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CPE-005 · synthetic case LIVER-FX-20
Raised ALT and no viral testing
ALT 78 with no hepatitis B or C results.
Purpose: ALT 78 with no hepatitis B or C results.
Inputs the engine received
Liver tests and imaging
- AST
- 52 U/L
- ALT
- 78 U/L
- Platelets
- 260 ×10⁹/L
Patient
- Age
- 46 years
- Sex
- Female
Cardiometabolic criteria
- BMI
- 31 kg/m²
- Fasting glucose
- 104 mg/dL
- Triglycerides
- 170 mg/dL
What the engine reports
Detected clinical pattern
Fibrosis Screening Opportunity
Steatosis is not documented, but the risk profile warrants FIB-4 under AASLD 2023. This is not a MASLD diagnosis. Fibrosis risk by non-invasive tests: low.
- Fibrosis risk: Fibrosis risk · low
Calculations
- FIB-4
- 1.04
Lower cutoff 1.3; high above 2.67.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Review the FIB-4 result and consider liver imaging to document steatosis.AASLD 2023 recommends FIB-4 in these risk profiles.
- 2Consider hepatitis B and C testing: CDC recommends one-time universal screening in adults.
Evidence and rule trace · 5 rules
LV-02Steatosis not documented, fibrosis screening indicated
Inputs: 3 cardiometabolic risk factors · steatosis not documented
Fibrosis screening opportunity.
LV-04ALT above the AASLD upper limit
Inputs: ALT 78 U/L (limit 25 for female)
ALT above the sex-specific upper limit.
LV-VIR-01Viral hepatitis not excluded
Inputs: raised aminotransferase or steatosis · hepatitis B and C testing not documented
Testing prompt.
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-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-CDC-HEP-2020 · Schillie S, Wester C, Osborne M, et al. CDC Recommendations for Hepatitis C Screening Among Adults. MMWR Recomm Rep. 2020;69(2):1-17; and Conners EE, et al. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations. MMWR Recomm Rep. 2023;72(1):1-25.
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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