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CPE-005 · Classification
LV-01: MASLD criteria met
MASLD criteria met. Evaluates hepatic steatosis documented by imaging or biopsy.
Condition
- 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)
What it reports
- Pattern meeting the 2023 MASLD criteria
Recommended next steps (for physician review)
- Assess fibrosis risk with FIB-4, then elastography or ELF when indeterminate or high
- Assess cardiovascular risk, the leading cause of death in MASLD
Diagnostic boundary
- A classification that needs steatosis; it says nothing about fibrosis stage.
Evidence
- EV-AASLD-2023Rinella 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
- EV-DELPHI-2023Rinella 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
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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-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.
LIVER-FX-07
ELF 10.1
A high ELF with FIB-4 in the indeterminate range.
LIVER-FX-12
ALT falling while platelets fall
Known fatty liver, ALT now normal and platelets down to 140.
LIVER-FX-13
Cirrhosis with no ultrasound for nine months
A surveillance gap in known cirrhosis.
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