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CPE-005 · synthetic case LIVER-FX-15
Jaundice and ascites
Signs of decompensation.
Purpose: Signs of decompensation.
Inputs the engine received
Liver tests and imaging
- Hepatic steatosis documented
- Yes
- Total bilirubin
- 4.8 mg/dL
Patient
- Age
- 61 years
- Sex
- Male
Other liver disease and context
- Hepatitis B and C testing already done
- Yes
Cirrhosis, decompensation and trends
- Cirrhosis known
- Yes
- Months since last liver ultrasound
- 3 months
- Jaundice
- Yes
- Ascites
- Yes
What the engine reports
Jaundice, ascites, encephalopathy or portal-hypertensive bleeding need urgent clinical assessment, not the routine outpatient fibrosis pathway.
A high-risk non-invasive result (or known cirrhosis) needs specialist evaluation. Confirmation of stage belongs to hepatology.
Bilirubin, INR or albumin is outside the range expected in uncomplicated MASLD. Do not attribute to MASLD without excluding other causes.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- Pattern: cirrhosis pathway
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent clinical assessment of possible decompensated liver disease.
- 2Priority review of impaired liver function.
- 3Consider referral to hepatology.AASLD 2023.
Differentials, pitfalls and contradicting signals
- Other causes of steatosis: drugs, genetic and endocrine causes, rapid weight loss, malnutrition, lipodystrophy.
Missing information
- FIB-4 inputs: AST, ALT, platelets.
Evidence and rule trace · 6 rules
LV-03Steatosis without a cardiometabolic risk factor
Inputs: steatosis documented · no cardiometabolic risk factor
MASLD criteria not met; consider other causes of steatosis.
LV-REF-01Hepatology referral to consider
Inputs: advanced fibrosis likely · decompensation
Referral to hepatology is reasonable to consider.
LV-SAFE-01Signs of decompensated liver disease
Inputs: jaundice · ascites
Urgent clinical assessment: possible decompensated liver disease.
LV-SAFE-03Synthetic dysfunction or marked cholestasis
Inputs: bilirubin 4.8 mg/dL
Priority review: markers of impaired liver function.
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.
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
No stage is assigned for the values entered.
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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