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CPE-005 · Classification
LV-04: ALT above the AASLD upper limit
ALT above the AASLD upper limit. Evaluates ALT above 33 U/L (men) or above 25 U/L (women).
Condition
- ALT > 33 U/L (men) or > 25 U/L (women)
What it reports
- ALT is above the sex-specific upper limit AASLD recommends
Diagnostic boundary
- Normal ALT does not exclude advanced fibrosis.
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
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-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-07
ELF 10.1
A high ELF with FIB-4 in the indeterminate range.
LIVER-FX-08
Alcohol in the MetALD range
A woman drinking about 35 g a day with steatosis and metabolic risk.
LIVER-FX-09
Alcohol-related liver disease predominant
About 90 g a day in a man with steatosis.
LIVER-FX-10
Hepatitis B surface antigen positive
Steatosis plus a second liver disease.
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