@precisa-saude/fhir 0.33.0 → 0.35.0

package/dist/cli.js

@@ -115,6 +115,32 @@ var BIOMARKER_DEFINITIONS = [
     category: "coracao",
     code: "LDL",
     loinc: "2089-1",
+    // Os três irmãos de 2089-1 no eixo Method, conferidos ativos em out/2026.
+    // Medido em três dezenas de laudos reais, a única pista escrita foi a
+    // nota de rodapé de um laboratório norte-americano que declara o cálculo de
+    // Martin-Hopkins. Nenhum laudo brasileiro do corpus imprimiu "calculado",
+    // "direto" ou "Método:" perto do LDL, e por isso as outras duas variantes
+    // ficam sem pista até aparecer laudo que as afirme.
+    methodVariants: [
+      {
+        cues: { en: ["calculated using the Martin-Hopkins"], pt: [] },
+        loinc: "96259-7",
+        method: "Calculated.Martin-Hopkins",
+        note: 'Rodap\xE9 "LDL-C is now calculated using the Martin-Hopkins calculation", que menciona Friedewald s\xF3 para comparar. Por isso a pista \xE9 a frase afirmativa, e n\xE3o o nome do m\xE9todo.'
+      },
+      {
+        cues: { en: [], pt: [] },
+        loinc: "13457-7",
+        method: "Calculated",
+        note: "Friedewald. Sem pista: nenhum laudo do corpus afirmou o c\xE1lculo por escrito."
+      },
+      {
+        cues: { en: [], pt: [] },
+        loinc: "18262-6",
+        method: "Direct assay",
+        note: "Dosagem direta. Sem pista: nenhum laudo do corpus afirmou o m\xE9todo por escrito."
+      }
+    ],
     names: {
       en: ["LDL Cholesterol", "LDL", "Low-Density Lipoprotein"],
       pt: ["Colesterol LDL", "LDL", "LDL-Colesterol"]
@@ -3313,6 +3339,10 @@ for (const def of BIOMARKER_DEFINITIONS) {
       validLoincSet.add(alias);
     }
   }
+  for (const variant of def.methodVariants ?? []) {
+    loincToCodeMap.set(variant.loinc, def.code);
+    validLoincSet.add(variant.loinc);
+  }
   if (def.codeAliases) {
     for (const alias of def.codeAliases) {
       codeAliasToCanonicalMap.set(alias, def.code);
@@ -3324,6 +3354,9 @@ for (const def of BIOMARKER_DEFINITIONS) {
 function loincToCode(loinc) {
   return loincToCodeMap.get(loinc);
 }
+function methodVariantOf(code, loinc) {
+  return codeToDefinitionMap.get(code)?.methodVariants?.find((v) => v.loinc === loinc);
+}
 function codeToLoinc(code) {
   return codeToLoincMap.get(code);
 }
@@ -4412,628 +4445,89 @@ function resolveUcum(unit, biomarkerCode) {
   return isUcumCode(unit) ? unit : void 0;
 }
 
-// src/converter.ts
-function interpretationCode(flag) {
-  switch (flag) {
-    case "H":
-      return "H";
-    // High
-    case "L":
-      return "L";
-    // Low
-    default:
-      return "N";
-  }
-}
-function interpretationDisplay(flag) {
-  switch (flag) {
-    case "H":
-      return "High";
-    case "L":
-      return "Low";
-    default:
-      return "Normal";
-  }
-}
-var SEX_CODING = {
-  female: {
-    code: "female",
-    display: "Female",
-    system: "http://hl7.org/fhir/administrative-gender"
+// src/reference-ranges.ts
+var biomarkerRangeDefinitions = {
+  Albumin_Creatinine_Ratio: {
+    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/g" },
+    kind: "decision-threshold",
+    source: "tietz-7ed-2015"
   },
-  male: { code: "male", display: "Male", system: "http://hl7.org/fhir/administrative-gender" }
-};
-var buildReferenceRanges = (observation, quantity) => {
-  const toRanges = (low, high, sex) => {
-    if (low === void 0 && high === void 0) return [];
-    return [
+  Adiponectin: {
+    default: { max: 26, min: 4, optimalMax: 20, optimalMin: 8, unit: "mcg/mL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  ADMA: {
+    default: { max: 0.7, min: 0.3, optimalMax: 0.55, optimalMin: 0.3, unit: "umol/L" },
+    kind: "reference-interval",
+    source: "nemeth-adma-2017"
+  },
+  AFP: {
+    default: { max: 10, min: 0, optimalMax: 8, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
+    source: "sturgeon-nacb-2008"
+  },
+  Albumin_Globulin_Ratio: {
+    default: { max: 2.5, min: 1, optimalMax: 2.2, optimalMin: 1.2, unit: "" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Albumin: {
+    default: { max: 5, min: 3.5, optimalMax: 4.8, optimalMin: 4, unit: "g/dL" },
+    kind: "reference-interval",
+    source: "pns-bioquimica-2019"
+  },
+  AlkalinePhosphatase: {
+    default: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
       {
-        ...sex === void 0 ? {} : { appliesTo: [{ coding: [SEX_CODING[sex]] }] },
-        ...high === void 0 ? {} : { high: quantity(high) },
-        ...low === void 0 ? {} : { low: quantity(low) }
-      }
-    ];
-  };
-  if (observation.referenceRanges && observation.referenceRanges.length > 0) {
-    return observation.referenceRanges.flatMap((r) => toRanges(r.low, r.high, r.appliesTo));
-  }
-  return toRanges(observation.referenceMin, observation.referenceMax);
-};
-function labObservationToFHIR(observation, patientId, laboratoryName) {
-  const loincCode = codeToLoinc(observation.biomarkerCode);
-  const sourceUnit = observation.unit || getDefaultUnit(observation.biomarkerCode) || observation.unit;
-  const ucumUnit = resolveUcum(sourceUnit, observation.biomarkerCode);
-  const quantity = (value) => ({
-    ...ucumUnit ? { code: ucumUnit, system: "http://unitsofmeasure.org" } : {},
-    ...sourceUnit ? { unit: sourceUnit } : {},
-    value
-  });
-  const isQualitative = observation.isQualitative || typeof observation.value === "string";
-  const fhirObs = {
-    category: [
+        ageMin: 18,
+        range: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
+        sex: "M"
+      },
       {
-        coding: [
-          {
-            code: "laboratory",
-            display: "Laboratory",
-            system: "http://terminology.hl7.org/CodeSystem/observation-category"
-          }
-        ]
+        ageMin: 18,
+        range: { max: 104, min: 35, optimalMax: 90, optimalMin: 40, unit: "U/L" },
+        sex: "F"
       }
-    ],
-    code: {
-      // Sem LOINC, o coding LOINC simplesmente não sai. Antes ia `99999-9`,
-      // que não é código LOINC nenhum: publicava sob `http://loinc.org` uma
-      // afirmação falsa, e quem consumisse o bundle confiando no system
-      // trataria aquilo como código de verdade. Composição corporal, densidade
-      // óssea e escore de cálcio não têm LOINC, e o certo é a lacuna explícita.
