{
  "engine": {
    "id": "cpe-005",
    "code": "CPE-005",
    "name": "MASLD Pattern Engine",
    "version": "1.0.0",
    "url": "https://biod.ai/tools/liver",
    "status": "Executable specification v1.0.0, authored by Biod from the narrative CPE-005 specification and current guidance. Reviewed by Dr. Vinicius Amaral, D.O. Not for clinical production use."
  },
  "notice": "Clinical decision support for licensed clinicians. Synthetic-data demonstration. Not FDA cleared. Physician adjudication required.",
  "rules": [
    {
      "id": "LV-SCOPE-01",
      "name": "Patients under 18 routed out",
      "group": "Scope and validity",
      "status": "active",
      "classification": "Priority 1",
      "summary": "Patients under 18 routed out. Evaluates age_years below 18.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "age_years < 18"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Routing: pediatric fatty-liver pathway",
            "No adult classification is produced"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Pediatric steatotic liver disease uses different criteria and tests."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-scope-01"
    },
    {
      "id": "LV-EXC-01",
      "name": "Another liver disease or cause is present",
      "group": "Scope and validity",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Another liver disease or cause is present. Evaluates HBsAg positive OR HCV antibody positive OR hepatotoxic drug (for example amiodarone, methotrexate, tamoxifen, valproate, long-term glucocorticoid) OR autoimmune hepatitis suspected OR Wilson disease suspected OR hemochromatosis pattern.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "HBsAg positive OR HCV antibody positive OR hepatotoxic drug (for example amiodarone, methotrexate, tamoxifen, valproate, long-term glucocorticoid) OR autoimmune hepatitis suspected OR Wilson disease suspected OR hemochromatosis pattern"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Another cause of liver injury is present or suspected: steatosis may still be metabolic, but the liver disease cannot be attributed to MASLD alone"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Address the other cause and reassess; MASLD can coexist with it"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Coexistence is common; this rule withholds the MASLD label, not the metabolic risk."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023",
        "EV-DELPHI-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-exc-01"
    },
    {
      "id": "LV-ALC-01",
      "name": "Alcohol intake category",
      "group": "Scope and validity",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Alcohol intake category. Evaluates alcohol intake entered.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "alcohol intake entered"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "MASLD range: under 20 g/day (women) or 30 g/day (men)",
            "MetALD range: 20–50 g/day (women) or 30–60 g/day (men)",
            "Alcohol-related liver disease predominant: over 50 g/day (women) or 60 g/day (men)"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Intake is self-reported; direct biomarkers are not used here."
          ]
        }
      ],
      "evidence": [
        "EV-DELPHI-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-alc-01"
    },
    {
      "id": "LV-01",
      "name": "MASLD criteria met",
      "group": "Classification",
      "status": "active",
      "classification": "Priority 3",
      "summary": "MASLD criteria met. Evaluates hepatic steatosis documented by imaging or biopsy.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "hepatic steatosis documented by imaging or biopsy",
            "at least one cardiometabolic risk factor (BMI ≥25, or ≥23 in Asian patients; or waist ≥94 cm men / ≥80 cm women; glucose ≥100 mg/dL, HbA1c ≥5.7%, or diabetes; blood pressure ≥130/85 or treated; triglycerides ≥150 or lipid-lowering treatment; HDL ≤40 men / ≤50 women or treated)",
            "alcohol in the MASLD range",
            "no other cause identified (LV-EXC-01 not fired)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Pattern meeting the 2023 MASLD criteria"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Assess fibrosis risk with FIB-4, then elastography or ELF when indeterminate or high",
            "Assess cardiovascular risk, the leading cause of death in MASLD"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A classification that needs steatosis; it says nothing about fibrosis stage."
