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CPE-005 · Scope and validity
LV-EXC-01: Another liver disease or cause is present
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.
Condition
- 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
What it reports
- Another cause of liver injury is present or suspected: steatosis may still be metabolic, but the liver disease cannot be attributed to MASLD alone
Recommended next steps (for physician review)
- Address the other cause and reassess; MASLD can coexist with it
Diagnostic boundary
- Coexistence is common; this rule withholds the MASLD label, not the metabolic risk.
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.
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