-      coding: [
-        ...loincCode ? [
-          {
-            code: loincCode,
-            display: observation.biomarkerName,
-            system: LOINC_SYSTEM
-          }
-        ] : [],
-        {
-          code: observation.biomarkerCode,
-          display: observation.biomarkerName,
-          system: BIOMARKER_CODE_SYSTEM
-        }
-      ],
-      text: observation.biomarkerName
-    },
-    effectiveDateTime: observation.collectionDate,
-    id: `${observation.reportId}-${observation.biomarkerCode}`,
-    interpretation: [
+    ]
+  },
+  ALT: {
+    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
       {
-        coding: [
-          {
-            code: interpretationCode(observation.flag),
-            display: interpretationDisplay(observation.flag),
-            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
-          }
-        ]
-      }
-    ],
-    performer: laboratoryName ? [{ display: laboratoryName }] : void 0,
-    resourceType: "Observation",
-    status: "final",
-    subject: {
-      reference: `Patient/${patientId}`
-    }
-  };
-  if (isQualitative) {
-    fhirObs.valueString = String(observation.value);
-  } else {
-    fhirObs.valueQuantity = quantity(observation.value);
-    const referenceRange = buildReferenceRanges(observation, quantity);
-    if (referenceRange.length > 0) fhirObs.referenceRange = referenceRange;
-  }
-  return fhirObs;
-}
-function labReportToFHIR(report, patientId, observationIds) {
-  let status;
-  switch (report.processingStatus) {
-    case "complete":
-      status = "final";
-      break;
-    case "partial":
-      status = "partial";
-      break;
-    case "pending_review":
-      status = "preliminary";
-      break;
-    default:
-      status = "final";
-  }
-  return {
-    category: [
+        ageMin: 18,
+        range: { max: 56, min: 7, optimalMax: 35, optimalMin: 10, unit: "U/L" },
+        sex: "M"
+      },
       {
-        coding: [
-          {
-            code: "LAB",
-            display: "Laboratory",
-            system: "http://terminology.hl7.org/CodeSystem/v2-0074"
-          }
-        ]
+        ageMin: 18,
+        range: { max: 45, min: 7, optimalMax: 30, optimalMin: 10, unit: "U/L" },
+        sex: "F"
       }
-    ],
-    code: {
-      coding: [
-        {
-          code: "11502-2",
-          // Laboratory report
-          display: "Laboratory report",
-          system: "http://loinc.org"
-        }
-      ],
-      text: "Laboratory Results"
-    },
-    conclusion: report.overallStatus === "NORMAL" ? "All results within normal limits" : "One or more abnormal results detected",
-    conclusionCode: report.overallStatus === "ANORMAL" ? [
+    ]
+  },
+  // AMH — fortemente dependente de idade e sexo. As variantes femininas por
+  // faixa etária são a referência clínica; o `default` foi ajustado para
+  // refletir uma faixa adulta conservadora (~18-40 anos, mulheres em idade
+  // reprodutiva geral). optimalMax anterior (6.9 ng/mL) sobrepunha-se a
+  // valores sugestivos de SOP ou risco de OHSS; clinicamente, valores acima
+  // de ~4 ng/mL já merecem investigação.
+  AMH: {
+    default: { max: 6, min: 1, optimalMax: 4, optimalMin: 1.5, unit: "ng/mL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
       {
-        coding: [
-          {
-            code: "A",
-            display: "Abnormal",
-            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
-          }
-        ]
-      }
-    ] : void 0,
-    effectiveDateTime: report.collectionDate,
-    id: report.reportId,
-    issued: report.createdAt,
-    performer: report.laboratoryName ? [{ display: report.laboratoryName }] : void 0,
-    resourceType: "DiagnosticReport",
-    result: observationIds.map((id) => ({ reference: `Observation/${id}` })),
-    status,
-    subject: {
-      reference: `Patient/${patientId}`
-    }
-  };
-}
-function userProfileToFHIR(profile) {
-  const nameParts = profile.name.split(" ");
-  const given = nameParts.slice(0, -1);
-  const family = nameParts[nameParts.length - 1] || "";
-  return {
-    address: profile.address ? [
-      {
-        city: profile.address.city,
-        country: profile.address.country || "BR",
-        line: [
-          profile.address.street && profile.address.number ? `${profile.address.street}, ${profile.address.number}` : profile.address.street,
-          profile.address.complement
-        ].filter(Boolean),
-        postalCode: profile.address.postalCode,
-        state: profile.address.state
-      }
-    ] : void 0,
-    birthDate: profile.birthDate,
-    gender: profile.gender,
-    id: profile.userId,
-    name: [
-      {
-        family,
-        given: given.length > 0 ? given : void 0,
-        text: profile.name
-      }
-    ],
-    resourceType: "Patient",
-    telecom: [
-      ...profile.email ? [{ system: "email", value: profile.email }] : [],
-      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
-    ].length > 0 ? [
-      ...profile.email ? [{ system: "email", value: profile.email }] : [],
-      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
-    ] : void 0
-  };
-}
-function labResultToFHIRBundle(report, observations, userProfile) {
-  const patientId = userProfile.userId;
-  const fhirObservations = observations.map((obs) => {
-    const resource = labObservationToFHIR(
-      { ...obs, collectionDate: report.collectionDate },
-      patientId,
-      report.laboratoryName
-    );
-    return { fullUrl: entryFullUrl(resource), resource };
-  });
-  const observationIds = fhirObservations.map((entry) => entry.resource.id);
-  const diagnosticReport = labReportToFHIR(report, patientId, observationIds);
-  const fhirPatient = userProfileToFHIR(userProfile);
-  return {
-    entry: [
-      { fullUrl: entryFullUrl(fhirPatient), resource: fhirPatient },
-      { fullUrl: entryFullUrl(diagnosticReport), resource: diagnosticReport },
-      ...fhirObservations
-    ],
-    resourceType: "Bundle",
-    type: "collection"
-  };
-}
-
-// src/cli/commands/convert.ts
-async function convert(args, json) {
-  const raw = await getInput(args[0]);
-  const data = parseJson(
-    raw,
-    "JSON inv\xE1lido. Forne\xE7a um objeto com { report, observations, profile }."
