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CPE-005 · synthetic case LIVER-FX-08
Alcohol in the MetALD range
A woman drinking about 35 g a day with steatosis and metabolic risk.
Purpose: A woman drinking about 35 g a day with steatosis and metabolic risk.
Inputs the engine received
Liver tests and imaging
- Hepatic steatosis documented
- Yes
- AST
- 40 U/L
- ALT
- 36 U/L
- Platelets
- 240 ×10⁹/L
Patient
- Age
- 45 years
- Sex
- Female
- Alcohol intake
- 35 g/day
Cardiometabolic criteria
- BMI
- 31 kg/m²
Other liver disease and context
- Hepatitis B and C testing already done
- Yes
What the engine reports
Detected clinical pattern
MetALD Pattern
Steatosis with a cardiometabolic risk factor and alcohol intake in the MetALD range. Both contribute.
- Alcohol: Alcohol 35 g/day · MetALD range
- Fibrosis risk: Fibrosis risk · low
Calculations
- FIB-4
- 1.25
Lower cutoff 1.3; high above 2.67.
Evidence and rule trace · 4 rules
LV-ALC-01Alcohol intake category
Inputs: alcohol 35 g/day (female)
Alcohol intake in the MetALD range.
LV-04ALT above the AASLD upper limit
Inputs: ALT 36 U/L (limit 25 for female)
ALT above the sex-specific upper limit.
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.
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-06
Stiffness 14 kPa with a low FIB-4
Discordant tests: the elastography result prevails as a warning.
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