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CPE-002 · synthetic case CPE002-FX-019

MASLD Cross-Trigger with FIB-4

Hepatic steatosis on ultrasound. AST 48, ALT 62, platelets 170.

Synthetic · no real patientReviewed acceptance scenarioMetabolic engine v1.0.0

Purpose: A liver-risk review with FIB-4 routing.

Inputs the engine received

Patient

Age
55 years

Context

Sex for threshold application
male
Fasting confirmed
Yes
Active medication list available
Yes
Documented hepatic steatosis
Yes
Liver risk review indicated
Yes

Laboratory

Fasting plasma glucose
99 mg/dL
AST
48 U/L
ALT
62 U/L
Platelets
170 10⁹/L

What the engine reports

Detected clinical pattern

No Dysglycemia Criterion Identified

The interpretable test(s) entered do not meet a prediabetes or diabetes criterion. This is not a statement that the patient has no metabolic risk.

  • Glycemic: No Dysglycemia Criterion Identified
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: IR-associated pattern: not assessable

Why this pattern was identified

  • No glycemic criterion met. Evaluated: FPG 99 mg/dL.
  • Liver-risk review. Routes to the hepatic pathway. It does not diagnose MASLD or insulin resistance by itself.

Calculations

FIB-4
1.97

Used inside the hepatic pathway only; <1.3 is generally a low-risk initial result.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Review hepatic risk within the hepatic pathway (FIB-4 when indicated).Cross-engine liver-risk trigger.
  2. 2Consider secondary fibrosis-risk assessment within the hepatic pathway.FIB-4 ≥1.3.

Missing information

  • Metabolic syndrome components not entered: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 9 rules

GLY-001No Dysglycemia Criterion Identified

Inputs: FPG 99 mg/dL

NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 0 of 5 components met · missing: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

CROSS-MASLD-001MASLD/Liver Review Trigger

Inputs: documented hepatic steatosis

MASLD_OR_LIVER_RISK_REVIEW

CROSS-MASLD-002FIB-4 Routing

Inputs: FIB-4 1.97 ≥ 1.3

SECONDARY_FIBROSIS_RISK_ASSESSMENT_CONSIDERATION

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-ADA-2026-DIAG · American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49.
  • EV-AASLD-MASLD · American Association for the Study of Liver Diseases. Noninvasive Assessment of Patients with MASLD.

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 components0 of 5

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

● 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

Detected clinical pattern

No Dysglycemia Criterion Identified

The interpretable test(s) entered do not meet a prediabetes or diabetes criterion. This is not a statement that the patient has no metabolic risk.

  • Glycemic: No Dysglycemia Criterion Identified
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: IR-associated pattern: not assessable

Why this pattern was identified

  • No glycemic criterion met. Evaluated: FPG 99 mg/dL.
  • Liver-risk review. Routes to the hepatic pathway. It does not diagnose MASLD or insulin resistance by itself.

Calculations

FIB-4
1.97

Used inside the hepatic pathway only; <1.3 is generally a low-risk initial result.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Review hepatic risk within the hepatic pathway (FIB-4 when indicated).Cross-engine liver-risk trigger.
  2. 2Consider secondary fibrosis-risk assessment within the hepatic pathway.FIB-4 ≥1.3.

Missing information

  • Metabolic syndrome components not entered: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 9 rules

GLY-001No Dysglycemia Criterion Identified

Inputs: FPG 99 mg/dL

NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 0 of 5 components met · missing: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

CROSS-MASLD-001MASLD/Liver Review Trigger

Inputs: documented hepatic steatosis

MASLD_OR_LIVER_RISK_REVIEW

CROSS-MASLD-002FIB-4 Routing

Inputs: FIB-4 1.97 ≥ 1.3

SECONDARY_FIBROSIS_RISK_ASSESSMENT_CONSIDERATION

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-ADA-2026-DIAG · American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49.
  • EV-AASLD-MASLD · American Association for the Study of Liver Diseases. Noninvasive Assessment of Patients with MASLD.

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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