-  );
-  if (!data.report || !data.observations || !data.profile) {
-    exitWithError(
-      'Formato esperado: { "report": LabReportData, "observations": LabObservationData[], "profile": UserProfileData }'
-    );
-  }
-  const bundle = labResultToFHIRBundle(data.report, data.observations, data.profile);
-  if (json) {
-    outputJson(bundle);
-  } else {
-    outputText(JSON.stringify(bundle, null, 2));
-  }
-}
-
-// src/validators.ts
-function validateFHIRImportBundle(data) {
-  const errors = [];
-  if (!data || typeof data !== "object") {
-    errors.push({ details: "Input must be a JSON object", field: "root" });
-    return errors;
-  }
-  const bundle = data;
-  if (bundle.resourceType !== "Bundle") {
-    errors.push({
-      details: `Expected resourceType "Bundle", got "${String(bundle.resourceType)}"`,
-      field: "resourceType"
-    });
-  }
-  if (!Array.isArray(bundle.entry)) {
-    errors.push({ details: 'Bundle must contain an "entry" array', field: "entry" });
-  } else if (bundle.entry.length === 0) {
-    errors.push({ details: "Bundle entry array is empty", field: "entry" });
-  }
-  return errors;
-}
-
-// src/importer.ts
-var MAX_OBSERVATIONS = 5e3;
-var MAX_FILE_SIZE = 15 * 1024 * 1024;
-function resolveBiomarkerCode(observation) {
-  const coding = observation.code?.coding ?? [];
-  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;
-  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;
-  const seenCodes = [
-    ...loincCode ? [`LOINC ${loincCode}`] : [],
-    ...declaredCode ? [`biomarker code ${declaredCode}`] : []
-  ];
-  let reason;
-  if (seenCodes.length > 0) {
-    reason = `Unknown code: ${seenCodes.join(", ")}`;
-  } else if (coding.length > 0) {
-    const systems = [...new Set(coding.map((c) => c.system ?? "(sem system)"))];
-    reason = `No code in a supported system (found: ${systems.join(", ")})`;
-  } else {
-    reason = "No code found in observation coding";
-  }
-  const fromLoinc = loincCode ? loincToCode(loincCode) : void 0;
-  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };
-  if (declaredCode && isValidCode(declaredCode)) {
-    const canonical = normalizeCode(declaredCode);
-    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };
-  }
-  return { loincCode, reason };
-}
-function extractFlag(observation) {
-  const code = observation.interpretation?.[0]?.coding?.[0]?.code;
-  if (code === "H" || code === "HH") return "H";
-  if (code === "L" || code === "LL") return "L";
-  return "";
-}
-function extractObservationsFromBundle(bundle) {
-  const observations = [];
-  const skipped = [];
-  for (let i = 0; i < bundle.entry.length; i++) {
-    const entry = bundle.entry[i];
-    if (!entry.resource) {
-      skipped.push({ index: i, reason: "Entry has no resource" });
-      continue;
-    }
-    if (entry.resource.resourceType !== "Observation") {
-      continue;
-    }
-    if (observations.length >= MAX_OBSERVATIONS) {
-      skipped.push({ index: i, reason: `Maximum of ${MAX_OBSERVATIONS} observations exceeded` });
-      continue;
-    }
-    observations.push(entry.resource);
-  }
-  return { observations, skipped };
-}
-function mapFHIRObservationToInternal(observation, index) {
-  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);
-  if (!internalCode) {
-    return {
-      skipped: { index, loincCode, reason, resourceType: "Observation" }
-    };
-  }
-  const definition = getDefinitionByCode(internalCode);
-  let value;
-  let unit = "";
-  let isQualitative = false;
-  if (observation.valueQuantity?.value !== void 0) {
-    value = observation.valueQuantity.value;
-    unit = observation.valueQuantity.unit || observation.valueQuantity.code || "";
-  } else if (observation.valueString) {
-    value = observation.valueString;
-    isQualitative = true;
-  } else {
-    return {
-      skipped: {
-        index,
-        loincCode,
-        reason: "Observation has no value (valueQuantity or valueString)",
-        resourceType: "Observation"
-      }
-    };
-  }
-  const collectionDate = observation.effectiveDateTime || observation.effectivePeriod?.start || "";
-  if (!collectionDate) {
-    return {
-      skipped: {
-        index,
-        loincCode,
-        reason: "Observation has no effectiveDateTime or effectivePeriod.start",
-        resourceType: "Observation"
-      }
-    };
-  }
-  let referenceMin;
-  let referenceMax;
-  if (observation.referenceRange?.[0]) {
-    referenceMin = observation.referenceRange[0].low?.value;
-    referenceMax = observation.referenceRange[0].high?.value;
-  }
-  const imported = {
-    biomarkerCode: internalCode,
-    biomarkerName: definition?.names.pt[0] || definition?.names.en[0] || observation.code.text || internalCode,
-    collectionDate,
-    flag: extractFlag(observation),
-    isQualitative,
-    loincCode,
-    referenceMax,
-    referenceMin,
-    unit: unit || definition?.unit || "",
-    value
-  };
-  return { observation: imported };
-}
-function processImportBundle(data) {
-  const validationErrors = validateFHIRImportBundle(data);
-  if (validationErrors.length > 0) {
-    return {
-      errors: validationErrors,
-      imported: [],
-      skipped: [],
-      totalProcessed: 0
-    };
-  }
-  const bundle = data;
-  const { observations, skipped } = extractObservationsFromBundle(bundle);
-  const imported = [];
-  const allSkipped = [...skipped];
-  for (let i = 0; i < observations.length; i++) {
-    const result = mapFHIRObservationToInternal(observations[i], i);
-    if ("observation" in result) {
-      imported.push(result.observation);
-    } else {
-      allSkipped.push(result.skipped);
-    }
-  }
-  return {
-    errors: [],
-    imported,
-    skipped: allSkipped,
-    totalProcessed: observations.length
-  };
-}
-
-// src/cli/commands/import.ts
-async function importBundle(args, json) {
-  const raw = await getInput(args[0]);
-  const bundle = parseJson(raw, "JSON inv\xE1lido.");
-  const result = processImportBundle(bundle);
-  if (json) {
-    outputJson(result);
-    return;
-  }
-  outputText(`Processados: ${result.totalProcessed}`);
-  outputText(`Importados:  ${result.imported.length}`);
-  outputText(`Ignorados:   ${result.skipped.length}`);
-  outputText(`Erros:       ${result.errors.length}`);
-  if (result.imported.length > 0) {
-    outputText("\nObserva\xE7\xF5es importadas:");
-    for (const obs of result.imported) {
-      outputText(`  ${obs.biomarkerCode} (${obs.loincCode}): ${obs.value} ${obs.unit}`);
-    }
-  }
-  if (result.errors.length > 0) {
-    outputText("\nErros:");
-    for (const err of result.errors) {
-      outputText(`  ${err.field}: ${err.details}`);
-    }
-  }
-}
-
-// src/cli/commands/list.ts
-import { parseArgs } from "util";
-async function list(args, json) {
-  const { values } = parseArgs({
-    args,
-    options: {
-      category: { type: "string" },
-      visible: { default: false, type: "boolean" }
-    },
-    strict: false
-  });
-  let defs;
-  if (values.category) {
-    defs = getBiomarkersByCategory(values.category);
-    if (defs.length === 0) {
-      exitWithError(`Categoria n\xE3o encontrada ou vazia: ${values.category}`);
-    }
-  } else if (values.visible) {
-    defs = getVisibleDefinitions();
-  } else {
-    defs = getAllDefinitions();
-  }
-  if (json) {
-    outputJson(defs);
-    return;
-  }
-  const rows = defs.map((d) => [
-    d.code,
-    d.loinc ?? "\u2014",
-    d.names.pt[0] ?? "",
-    d.unit ?? "\u2014",
-    Array.isArray(d.category) ? d.category.join(", ") : d.category
-  ]);
-  outputText(formatTable(["C\xF3digo", "LOINC", "Nome (pt)", "Unidade", "Categoria"], rows));
-  outputText(`
-Total: ${defs.length} biomarcadores`);
-}
-
-// src/cli/commands/loinc-map.ts
-async function loincMap(_args, json) {
-  const defs = getAllDefinitions().filter((d) => d.loinc);
-  if (json) {
-    const map = Object.fromEntries(defs.map((d) => [d.loinc, d.code]));
-    outputJson(map);
-    return;