          ]
        }
      ],
      "evidence": [
        "EV-DELPHI-2023",
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-01"
    },
    {
      "id": "LV-02",
      "name": "Steatosis not documented, fibrosis screening indicated",
      "group": "Classification",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Steatosis not documented, fibrosis screening indicated. Evaluates steatosis not documented.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "steatosis not documented",
            "type 2 diabetes OR prediabetes OR at least two cardiometabolic risk factors OR persistently raised ALT"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Screening opportunity: AASLD recommends FIB-4 in patients with these risk profiles"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Calculate FIB-4",
            "Consider liver imaging to document steatosis"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Does not diagnose MASLD; steatosis must be documented."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-02"
    },
    {
      "id": "LV-03",
      "name": "Steatosis without a cardiometabolic risk factor",
      "group": "Classification",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Steatosis without a cardiometabolic risk factor. Evaluates hepatic steatosis documented.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "hepatic steatosis documented",
            "no cardiometabolic risk factor present",
            "alcohol in the MASLD range"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "MASLD criteria are not met: consider other causes of steatosis (drugs, genetic and endocrine causes, rapid weight loss, malnutrition, lipodystrophy)"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Does not name the cause."
          ]
        }
      ],
      "evidence": [
        "EV-DELPHI-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-03"
    },
    {
      "id": "LV-04",
      "name": "ALT above the AASLD upper limit",
      "group": "Classification",
      "status": "active",
      "classification": "Priority 6",
      "summary": "ALT above the AASLD upper limit. Evaluates ALT above 33 U/L (men) or above 25 U/L (women).",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "ALT > 33 U/L (men) or > 25 U/L (women)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "ALT is above the sex-specific upper limit AASLD recommends"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Normal ALT does not exclude advanced fibrosis."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-04"
    },
    {
      "id": "LV-FIB-01",
      "name": "FIB-4 and its stratum",
      "group": "Fibrosis risk",
      "status": "active",
      "classification": "Priority 4",
      "summary": "FIB-4 and its stratum. Evaluates age, AST, ALT and platelets available.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "age, AST, ALT and platelets available"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "FIB-4 = age × AST ÷ (platelets × √ALT)",
            "Low risk: below 1.3 (below 2.0 from age 65)",
            "Indeterminate: 1.3 to 2.67 (2.0 to 2.67 from age 65)",
            "High risk: above 2.67"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A rule-out test for advanced fibrosis, not a diagnosis of fibrosis."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023",
        "EV-MCPHERSON-2017"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-fib-01"
    },
    {
      "id": "LV-FIB-02",
      "name": "Elastography or ELF stratum",
      "group": "Fibrosis risk",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Elastography or ELF stratum. Evaluates liver stiffness (kPa) OR ELF score entered.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "liver stiffness (kPa) OR ELF score entered"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Stiffness below 8 kPa: low risk",
            "8 to 12 kPa: indeterminate",
            "12 kPa or above: high likelihood of advanced fibrosis",
            "ELF below 7.7 low, 7.7 to 9.8 intermediate, 9.8 or above high"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Cutoffs are device and assay specific."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023",
        "EV-EASL-NIT-2021"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-fib-02"
    },
    {
      "id": "LV-FIB-03",
      "name": "FIB-4 and elastography disagree",
      "group": "Fibrosis risk",
      "status": "active",
      "classification": "Priority 3",
      "summary": "FIB-4 and elastography disagree. Evaluates FIB-4 low and liver stiffness 12 kPa or above, OR FIB-4 high and liver stiffness below 8 kPa.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "FIB-4 low and liver stiffness 12 kPa or above, OR FIB-4 high and liver stiffness below 8 kPa"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Discordant non-invasive tests: the result is not reassuring"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Consider repeating or adding another test (ELF, or elastography at a specialist center)"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Does not choose which test is right."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023",
        "EV-EASL-NIT-2021"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-fib-03"
    },
    {
      "id": "LV-FIB-04",
      "name": "ALT normalizing with falling platelets",
      "group": "Fibrosis risk",
      "status": "active",
      "classification": "Priority 3",
      "summary": "ALT normalizing with falling platelets. Evaluates steatotic liver disease known.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "steatotic liver disease known",
            "ALT falling or newly normal",
