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CPE-002 · synthetic case CPE002-FX-015

Severe Hypertriglyceridemia

Triglycerides of 640 mg/dL.

Synthetic · no real patientReviewed acceptance scenarioMetabolic engine v1.0.0

Purpose: Severe hypertriglyceridemia (priority review).

Inputs the engine received

Patient

Age
46 years

Context

Sex for threshold application
male
Active medication list available
Yes

Laboratory

Triglycerides
640 mg/dL
HDL cholesterol
34 mg/dL

What the engine reports

Priority

Severe hypertriglyceridemia — priority review

SAFE-TG-001

Triglycerides ≥500 mg/dL require severe hypertriglyceridemia and pancreatitis-risk review.

Detected clinical pattern

Priority Review Finding

A safety rule calls for priority physician review: severe hypertriglyceridemia — priority review.

  • Glycemic: Glycemic Category Not Assessable
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: Metabolic screening opportunity
  • Safety: Priority review

Why this pattern was identified

  • Atherogenic dyslipidemia supporting pattern. High triglycerides with low HDL-C. Supports metabolic risk context; it does not diagnose insulin resistance.
  • Metabolic screening opportunity. Risk context identified; insulin resistance is not diagnosed.

Calculations

TG/HDL-C ratio
18.82

Informational only. No threshold interpretation is enabled; it does not diagnose insulin resistance.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Priority physician review of severe hypertriglyceridemia and pancreatitis risk.
  2. 2Consider obtaining a glycemic test: confirmed-fasting glucose, HbA1c or a 75-g OGTT.Risk context is present without an interpretable glycemic test.
  3. 3Review cardiovascular risk.Metabolic syndrome or atherogenic dyslipidemia pattern.

Missing information

  • An interpretable glycemic test (confirmed-fasting glucose, HbA1c without interference, or a protocol-confirmed 2-h OGTT).
  • Metabolic syndrome components not entered: Elevated waist circumference; BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 13 rules

SAFE-TG-001Severe Hypertriglyceridemia

Inputs: triglycerides 640 mg/dL

SEVERE_HYPERTRIGLYCERIDEMIA_PANCREATITIS_RISK_REVIEW

METS-COMP-002Triglycerides ≥150 mg/dL (or treated)

Inputs: triglycerides 640 mg/dL

METS_TRIGLYCERIDES_COMPONENT_MET

METS-COMP-003Low HDL-C (men <40, women <50 mg/dL)

Inputs: HDL-C 34 mg/dL (male)

METS_HDL_COMPONENT_MET

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 2 of 5 components met · missing: Elevated waist circumference; BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

LIPID-001TG to HDL Ratio Informational Calculation

Inputs: TG 640 · HDL-C 34

TG_HDL_RATIO_CALCULATED

LIPID-002Atherogenic Dyslipidemia Supporting Pattern

Inputs: TG 640 ≥150 · HDL-C 34 (low for sex)

ATHEROGENIC_DYSLIPIDEMIA_SUPPORTING_PATTERN

CROSS-CV-001Cardiovascular Risk Review

Inputs: atherogenic dyslipidemia supporting pattern

CARDIOVASCULAR_RISK_REVIEW

IRP-001Metabolic Screening Opportunity

Inputs: Atherogenic dyslipidemia supporting pattern

METABOLIC_SCREENING_OPPORTUNITY_IDENTIFIED

MISS-001Insulin Pattern Missing Data

Inputs: fasting insulin not provided

IR_PATTERN_NOT_FULLY_ASSESSABLE_WITH_CURRENT_DATA

IRP-002Hyperinsulinemic Supporting Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-003Elevated HOMA-IR Supporting Findingsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-004Convergent IR-Associated Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

TREND-MET-001Composite Metabolic Deterioration Warningsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

Evidence

  • EV-NIDDK-IR · National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance & Prediabetes.
  • EV-METS-2009 · IDF/AHA/NHLBI/WHF/IAS/IASO Joint Interim Statement. Harmonizing the Metabolic Syndrome. Circulation. 2009;120:1640-1645.
  • EV-ACC-TG-2021 · American College of Cardiology Expert Consensus Decision Pathway. Persistent Hypertriglyceridemia. 2021.

Physician adjudication required. Clinical decision support only. This output identifies guideline-based glycemic and metabolic findings and risk context. It does not diagnose insulin resistance, select treatment or recommend medication. Physician adjudication is required.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

Glycemic testsDrag the sliders to cross a threshold
  • <100
  • 100–125 prediabetes
  • ≥126 diabetes range
  • <5.7
  • 5.7–6.4 prediabetes
  • ≥6.5 diabetes range

75-g protocol

Lipids, body and blood pressure
  • <150
  • 150–499
  • ≥500 priority
  • ≥1000 urgent

Metabolic syndrome components2 of 5

  • ○ Waist not entered
  • ● Triglycerides met
  • ● Low HDL-C met
  • ○ Blood pressure not entered
  • ○ Fasting glucose not entered

● met · ◌ not met · ○ not entered. Three or more meet the criteria; that does not confirm insulin resistance.