-  }
-  const rows = defs.map((d) => [d.loinc, d.code, d.names.pt[0] ?? d.names.en[0] ?? ""]);
-  outputText(formatTable(["LOINC", "C\xF3digo", "Nome (pt)"], rows));
-  outputText(`
-Total: ${rows.length} mapeamentos`);
-}
-
-// src/cli/commands/lookup.ts
-function displayDefinition(def) {
-  const cat = Array.isArray(def.category) ? def.category.join(", ") : def.category;
-  outputText(
-    [
-      `Biomarcador: ${def.code}`,
-      `  LOINC:      ${def.loinc ?? "\u2014"}`,
-      `  Nomes (pt): ${def.names.pt.join(", ")}`,
-      `  Nomes (en): ${def.names.en.join(", ")}`,
-      `  Categoria:  ${cat}`,
-      `  Unidade:    ${def.unit ?? "\u2014"}`,
-      `  Sexo:       ${def.sex ?? "ambos"}`,
-      `  Vis\xEDvel:    ${def.hidden ? "n\xE3o" : "sim"}`
-    ].join("\n")
-  );
-}
-async function lookup(args, json) {
-  const code = args[0];
-  if (!code) exitWithError("Uso: fhir-bio lookup <c\xF3digo>");
-  const def = getDefinitionByCode(code);
-  if (!def) exitWithError(`Biomarcador n\xE3o encontrado: ${code}`);
-  if (json) {
-    outputJson(def);
-  } else {
-    displayDefinition(def);
-  }
-}
-async function lookupLoinc(args, json) {
-  const loinc = args[0];
-  if (!loinc) exitWithError("Uso: fhir-bio lookup-loinc <loinc>");
-  const def = getDefinitionByLoinc(loinc);
-  if (!def) exitWithError(`Biomarcador n\xE3o encontrado para LOINC: ${loinc}`);
-  if (json) {
-    outputJson(def);
-  } else {
-    displayDefinition(def);
-  }
-}
-
-// src/cli/commands/range.ts
-import { parseArgs as parseArgs2 } from "util";
-
-// src/reference-ranges.ts
-var biomarkerRangeDefinitions = {
-  Albumin_Creatinine_Ratio: {
-    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/g" },
-    source: "tietz-7ed-2015"
-  },
-  Adiponectin: {
-    default: { max: 26, min: 4, optimalMax: 20, optimalMin: 8, unit: "mcg/mL" },
-    source: "tietz-7ed-2015"
-  },
-  ADMA: {
-    default: { max: 0.7, min: 0.3, optimalMax: 0.55, optimalMin: 0.3, unit: "umol/L" },
-    source: "nemeth-adma-2017"
-  },
-  AFP: {
-    default: { max: 10, min: 0, optimalMax: 8, optimalMin: 0, unit: "ng/mL" },
-    source: "sturgeon-nacb-2008"
-  },
-  Albumin_Globulin_Ratio: {
-    default: { max: 2.5, min: 1, optimalMax: 2.2, optimalMin: 1.2, unit: "" },
-    source: "tietz-7ed-2015"
-  },
-  Albumin: {
-    default: { max: 5, min: 3.5, optimalMax: 4.8, optimalMin: 4, unit: "g/dL" },
-    source: "pns-bioquimica-2019"
-  },
-  AlkalinePhosphatase: {
-    default: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
-    source: "tietz-7ed-2015",
-    variants: [
-      {
-        ageMin: 18,
-        range: { max: 147, min: 44, optimalMax: 120, optimalMin: 50, unit: "U/L" },
-        sex: "M"
-      },
-      {
-        ageMin: 18,
-        range: { max: 104, min: 35, optimalMax: 90, optimalMin: 40, unit: "U/L" },
-        sex: "F"
-      }
-    ]
-  },
-  ALT: {
-    default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
-    source: "tietz-7ed-2015",
-    variants: [
-      {
-        ageMin: 18,
-        range: { max: 56, min: 7, optimalMax: 35, optimalMin: 10, unit: "U/L" },
-        sex: "M"
-      },
-      {
-        ageMin: 18,
-        range: { max: 45, min: 7, optimalMax: 30, optimalMin: 10, unit: "U/L" },
-        sex: "F"
-      }
-    ]
-  },
-  // AMH — fortemente dependente de idade e sexo. As variantes femininas por
-  // faixa etária são a referência clínica; o `default` foi ajustado para
-  // refletir uma faixa adulta conservadora (~18-40 anos, mulheres em idade
-  // reprodutiva geral). optimalMax anterior (6.9 ng/mL) sobrepunha-se a
-  // valores sugestivos de SOP ou risco de OHSS; clinicamente, valores acima
-  // de ~4 ng/mL já merecem investigação.
-  AMH: {
-    default: { max: 6, min: 1, optimalMax: 4, optimalMin: 1.5, unit: "ng/mL" },
-    source: "tietz-7ed-2015",
-    variants: [
-      {
-        ageMax: 24,
-        ageMin: 18,
-        range: { max: 13, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "ng/mL" },
-        sex: "F"
-      },
+        ageMax: 24,
+        ageMin: 18,
+        range: { max: 13, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "ng/mL" },
+        sex: "F"
+      },
       {
         ageMax: 30,
         ageMin: 25,
@@ -5061,14 +4555,17 @@ var biomarkerRangeDefinitions = {
   },
   Ammonia: {
     default: { max: 45, min: 15, optimalMax: 40, optimalMin: 20, unit: "umol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   AntiThyroglobulin: {
     default: { max: 115, min: 0, optimalMax: 40, optimalMin: 0, unit: "IU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   AntiTPO: {
     default: { max: 34, min: 0, optimalMax: 9, optimalMin: 0, unit: "IU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Aortic valve calcium — no standardized clinical threshold; use mild cutoff
@@ -5076,23 +4573,28 @@ var biomarkerRangeDefinitions = {
   AorticValveCalcium: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   ApoA1: {
     default: { max: 200, min: 100, optimalMax: 180, optimalMin: 120, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "contois-apoa1-1996"
   },
   ApoB: {
     default: { max: 90, min: 0, optimalMax: 70, optimalMin: 0, unit: "mg/dL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   ApoCIII: {
     default: { max: 10, min: 0, optimalMax: 7, optimalMin: 0, unit: "mg/dL" },
+    kind: "decision-threshold",
     source: "khetarpal-apociii-2016"
   },
   Omega6_AA: {
     default: { max: 15, min: 5, optimalMax: 12, optimalMin: 7, unit: "%" },
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   // Razão Ácido Araquidônico/EPA (sangue total) — `lower-better`: razão menor =
@@ -5105,16 +4607,19 @@ var biomarkerRangeDefinitions = {
   // dentro do intervalo. Sem `optimal*`: não há corte ótimo de AA/EPA com fonte.
   // Em telas de relatório único, prefira o intervalo impresso pelo laboratório.
   AA_EPA_Ratio: {
-    default: { max: 40.7, min: 3.7, unit: "" },
+    default: { max: 40.7, min: 3.7, minKind: "display", unit: "" },
     direction: "lower-better",
+    kind: "population",
     source: "torrissen-omega3-dbs-2025"
   },
   Arsenic: {
     default: { max: 35, min: 0, optimalMax: 20, optimalMin: 0, unit: "mcg/L" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   AST: {
     default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5133,6 +4638,7 @@ var biomarkerRangeDefinitions = {
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Basophils_Abs: {
     default: { max: 0.072, min: 0, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 0.062, min: 0, unit: "K/uL" }, sex: "M" },
@@ -5141,6 +4647,7 @@ var biomarkerRangeDefinitions = {
   },
   Bicarbonate: {
     default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // β-Hidroxibutirato (BHB) sérico — corpos cetônicos. Faixa derivada de
@@ -5150,23 +4657,28 @@ var biomarkerRangeDefinitions = {
   // superior aqui reflete estado pós-prandial habitual, não jejum.
   BetaHydroxybutyrate: {
     default: { max: 0.28, min: 0.02, optimalMax: 0.28, optimalMin: 0.02, unit: "mmol/L" },
+    kind: "reference-interval",
     source: "klee-bhb-2020"
   },
   BilirubinDirect: {
     default: { max: 0.3, min: 0, optimalMax: 0.2, optimalMin: 0, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   BilirubinIndirect: {
     default: { max: 0.8, min: 0, optimalMax: 0.6, optimalMin: 0, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   BilirubinTotal: {
     default: { max: 1.2, min: 0.1, optimalMax: 0.9, optimalMin: 0.2, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // BNP: 35 pg/mL = corte não-agudo para triagem de IC (SBC IC 2018)
   BNP: {
     default: { max: 35, min: 0, optimalMax: 20, optimalMin: 0, unit: "pg/mL" },
+    kind: "decision-threshold",
     source: "sbc-ic-2018"
   },
   // Razão BUN/Creatinina — faixa 10-20 aplica-se ao Nitrogênio Ureico (BUN).
@@ -5177,14 +4689,17 @@ var biomarkerRangeDefinitions = {
   // distinta. Ver issue #41 para alinhamento de nomenclatura/LOINC.
