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CPE-005 · Fibrosis risk
LV-REF-01: Hepatology referral to consider
Hepatology referral to consider. Evaluates advanced fibrosis likely (LV-FIB-05), OR decompensation, OR indeterminate non-invasive tests that stay indeterminate.
Condition
- advanced fibrosis likely (LV-FIB-05), OR decompensation, OR indeterminate non-invasive tests that stay indeterminate
What it reports
- Referral to hepatology is reasonable to consider
Diagnostic boundary
- A prompt, not an order.
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-04
High FIB-4
FIB-4 above 5 in a 63-year-old man with low platelets.
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-09
Alcohol-related liver disease predominant
About 90 g a day in a man with steatosis.
LIVER-FX-13
Cirrhosis with no ultrasound for nine months
A surveillance gap in known cirrhosis.
LIVER-FX-14
Cirrhosis with recent surveillance
Ultrasound four months ago.
LIVER-FX-15
Jaundice and ascites
Signs of decompensation.
LIVER-FX-16
ALT 1,350 U/L
Values far above anything MASLD explains.
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