            "platelets falling"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Caution: falling ALT with falling platelets can mean advancing fibrosis, not improvement"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Recalculate FIB-4 and consider elastography; do not reassure on ALT alone"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A trend flag; it does not stage fibrosis."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-fib-04"
    },
    {
      "id": "LV-FIB-05",
      "name": "Advanced fibrosis likely",
      "group": "Fibrosis risk",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Advanced fibrosis likely. Evaluates FIB-4 above 2.67, OR liver stiffness 12 kPa or above, OR ELF 9.8 or above, OR cirrhosis known.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "FIB-4 above 2.67, OR liver stiffness 12 kPa or above, OR ELF 9.8 or above, OR cirrhosis known"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "High-risk fibrosis result: advanced fibrosis or cirrhosis is likely enough to need specialist evaluation"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Confirmation of stage belongs to hepatology."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-fib-05"
    },
    {
      "id": "LV-REF-01",
      "name": "Hepatology referral to consider",
      "group": "Fibrosis risk",
      "status": "active",
      "classification": "Priority 3",
      "summary": "Hepatology referral to consider. Evaluates advanced fibrosis likely (LV-FIB-05), OR decompensation, OR indeterminate non-invasive tests that stay indeterminate.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "advanced fibrosis likely (LV-FIB-05), OR decompensation, OR indeterminate non-invasive tests that stay indeterminate"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Referral to hepatology is reasonable to consider"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A prompt, not an order."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-ref-01"
    },
    {
      "id": "LV-SAFE-01",
      "name": "Signs of decompensated liver disease",
      "group": "Safety",
      "status": "active",
      "classification": "Priority 1",
      "summary": "Signs of decompensated liver disease. Evaluates jaundice OR ascites OR hepatic encephalopathy OR variceal or portal-hypertensive bleeding documented.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "jaundice OR ascites OR hepatic encephalopathy OR variceal or portal-hypertensive bleeding documented"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Urgent clinical assessment: possible decompensated liver disease"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Routine outpatient pathway is not appropriate."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-safe-01"
    },
    {
      "id": "LV-SAFE-02",
      "name": "Marked aminotransferase elevation",
      "group": "Safety",
      "status": "active",
      "classification": "Priority 1",
      "summary": "Marked aminotransferase elevation. Evaluates ALT or AST ≥ 1000 U/L (urgent).",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "ALT or AST ≥ 1000 U/L (urgent)",
            "ALT or AST 200 to 999 U/L (priority)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Values this high are not typical of MASLD: acute hepatitis (viral, drug, ischemic, autoimmune) needs to be considered"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Does not identify the cause."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-safe-02"
    },
    {
      "id": "LV-SAFE-03",
      "name": "Synthetic dysfunction or marked cholestasis",
      "group": "Safety",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Synthetic dysfunction or marked cholestasis. Evaluates total bilirubin above 3 mg/dL OR INR above 1.5 OR albumin below 3.0 g/dL.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "total bilirubin > 3 mg/dL OR INR > 1.5 OR albumin < 3.0 g/dL"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Priority review: markers of impaired liver function"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Do not attribute to MASLD without excluding other causes."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-safe-03"
    },
    {
      "id": "LV-HCC-01",
      "name": "Cirrhosis without recent surveillance imaging",
      "group": "Safety",
      "status": "active",
      "classification": "Priority 2",
      "summary": "Cirrhosis without recent surveillance imaging. Evaluates cirrhosis known.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "cirrhosis known",
            "no liver ultrasound in the last 6 months"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Surveillance gap: AASLD recommends ultrasound with or without AFP every 6 months in cirrhosis"
          ]
        },
        {
          "heading": "Recommended next steps (for physician review)",
          "items": [
            "Arrange surveillance imaging per AASLD 2023"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "FIB-4 alone does not trigger surveillance; cirrhosis must be established."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-HCC-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-hcc-01"
    },
    {
      "id": "LV-VIR-01",
      "name": "Viral hepatitis not excluded",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 4",
      "summary": "Viral hepatitis not excluded. Evaluates raised ALT or AST OR steatosis documented.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "raised ALT or AST OR steatosis documented",
            "hepatitis B surface antigen and hepatitis C antibody not documented"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Testing prompt: CDC recommends universal one-time screening for hepatitis B and C in adults"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "A testing prompt."