   BUN_Creatinine_Ratio: {
     default: { max: 20, min: 10, optimalMax: 18, optimalMin: 12, unit: "" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CA125: {
     default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008"
   },
   CA199: {
     default: { max: 37, min: 0, optimalMax: 30, optimalMin: 0, unit: "U/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008"
   },
   // CAC: Agatston classification — 0=none, 1-99=mild, 100-399=moderate, 400+=severe
@@ -5192,44 +4707,53 @@ var biomarkerRangeDefinitions = {
   CAC: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   // Per-vessel scores — same Agatston classification applied per vessel
   CAC_LAD: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_LCX: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_LMA: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_Percentile: {
     default: { max: 50, min: 0, optimalMax: 25, optimalMin: 0, unit: "%", warningMax: 75 },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   CAC_RCA: {
     default: { max: 99, min: 0, optimalMax: 0, optimalMin: 0, unit: "AU" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "rumberger-cac-1999"
   },
   Cadmium: {
     default: { max: 1.2, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "mcg/L" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   Calcium: {
     default: { max: 10.5, min: 8.5, optimalMax: 10, optimalMin: 9, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CEA: {
     default: { max: 3, min: 0, optimalMax: 2.5, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008"
   },
   // CK: valores conservadores baseados em faixas laboratoriais típicas
@@ -5254,6 +4778,7 @@ var biomarkerRangeDefinitions = {
   // autodeclaração de raça/Cor". Ver a issue #3 para a decisão registrada.
   CK: {
     default: { max: 314, min: 30, optimalMax: 170, optimalMin: 40, unit: "U/L" },
+    kind: "reference-interval",
     source: "kalaria-ck-ri-2026",
     variants: [
       { sex: "F", range: { max: 170, min: 30, optimalMax: 150, optimalMin: 40, unit: "U/L" } }
@@ -5261,6 +4786,7 @@ var biomarkerRangeDefinitions = {
   },
   Chloride: {
     default: { max: 106, min: 98, optimalMax: 105, optimalMin: 100, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Colesterol total — SBC 2017/2025: valor desejável < 190 mg/dL para adultos,
@@ -5268,6 +4794,7 @@ var biomarkerRangeDefinitions = {
   // (NCEP, 2002), superada pelas atualizações brasileiras.
   Cholesterol: {
     default: { max: 190, min: 0, optimalMax: 170, optimalMin: 0, unit: "mg/dL" },
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   // Índice de Castelli I (CT/HDL-c)
@@ -5275,6 +4802,7 @@ var biomarkerRangeDefinitions = {
     // Índice de Castelli I — SBC 2017: M <4.9, F <4.3
     default: { max: 4.9, min: 0, optimalMax: 3.5, optimalMin: 0, unit: "" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "castelli-ratio-1992",
     variants: [
       {
@@ -5291,22 +4819,27 @@ var biomarkerRangeDefinitions = {
   },
   CO2: {
     default: { max: 29, min: 23, optimalMax: 28, optimalMin: 24, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Copper: {
     default: { max: 175, min: 70, optimalMax: 150, optimalMin: 85, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CoQ10: {
     default: { max: 1.5, min: 0.5, optimalMax: 1.3, optimalMin: 0.7, unit: "mg/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Cortisol: {
     default: { max: 25, min: 5, optimalMax: 20, optimalMin: 10, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CortisolFree: {
     default: { max: 2.5, min: 0.5, optimalMax: 2, optimalMin: 0.8, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   CPeptide: {
@@ -5318,10 +4851,12 @@ var biomarkerRangeDefinitions = {
       optimalMin: 1,
       unit: "ng/mL"
     },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Creatinine: {
     default: { max: 1.2, min: 0.6, optimalMax: 1, optimalMin: 0.7, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "pns-bioquimica-2019",
     variants: [
       // Gestação: hiperfiltração glomerular (↑ 40–50% GFR) reduz a creatinina
@@ -5347,10 +4882,12 @@ var biomarkerRangeDefinitions = {
   CRP: {
     default: { max: 3, min: 0, optimalMax: 1, optimalMin: 0, unit: "mg/L" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "tietz-7ed-2015"
   },
   CystatinC: {
     default: { max: 1, min: 0.5, optimalMax: 0.9, optimalMin: 0.6, unit: "mg/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // D-Dímero — exame de exclusão de TEV (tromboembolismo venoso) com
@@ -5364,6 +4901,7 @@ var biomarkerRangeDefinitions = {
   DDimer: {
     default: { max: 500, min: 0, unit: "ng/mL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "wells-ddimer-2003",
     variants: [
       // Corte ajustado por idade — ESC 2019 (Konstantinides et al.) e
@@ -5377,10 +4915,12 @@ var biomarkerRangeDefinitions = {
   },
   Omega3_DHA: {
     default: { max: 8, min: 2, optimalMax: 6.5, optimalMin: 3.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   DHEAS: {
     default: { max: 500, min: 100, optimalMax: 400, optimalMin: 150, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5421,20 +4961,30 @@ var biomarkerRangeDefinitions = {
   },
   Omega3_DPA: {
     default: { max: 2, min: 0.3, optimalMax: 1.5, optimalMin: 0.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   eGFR: {
-    default: { max: 120, min: 60, optimalMax: 120, optimalMin: 90, unit: "mL/min/1.73m\xB2" },
+    default: {
+      max: 120,
+      maxKind: "display",
+      min: 60,
+      optimalMax: 120,
+      optimalMin: 90,
+      unit: "mL/min/1.73m\xB2"
+    },
     // KDIGO 2024: TFG 60-89 (G2) sem marcador de lesão renal não é DRC, em
     // nenhuma faixa etária. A variante por idade que existia aqui rebaixava o
     // piso só para 60+ e ainda limitava o teto a 90, o que sinalizava como
     // alterado qualquer idoso com função preservada.
+    kind: "decision-threshold",
     source: "kdigo-ckd-2024"
   },
   // `Eosinophils` (%) fica sem faixa de propósito e `Eosinophils_Abs` usa os limites da
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Eosinophils_Abs: {
     default: { max: 0.66, min: 0, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 0.66, min: 0, unit: "K/uL" }, sex: "M" },
@@ -5443,18 +4993,22 @@ var biomarkerRangeDefinitions = {
   },
   Omega3_EPA: {
     default: { max: 3.5, min: 0.5, optimalMax: 2.5, optimalMin: 1, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   EPADPADHA: {
     default: { max: 10, min: 3, optimalMax: 9, optimalMin: 5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   ESR: {
     default: { max: 20, min: 0, optimalMax: 10, optimalMin: 0, unit: "mm/hr" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Estradiol: {
     default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5477,6 +5031,7 @@ var biomarkerRangeDefinitions = {
   },
   F2Isoprostanes: {
     default: { max: 86, min: 0, optimalMax: 60, optimalMin: 0, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Ferritina — WHO 2020 é o documento de referência específico para avaliação
@@ -5486,6 +5041,7 @@ var biomarkerRangeDefinitions = {
   // tipo de faixa, mas documentado aqui para consumidores).
