assigned.
LV-FIB-03FIB-4 and elastography disagree
Inputs: FIB-4 0.74 · stiffness 14 kPa
Discordant non-invasive tests.
LV-01MASLD criteria met
Inputs: steatosis documented · 1 cardiometabolic criterion/criteria: BMI 32 · 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-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.
- EV-EASL-NIT-2021 · European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis, 2021 update. J Hepatol. 2021;75(3):659-689.
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.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Fibrosis risk by non-invasive tests
✓ Low
FIB-4 <1.3 (<2.0 from 65), stiffness <8 kPa
✓ Indeterminate
Needs a second-line test
● High
FIB-4 >2.67, stiffness ≥12 kPa or ELF ≥9.8
Liver tests and imaging
Patient
A standard US drink is about 14 g.
Cardiometabolic criteria
Other liver disease and context
Cirrhosis, decompensation and trends
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-04
High FIB-4
FIB-4 above 5 in a 63-year-old man with low platelets.
LIVER-FX-05
FIB-4 of 1.65 at age 70
Low risk under the age-adjusted cutoff of 2.0.
LIVER-FX-07
ELF 10.1
A high ELF with FIB-4 in the indeterminate range.
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