          ]
        }
      ],
      "evidence": [
        "EV-CDC-HEP-2020"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-vir-01"
    },
    {
      "id": "LV-HFE-01",
      "name": "Iron-overload pattern",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 3",
      "summary": "Iron-overload pattern. Evaluates transferrin saturation above 45%.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "transferrin saturation > 45%",
            "ferritin > 300 ng/mL (men) or > 200 ng/mL (women)"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Possible iron overload: hemochromatosis testing may be appropriate"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Hyperferritinemia is common in MASLD; high saturation is what makes this pattern."
          ]
        }
      ],
      "evidence": [
        "EV-EASL-HFE-2022"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-hfe-01"
    },
    {
      "id": "LV-CV-01",
      "name": "Cardiovascular risk assessment",
      "group": "Context triggers",
      "status": "active",
      "classification": "Priority 5",
      "summary": "Cardiovascular risk assessment. Evaluates MASLD criteria met.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "MASLD criteria met"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "Cardiovascular disease is the leading cause of death in MASLD: a formal risk assessment is part of the work-up"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Hands off to the cardiovascular risk engine."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-cv-01"
    },
    {
      "id": "LV-MISS-01",
      "name": "FIB-4 inputs incomplete",
      "group": "Missing data",
      "status": "active",
      "classification": "Priority 8",
      "summary": "FIB-4 inputs incomplete. Evaluates steatosis documented OR fibrosis screening indicated.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "steatosis documented OR fibrosis screening indicated",
            "age, AST, ALT or platelets missing"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "FIB-4 cannot be calculated with the data entered"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Names what is needed; never infers a value."
          ]
        }
      ],
      "evidence": [
        "EV-AASLD-2023"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-miss-01"
    },
    {
      "id": "LV-CALC-01",
      "name": "Derived value",
      "group": "Calculations",
      "status": "module",
      "classification": "Context",
      "summary": "Derived value. Evaluates age, AST, ALT and platelets available.",
      "sections": [
        {
          "heading": "Condition",
          "items": [
            "age, AST, ALT and platelets available"
          ]
        },
        {
          "heading": "What it reports",
          "items": [
            "FIB-4"
          ]
        },
        {
          "heading": "Diagnostic boundary",
          "items": [
            "Informational."
          ]
        }
      ],
      "evidence": [
        "EV-MCPHERSON-2017"
      ],
      "url": "https://biod.ai/tools/liver/rules/lv-calc-01"
    }
  ],
  "evidence": [
    {
      "id": "EV-AASLD-2023",
      "citation": "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.",
      "supports": [
        "FIB-4 first for risk stratification; thresholds <1.3 and >2.67; elastography 8 and 12 kPa; ELF 7.7 and 9.8",
        "ALT upper limits near 29–33 U/L (men) and 19–25 U/L (women)",
        "Cardiovascular risk is the leading cause of death in MASLD"
      ]
    },
    {
      "id": "EV-DELPHI-2023",
      "citation": "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.",
      "supports": [
        "MASLD criteria: steatosis plus at least one cardiometabolic risk factor and no other cause",
        "MetALD and alcohol-related liver disease separated by intake"
      ]
    },
    {
      "id": "EV-MCPHERSON-2017",
      "citation": "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.",
      "supports": [
        "FIB-4 lower cutoff of 2.0 in patients aged 65 and over"
      ]
    },
    {
      "id": "EV-EASL-NIT-2021",
      "citation": "European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis, 2021 update. J Hepatol. 2021;75(3):659-689.",
      "supports": [
        "Use of elastography and serum tests in sequence, and handling of discordant results"
      ]
    },
    {
      "id": "EV-AASLD-HCC-2023",
      "citation": "Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922-1965.",
      "supports": [
        "Surveillance with ultrasound with or without AFP every 6 months in cirrhosis"
      ]
    },
    {
      "id": "EV-CDC-HEP-2020",
      "citation": "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.",
      "supports": [
        "One-time universal screening for hepatitis C and hepatitis B in adults"
      ]
    },
    {
      "id": "EV-EASL-HFE-2022",
      "citation": "European Association for the Study of the Liver. EASL Clinical Practice Guidelines on haemochromatosis. J Hepatol. 2022;77(2):479-502.",
      "supports": [
        "Transferrin saturation >45% with raised ferritin prompts HFE testing"
      ]
    }
  ]
}