   Ferritin: {
     default: { max: 150, min: 12, optimalMax: 120, optimalMin: 30, unit: "ng/mL" },
+    kind: "decision-threshold",
     source: "who-iron-2020",
     variants: [
       // Gestação: ferritina cai fisiologicamente no 2º/3º trimestre pela expansão
@@ -5518,14 +5074,17 @@ var biomarkerRangeDefinitions = {
   // Fibrinogênio: 200-400 mg/dL — faixa de referência padrão (método de Clauss)
   Fibrinogen: {
     default: { max: 400, min: 200, optimalMax: 350, optimalMin: 250, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   FolicAcid: {
     default: { max: 20, min: 3, optimalMax: 15, optimalMin: 5, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   FSH: {
     default: { max: 12.4, min: 1.5, optimalMax: 10, optimalMin: 3, unit: "mIU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5549,26 +5108,29 @@ var biomarkerRangeDefinitions = {
   GGT: {
     default: { max: 55, min: 0, optimalMax: 30, optimalMin: 0, unit: "U/L" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
         ageMin: 18,
-        range: { max: 61, min: 8, optimalMax: 40, optimalMin: 10, unit: "U/L" },
+        range: { max: 61, min: 8, minKind: "display", optimalMax: 40, optimalMin: 10, unit: "U/L" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 36, min: 5, optimalMax: 25, optimalMin: 8, unit: "U/L" },
+        range: { max: 36, min: 5, minKind: "display", optimalMax: 25, optimalMin: 8, unit: "U/L" },
         sex: "F"
       }
     ]
   },
   Ghrelin: {
     default: { max: 1e3, min: 300, optimalMax: 800, optimalMin: 400, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Globulin: {
     default: { max: 3.5, min: 2, optimalMax: 3.2, optimalMin: 2.3, unit: "g/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // A faixa é de jejum, então mora na definição que afirma jejum. Glicose
@@ -5591,6 +5153,7 @@ var biomarkerRangeDefinitions = {
       optimalMin: 70,
       unit: "mg/dL"
     },
+    kind: "decision-threshold",
     source: "sbd-diabetes-2024",
     variants: [
       // Gestação: DMG (IADPSG/SBD 2024) usa cortes mais restritivos na glicemia
@@ -5612,10 +5175,12 @@ var biomarkerRangeDefinitions = {
   },
   GlycoMark: {
     default: { max: 40, min: 10, optimalMax: 35, optimalMin: 15, unit: "mcg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   GrowthHormone: {
     default: { max: 5, min: 0, optimalMax: 3, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // HbA1c — SBD 2024 não estabelece piso de referência clinicamente acionável.
@@ -5625,11 +5190,13 @@ var biomarkerRangeDefinitions = {
   // criar flag clínico em valores fisiologicamente baixos. optimalMin preserva
   // o alvo fisiológico da fração glicada.
   HbA1c: {
-    default: { max: 5.7, min: 2, optimalMax: 5.3, optimalMin: 4.5, unit: "%" },
+    default: { max: 5.7, min: 2, minKind: "display", optimalMax: 5.3, optimalMin: 4.5, unit: "%" },
+    kind: "decision-threshold",
     source: "sbd-diabetes-2024"
   },
   Hct: {
     default: { max: 50, min: 36, optimalMax: 48, optimalMin: 40, unit: "%" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       {
@@ -5651,18 +5218,40 @@ var biomarkerRangeDefinitions = {
   // não como ponto de corte clínico; consumidores devem tratar `direction:
   // higher-better` como sinal autoritativo.
   HDL: {
-    default: { max: 100, min: 40, optimalMax: 100, optimalMin: 50, unit: "mg/dL" },
+    default: {
+      max: 100,
+      maxKind: "display",
+      min: 40,
+      optimalMax: 100,
+      optimalMin: 50,
+      unit: "mg/dL"
+    },
     direction: "higher-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025",
     variants: [
       {
         ageMin: 18,
-        range: { max: 100, min: 40, optimalMax: 100, optimalMin: 45, unit: "mg/dL" },
+        range: {
+          max: 100,
+          maxKind: "display",
+          min: 40,
+          optimalMax: 100,
+          optimalMin: 45,
+          unit: "mg/dL"
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 100, min: 50, optimalMax: 100, optimalMin: 55, unit: "mg/dL" },
+        range: {
+          max: 100,
+          maxKind: "display",
+          min: 50,
+          optimalMax: 100,
+          optimalMin: 55,
+          unit: "mg/dL"
+        },
         sex: "F"
       }
     ]
@@ -5670,12 +5259,21 @@ var biomarkerRangeDefinitions = {
   HDL_Large: {
     // HDL Large: higher is better
     // Quest Ion Mobility reference: Male 4334-10815, Female 5038-17886 nmol/L, optimal >6729
-    default: { max: 17886, min: 4334, optimalMax: 17886, optimalMin: 6729, unit: "nmol/L" },
+    default: {
+      max: 17886,
+      maxKind: "display",
+      min: 4334,
+      optimalMax: 17886,
+      optimalMin: 6729,
+      unit: "nmol/L"
+    },
     direction: "higher-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   Hgb: {
     default: { max: 17.5, min: 12, optimalMax: 16, optimalMin: 13.5, unit: "g/dL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       // Gestação: hemodiluição fisiológica reduz o piso aceitável.
@@ -5731,19 +5329,23 @@ var biomarkerRangeDefinitions = {
       warningMax: 2.71
     },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "geloneze-brams-2009"
   },
   Homocysteine: {
-    default: { max: 15, min: 4, optimalMax: 10, optimalMin: 5, unit: "umol/L" },
+    default: { max: 15, min: 4, minKind: "display", optimalMax: 10, optimalMin: 5, unit: "umol/L" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "selhub-homocysteine-1999"
   },
   IGF1: {
     default: { max: 350, min: 100, optimalMax: 300, optimalMin: 150, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   ImmatureGranulocytes: {
     default: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Insulin: {
@@ -5755,10 +5357,12 @@ var biomarkerRangeDefinitions = {
       optimalMin: 3,
       unit: "uIU/mL"
     },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Iron: {
     default: { max: 170, min: 60, optimalMax: 140, optimalMin: 80, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "sbpc-ml-2021",
     variants: [
       {
@@ -5775,6 +5379,7 @@ var biomarkerRangeDefinitions = {
   },
   Lactate: {
     default: { max: 2.2, min: 0.5, optimalMax: 1.8, optimalMin: 0.7, unit: "mmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // DHL/LDH — método IFCC a 37 °C (padrão atual na maioria dos laboratórios
@@ -5786,6 +5391,7 @@ var biomarkerRangeDefinitions = {
   LDH: {
     default: { max: 248, min: 0, optimalMax: 248, optimalMin: 0, unit: "U/L" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "schumann-ifcc-ldh-2002",
     variants: [
       {
@@ -5803,59 +5409,109 @@ var biomarkerRangeDefinitions = {
   LDL: {
     default: { max: 100, min: 0, optimalMax: 70, optimalMin: 0, unit: "mg/dL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   LDL_Medium: {
     // LDL Medium (LDL Média): lower is better
     // Quest Ion Mobility reference: Male 167-485, Female 121-397 nmol/L, optimal <215
-    default: { max: 485, min: 121, optimalMax: 215, optimalMin: 121, unit: "nmol/L" },
+    default: {
+      max: 485,
+      min: 121,
+      minKind: "display",
+      optimalMax: 215,
+      optimalMin: 121,
+      unit: "nmol/L"
+    },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   LDL_ParticleNumber: {
     // LDL Particle Number: lower is better
     // Quest Ion Mobility reference: 1016-2185 nmol/L, optimal <1138
-    default: { max: 2185, min: 1016, optimalMax: 1138, optimalMin: 1016, unit: "nmol/L" },
+    default: {
+      max: 2185,
+      min: 1016,
+      minKind: "display",
+      optimalMax: 1138,
+      optimalMin: 1016,
+      unit: "nmol/L"
+    },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   LDL_Peak_Size: {
     // LDL Peak Size: higher is better (larger particles less atherogenic)
     // Quest Ion Mobility reference: optimal >222.9 Å (22.29 nm)
