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CPE-005 · synthetic case LIVER-FX-25
Steatosis in a lean patient with no metabolic risk
Fatty liver but no cardiometabolic criterion.
Purpose: Fatty liver but no cardiometabolic criterion.
Inputs the engine received
Liver tests and imaging
- Hepatic steatosis documented
- Yes
- AST
- 30 U/L
- ALT
- 34 U/L
- Platelets
- 270 ×10⁹/L
Patient
- Age
- 34 years
- Sex
- Female
- Alcohol intake
- 0 g/day
Cardiometabolic criteria
- BMI
- 21 kg/m²
- Fasting glucose
- 84 mg/dL
- Triglycerides
- 80 mg/dL
- HDL-C
- 66 mg/dL
- Systolic BP
- 110 mmHg
- Diastolic BP
- 68 mmHg
Other liver disease and context
- Hepatitis B and C testing already done
- Yes
What the engine reports
Detected clinical pattern
Steatosis Without a Cardiometabolic Criterion
MASLD criteria are not met. Consider other causes of steatosis.
- Alcohol: Alcohol 0 g/day · MASLD range
- Fibrosis risk: Fibrosis risk · low
Calculations
- FIB-4
- 0.65
Lower cutoff 1.3; high above 2.67.
Differentials, pitfalls and contradicting signals
- Other causes of steatosis: drugs, genetic and endocrine causes, rapid weight loss, malnutrition, lipodystrophy.
Evidence and rule trace · 5 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-04ALT above the AASLD upper limit
Inputs: ALT 34 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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