Established cirrhosis of any etiology (Child-Pugh A, B, or C) when the specific cause is...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHRONIC-CIRRHOSIS-ETIOLOGY-AGNOSTIC-HCC-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-20 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HCC-2023` `SRC-NCCN-HCC-2025`

Red Flag Origin

Definition	Established cirrhosis of any etiology (Child-Pugh A, B, or C) when the specific cause is either not yet classified, multi-factorial, or falls outside the dedicated etiology-specific RedFlags (RF-CHRONIC-HBV-MALIGNANCY-PREVENTION for chronic hepatitis B, RF-CHRONIC-HCV-NHL-PREVENTION for chronic hepatitis C, and any future dedicated RFs for chronic NAFLD/MASH, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson disease, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis). This etiology-agnostic anchor exists because the AASLD HCC Guidance 2023 endorses HCC surveillance in ALL cirrhotic patients regardless of underlying cause — the cirrhotic liver itself is the dominant HCC risk driver (annual HCC incidence ~1-4% across etiologies, far above population baseline ~0.001-0.01%). Surveillance with abdominal US ± AFP every 6 months reduces HCC-specific mortal...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "cirrhosis_established_etiology_agnostic",
      "value": true
    },
    {
      "finding": "cirrhosis_child_pugh_a",
      "value": true
    },
    {
      "finding": "cirrhosis_child_pugh_b",
      "value": true
    },
    {
      "finding": "cirrhosis_child_pugh_c",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 wave-N niche pathway — etiology-agnostic cirrhosis HCC surveillance. Fires on documented cirrhosis (clinical diagnosis, biopsy-proven, or imaging-consistent advanced fibrosis F4) when the specific causal etiology is unclassified, multi-factorial, or outside the dedicated etiology-specific RFs. This is the workhorse RF for the substantial population of cirrhotic patients whose etiology is alcoholic (where we currently don't have a dedicated alcoholic-cirrhosis RF), NAFLD/MASH (no dedicated RF yet), mixed alcoholic-NAFLD, cryptogenic, or hemochromatosis / Wilson / A1AT / autoimmune hepatitis (each rare enough that they share this etiology-agnostic anchor). Engine routes to PreventionPlan recommending: (a) IND-CIRRHOSIS-HCC-SURVEILLANCE (standard) — abdominal US + AFP q6 months at center experienced with cirrhotic-liver imaging; alcohol abstinence; obesity management (NAFLD subset); etiology-specific treatment of underlying liver disease (HBV antivirals, HCV DAAs, weight loss for NAFLD, venesection for hemochromatosis, etc.) where applicable; nutrition + sarcopenia management; pre-transplant evaluation when MELD ≥15 or HCC found within Milan criteria. (b) IND-CIRRHOSIS-HCC-OBSER...

Used By

Indications

IND-CIRRHOSIS-HCC-OBSERVATION - IND-CIRRHOSIS-HCC-OBSERVATION
IND-CIRRHOSIS-HCC-SURVEILLANCE - IND-CIRRHOSIS-HCC-SURVEILLANCE
IND-SEVERE-OBESITY-CANCER-PREVENTION-INTENSIFIED - IND-SEVERE-OBESITY-CANCER-PREVENTION-INTENSIFIED