-    default: { max: 250, min: 217.4, optimalMax: 250, optimalMin: 222.9, unit: "Angstrom" },
+    default: {
+      max: 250,
+      maxKind: "display",
+      min: 217.4,
+      optimalMax: 250,
+      optimalMin: 222.9,
+      unit: "Angstrom"
+    },
     direction: "higher-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   LDL_Small: {
     // LDL Small (LDL Pequena): lower is better (small dense LDL is most atherogenic)
     // Quest Ion Mobility reference: Male 123-441, Female 126-382 nmol/L, optimal <142
-    default: { max: 441, min: 123, optimalMax: 142, optimalMin: 123, unit: "nmol/L" },
+    default: {
+      max: 441,
+      min: 123,
+      minKind: "display",
+      optimalMax: 142,
+      optimalMin: 123,
+      unit: "nmol/L"
+    },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "caulfield-ionmobility-2008"
   },
   Lead: {
     default: { max: 5, min: 0, optimalMax: 2, optimalMin: 0, unit: "mcg/dL" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   Leptin: {
-    default: { max: 15, min: 2, optimalMax: 12, optimalMin: 3, unit: "ng/mL" },
+    default: { max: 15, min: 2, minKind: "clinical", optimalMax: 12, optimalMin: 3, unit: "ng/mL" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
         ageMin: 18,
-        range: { max: 10, min: 1, optimalMax: 8, optimalMin: 2, unit: "ng/mL" },
+        range: {
+          max: 10,
+          min: 1,
+          minKind: "clinical",
+          optimalMax: 8,
+          optimalMin: 2,
+          unit: "ng/mL"
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 25, min: 4, optimalMax: 18, optimalMin: 5, unit: "ng/mL" },
+        range: {
+          max: 25,
+          min: 4,
+          minKind: "clinical",
+          optimalMax: 18,
+          optimalMin: 5,
+          unit: "ng/mL"
+        },
         sex: "F"
       }
     ]
   },
   LH: {
     default: { max: 8.6, min: 1.7, optimalMax: 8, optimalMin: 2, unit: "mIU/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -5878,6 +5534,7 @@ var biomarkerRangeDefinitions = {
   },
   Omega6_LA: {
     default: { max: 35, min: 15, optimalMax: 28, optimalMin: 18, unit: "%" },
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   // Lp(a) — SBC 2025 (seção 3.1.1.2.7): níveis ≥ 50 mg/dL ou ≥ 125 nmol/L são
@@ -5889,12 +5546,14 @@ var biomarkerRangeDefinitions = {
   Lipoprotein_a: {
     default: { max: 125, min: 0, optimalMax: 75, optimalMin: 0, unit: "nmol/L" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   // `Lymphocytes` (%) fica sem faixa de propósito e `Lymphocytes_Abs` usa os limites da
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Lymphocytes_Abs: {
     default: { max: 3.414, min: 0.72, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 3.37, min: 0.72, unit: "K/uL" }, sex: "M" },
@@ -5903,40 +5562,49 @@ var biomarkerRangeDefinitions = {
   },
   Magnesium: {
     default: { max: 2.2, min: 1.7, optimalMax: 2.1, optimalMin: 1.9, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Magnesium_RBC: {
     default: { max: 6.8, min: 4, optimalMax: 6, optimalMin: 4.5, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   MCH: {
     default: { max: 33, min: 27, optimalMax: 32, optimalMin: 28, unit: "pg" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   MCHC: {
     default: { max: 36, min: 32, optimalMax: 35, optimalMin: 33, unit: "g/dL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   MCV: {
     default: { max: 100, min: 80, optimalMax: 98, optimalMin: 82, unit: "fL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Mercury: {
     default: { max: 10, min: 0, optimalMax: 5, optimalMin: 0, unit: "mcg/L" },
+    kind: "decision-threshold",
     source: "nr7-pcmso-2020"
   },
   Microalbumin: {
     default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
+    kind: "decision-threshold",
     source: "kdigo-ckd-2024"
   },
   MMA: {
     default: { max: 378, min: 0, optimalMax: 270, optimalMin: 0, unit: "nmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // `Monocytes` (%) fica sem faixa de propósito e `Monocytes_Abs` usa os limites da
   // Tabela 2 da PNS 2019. Ver o comentário em `Neutrophils_Abs`.
   Monocytes_Abs: {
     default: { max: 0.812, min: 0.011, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 0.812, min: 0.011, unit: "K/uL" }, sex: "M" },
@@ -5945,11 +5613,13 @@ var biomarkerRangeDefinitions = {
   },
   MPV: {
     default: { max: 11.5, min: 7.5, optimalMax: 10.5, optimalMin: 8, unit: "fL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   // MPO: Meuwese 2007 (EPIC-Norfolk) — risco CV elevado >322 pmol/L
   Myeloperoxidase: {
     default: { max: 470, min: 0, optimalMax: 322, optimalMin: 0, unit: "pmol/L" },
+    kind: "decision-threshold",
     source: "meuwese-mpo-2007"
   },
   // Leucograma diferencial em percentual (`Neutrophils`, `Lymphocytes`,
@@ -5973,6 +5643,7 @@ var biomarkerRangeDefinitions = {
   // (menor mínimo e maior máximo entre homens e mulheres).
   Neutrophils_Abs: {
     default: { max: 6.474, min: 0.576, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       { ageMin: 18, range: { max: 5.971, min: 0.576, unit: "K/uL" }, sex: "M" },
@@ -5982,22 +5653,27 @@ var biomarkerRangeDefinitions = {
   NonHDL_Cholesterol: {
     default: { max: 130, min: 0, optimalMax: 100, optimalMin: 0, unit: "mg/dL" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   NRBC: {
     default: { max: 0, min: 0, optimalMax: 0, optimalMin: 0, unit: "/100WBC" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   NTproBNP: {
     default: { max: 125, min: 0, optimalMax: 75, optimalMin: 0, unit: "pg/mL" },
+    kind: "decision-threshold",
     source: "sbc-ic-2018"
   },
   Oleic_Acid: {
     default: { max: 25, min: 15, optimalMax: 22, optimalMin: 18, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Omega3_Index: {
     default: { max: 8, min: 4, optimalMax: 8, optimalMin: 5.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   // Ômega-3 Total (% de ácidos graxos eritrocitários) — Harris & von Schacky
@@ -6007,39 +5683,55 @@ var biomarkerRangeDefinitions = {
   // a literatura e o próprio texto educacional do `platform`.
   Omega3_Total: {
     default: { max: 12, min: 3, optimalMax: 10, optimalMin: 8, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   Omega6_Total: {
     default: { max: 40, min: 20, optimalMax: 35, optimalMin: 25, unit: "%" },
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   Omega6_Omega3_Ratio: {
-    default: { max: 10, min: 1, optimalMax: 4, optimalMin: 1, unit: "" },
+    default: {
+      max: 10,
+      min: 1,
+      minKind: "display",
+      optimalMax: 4,
+      optimalMin: 1,
+      unit: ""
+    },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "simopoulos-omega-ratio-2002"
   },
   OmegaCheck: {
     default: { max: 8, min: 4, optimalMax: 8, optimalMin: 5.5, unit: "%" },
+    kind: "decision-threshold",
     source: "harris-omega3-2004"
   },
   Palmitic_Acid: {
     default: { max: 30, min: 20, optimalMax: 27, optimalMin: 22, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Phosphorus: {
     default: { max: 4.5, min: 2.5, optimalMax: 4, optimalMin: 3, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Platelets: {
     default: { max: 400, min: 150, optimalMax: 350, optimalMin: 180, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Potassium: {
     default: { max: 5, min: 3.5, optimalMax: 4.6, optimalMin: 3.8, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Prealbumin: {
     default: { max: 38, min: 18, optimalMax: 35, optimalMin: 20, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Progesterona — varia drasticamente com a fase do ciclo menstrual.
@@ -6050,6 +5742,7 @@ var biomarkerRangeDefinitions = {
   // ciclo, indisponível neste contexto.
