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CPE-005 · synthetic case LIVER-FX-11
Amiodarone exposure
A hepatotoxic drug is on the medication list.
Purpose: A hepatotoxic drug is on the medication list.
Inputs the engine received
Liver tests and imaging
- Hepatic steatosis documented
- Yes
- AST
- 41 U/L
- ALT
- 46 U/L
- Platelets
- 205 ×10⁹/L
Patient
- Age
- 67 years
- Sex
- Male
- Alcohol intake
- 0 g/day
Cardiometabolic criteria
- BMI
- 28 kg/m²
Other liver disease and context
- Hepatitis B and C testing already done
- Yes
- Hepatotoxic drug (amiodarone, methotrexate, tamoxifen…)
- Yes
What the engine reports
Detected clinical pattern
Another Liver Disease Is Present or Suspected
hepatotoxic drug exposure. MASLD can coexist, but the liver disease cannot be attributed to it alone.
- Alcohol: Alcohol 0 g/day · MASLD range
- Fibrosis risk: Fibrosis risk · low
Calculations
- FIB-4
- 1.98
Lower cutoff 2 (age 65 or older); high above 2.67.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Address the other cause and reassess; MASLD can coexist with it.
Evidence and rule trace · 5 rules
LV-EXC-01Another liver disease or cause is present
Inputs: hepatotoxic drug exposure
Another cause of liver injury is present or suspected.
LV-04ALT above the AASLD upper limit
Inputs: ALT 46 U/L (limit 33 for male)
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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