Patient and scope
Sex for thresholds
Ketones
Symptoms and safety
Risk context
Liver context
Medications
Outside the standard adult runtime
Fasting insulin (supporting only)Calculation and sandbox

Shown with HOMA-IR when fasting and same-collection are confirmed. It does not classify anything.

Research sandbox (unvalidated)

In production the insulin and HOMA-IR rules are off: no validated threshold profile exists. Here you can supply your own threshold to see how the sandbox rules would behave. The output is labeled a sandbox candidate and is never a diagnosis.

Live result · computed in your browser

Priority

Severe hypertriglyceridemia — priority review

SAFE-TG-001

Triglycerides ≥500 mg/dL require severe hypertriglyceridemia and pancreatitis-risk review.

Detected clinical pattern

Priority Review Finding

A safety rule calls for priority physician review: severe hypertriglyceridemia — priority review.

  • Glycemic: Glycemic Category Not Assessable
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: Metabolic screening opportunity
  • Safety: Priority review

Why this pattern was identified

  • Atherogenic dyslipidemia supporting pattern. High triglycerides with low HDL-C. Supports metabolic risk context; it does not diagnose insulin resistance.
  • Metabolic screening opportunity. Risk context identified; insulin resistance is not diagnosed.

Calculations

TG/HDL-C ratio
18.82

Informational only. No threshold interpretation is enabled; it does not diagnose insulin resistance.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Priority physician review of severe hypertriglyceridemia and pancreatitis risk.
  2. 2Consider obtaining a glycemic test: confirmed-fasting glucose, HbA1c or a 75-g OGTT.Risk context is present without an interpretable glycemic test.
  3. 3Review cardiovascular risk.Metabolic syndrome or atherogenic dyslipidemia pattern.

Missing information

  • An interpretable glycemic test (confirmed-fasting glucose, HbA1c without interference, or a protocol-confirmed 2-h OGTT).
  • Metabolic syndrome components not entered: Elevated waist circumference; BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 13 rules

SAFE-TG-001Severe Hypertriglyceridemia

Inputs: triglycerides 640 mg/dL

SEVERE_HYPERTRIGLYCERIDEMIA_PANCREATITIS_RISK_REVIEW

METS-COMP-002Triglycerides ≥150 mg/dL (or treated)

Inputs: triglycerides 640 mg/dL

METS_TRIGLYCERIDES_COMPONENT_MET

METS-COMP-003Low HDL-C (men <40, women <50 mg/dL)

Inputs: HDL-C 34 mg/dL (male)

METS_HDL_COMPONENT_MET

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 2 of 5 components met · missing: Elevated waist circumference; BP ≥130/85 mmHg (or treated); Fasting glucose ≥100 mg/dL (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

LIPID-001TG to HDL Ratio Informational Calculation

Inputs: TG 640 · HDL-C 34

TG_HDL_RATIO_CALCULATED

LIPID-002Atherogenic Dyslipidemia Supporting Pattern

Inputs: TG 640 ≥150 · HDL-C 34 (low for sex)

ATHEROGENIC_DYSLIPIDEMIA_SUPPORTING_PATTERN

CROSS-CV-001Cardiovascular Risk Review

Inputs: atherogenic dyslipidemia supporting pattern

CARDIOVASCULAR_RISK_REVIEW

IRP-001Metabolic Screening Opportunity

Inputs: Atherogenic dyslipidemia supporting pattern

METABOLIC_SCREENING_OPPORTUNITY_IDENTIFIED

MISS-001Insulin Pattern Missing Data

Inputs: fasting insulin not provided

IR_PATTERN_NOT_FULLY_ASSESSABLE_WITH_CURRENT_DATA

IRP-002Hyperinsulinemic Supporting Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-003Elevated HOMA-IR Supporting Findingsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-004Convergent IR-Associated Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

TREND-MET-001Composite Metabolic Deterioration Warningsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

Evidence

  • EV-NIDDK-IR · National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance & Prediabetes.
  • EV-METS-2009 · IDF/AHA/NHLBI/WHF/IAS/IASO Joint Interim Statement. Harmonizing the Metabolic Syndrome. Circulation. 2009;120:1640-1645.
  • EV-ACC-TG-2021 · American College of Cardiology Expert Consensus Decision Pathway. Persistent Hypertriglyceridemia. 2021.

Physician adjudication required. Clinical decision support only. This output identifies guideline-based glycemic and metabolic findings and risk context. It does not diagnose insulin resistance, select treatment or recommend medication. Physician adjudication is required.

More metabolic cases

CPE002-FX-001

Healthy Metabolic Baseline

A 35-year-old with normal glucose, lipids, waist and blood pressure.

CPE002-FX-002

Prediabetes by HbA1c

HbA1c of 6.0% and nothing else.

CPE002-FX-003

Prediabetes by FPG

Confirmed-fasting glucose of 108 mg/dL.

CPE002-FX-004

OGTT-Only Prediabetes

Only a 75-g OGTT: 2-hour glucose 165 mg/dL.

CPE002-FX-005

Diabetes-Range Finding

HbA1c 6.8% and fasting glucose 134 mg/dL.

CPE002-FX-006

Metabolic Syndrome with Normal Glucose

Normal glucose, but waist 108 cm, TG 190, HDL 36 and BP 138/88.

All metabolic cases

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