   Progesterone: {
     default: { max: 0.9, min: 0.1, optimalMax: 0.7, optimalMin: 0.2, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6076,6 +5769,7 @@ var biomarkerRangeDefinitions = {
   },
   Prolactin: {
     default: { max: 18, min: 2, optimalMax: 15, optimalMin: 4, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6092,6 +5786,7 @@ var biomarkerRangeDefinitions = {
   },
   PSA: {
     default: { max: 4, min: 0, optimalMax: 2.5, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008",
     variants: [
       {
@@ -6121,6 +5816,7 @@ var biomarkerRangeDefinitions = {
   },
   RBC: {
     default: { max: 5.5, min: 4, optimalMax: 5.2, optimalMin: 4.3, unit: "M/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019",
     variants: [
       {
@@ -6137,22 +5833,27 @@ var biomarkerRangeDefinitions = {
   },
   RDW: {
     default: { max: 14.5, min: 11.5, optimalMax: 14, optimalMin: 12, unit: "%" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Reticulocytes: {
     default: { max: 2.5, min: 0.5, optimalMax: 2, optimalMin: 0.8, unit: "%" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   SDMA: {
     default: { max: 0.6, min: 0.3, optimalMax: 0.5, optimalMin: 0.3, unit: "umol/L" },
+    kind: "reference-interval",
     source: "schwedhelm-sdma-2011"
   },
   Selenium: {
     default: { max: 150, min: 70, optimalMax: 125, optimalMin: 85, unit: "\xB5g/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   SHBG: {
     default: { max: 54, min: 18, optimalMax: 50, optimalMin: 20, unit: "nmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6169,34 +5870,42 @@ var biomarkerRangeDefinitions = {
   },
   Sodium: {
     default: { max: 145, min: 136, optimalMax: 143, optimalMin: 138, unit: "mEq/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   SpecificGravity_Urine: {
     default: { max: 1.03, min: 1.005, optimalMax: 1.025, optimalMin: 1.01, unit: "SG" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Stearic_Acid: {
     default: { max: 14, min: 8, optimalMax: 12, optimalMin: 10, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T3Free: {
     default: { max: 4.2, min: 2.3, optimalMax: 3.8, optimalMin: 2.8, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T3Reverse: {
     default: { max: 24, min: 10, optimalMax: 20, optimalMin: 12, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T4Free: {
     default: { max: 1.8, min: 0.8, optimalMax: 1.5, optimalMin: 1, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   T4Total: {
     default: { max: 12, min: 4.5, optimalMax: 10, optimalMin: 6, unit: "ug/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Testosterone: {
     default: { max: 1e3, min: 300, optimalMax: 800, optimalMin: 500, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6219,12 +5928,14 @@ var biomarkerRangeDefinitions = {
   },
   TestosteroneBioavailable: {
     default: { max: 200, min: 50, optimalMax: 150, optimalMin: 80, unit: "ng/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // TestosteroneFree - using direct immunoassay ranges (Quest/LabCorp standard)
   // Previous values (9.3-26.5 pg/mL) were based on equilibrium dialysis method
   TestosteroneFree: {
     default: { max: 155, min: 35, optimalMax: 120, optimalMin: 50, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6247,22 +5958,27 @@ var biomarkerRangeDefinitions = {
   },
   TIBC: {
     default: { max: 370, min: 250, optimalMax: 350, optimalMin: 280, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   TotalProtein: {
     default: { max: 8.3, min: 6, optimalMax: 7.8, optimalMin: 6.5, unit: "g/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Trans_Fat_Index: {
     default: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Transferrin: {
     default: { max: 360, min: 200, optimalMax: 340, optimalMin: 220, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   TransferrinSaturation: {
     default: { max: 50, min: 20, optimalMax: 45, optimalMin: 25, unit: "%" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6290,16 +6006,19 @@ var biomarkerRangeDefinitions = {
       unit: "mg/dL"
     },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   // TroponinI: 0.04 ng/mL = percentil 99 (ensaio Siemens TnI-Ultra)
   TroponinI: {
     default: { max: 0.04, min: 0, optimalMax: 0.02, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "keller-tni-2013"
   },
   // TroponinT: 14 ng/L = percentil 99 hs-cTnT (ensaio Roche Elecsys 5ª geração)
   TroponinT: {
     default: { max: 14, min: 0, optimalMax: 10, optimalMin: 0, unit: "ng/L" },
+    kind: "reference-interval",
     source: "giannitsis-hstnt-2010"
   },
   // TSH — 0.4–4.0 é a faixa de referência adulta geral. O alvo 2.5 µIU/mL é
@@ -6309,6 +6028,7 @@ var biomarkerRangeDefinitions = {
   // expandido (tolerância fisiológica do eixo em idosos, SBEM 2013).
   TSH: {
     default: { max: 4, min: 0.4, optimalMax: 3, optimalMin: 1, unit: "uIU/mL" },
+    kind: "reference-interval",
     source: "sbem-thyroid-2013",
     variants: [
       // Variantes gestacionais (ATA 2017 / SBEM): supressão fisiológica por hCG
@@ -6357,10 +6077,12 @@ var biomarkerRangeDefinitions = {
   // deve ser revisto em biomarkers.ts — ver issue #41.
   Urea: {
     default: { max: 50, min: 15, optimalMax: 40, optimalMin: 20, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   UricAcid: {
     default: { max: 7, min: 2.5, optimalMax: 5.5, optimalMin: 3, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -6377,50 +6099,62 @@ var biomarkerRangeDefinitions = {
   },
   Urobilinogen_Urine: {
     default: { max: 1, min: 0.1, optimalMax: 1, optimalMin: 0.1, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   pH_Urine: {
     default: { max: 8, min: 4.5, optimalMax: 7, optimalMin: 5.5, unit: "pH" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   HyalineCasts_Urine: {
     default: { max: 2, min: 0, optimalMax: 1, optimalMin: 0, unit: "/LPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   RBC_Urine: {
     default: { max: 3, min: 0, optimalMax: 1, optimalMin: 0, unit: "/HPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   SquamousEpithelial_Urine: {
     default: { max: 15, min: 0, optimalMax: 5, optimalMin: 0, unit: "/HPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Leukocytes_Urine: {
     default: { max: 5, min: 0, optimalMax: 2, optimalMin: 0, unit: "/HPF" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   Folate: {
     default: { max: 20, min: 3.9, optimalMax: 17, optimalMin: 5, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminA: {
     default: { max: 100, min: 20, optimalMax: 80, optimalMin: 30, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminB1: {
     default: { max: 180, min: 70, optimalMax: 150, optimalMin: 80, unit: "nmol/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminB12: {
     default: { max: 900, min: 200, optimalMax: 800, optimalMin: 400, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminB6: {
     default: { max: 50, min: 5, optimalMax: 40, optimalMin: 10, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminC: {
     default: { max: 2, min: 0.4, optimalMax: 1.5, optimalMin: 0.6, unit: "mg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // Vitamina D — posicionamento conjunto SBEM/SBPC-ML 2017:
@@ -6437,6 +6171,7 @@ var biomarkerRangeDefinitions = {
   // quando a modelagem de comorbidades chegar ao schema.
   VitaminD: {
     default: { max: 100, min: 20, optimalMax: 70, optimalMin: 40, unit: "ng/mL" },
+    kind: "decision-threshold",
     source: "ferreira-vitd-2017",
     variants: [
       {
@@ -6448,10 +6183,12 @@ var biomarkerRangeDefinitions = {
   },
   VitaminD_1_25: {
     default: { max: 72, min: 18, optimalMax: 60, optimalMin: 25, unit: "pg/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   VitaminE: {
     default: { max: 17, min: 5.5, optimalMax: 14, optimalMin: 7, unit: "mg/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // VLDL — estimado clinicamente via TG/5 (método Friedewald). O corte de
@@ -6460,30 +6197,34 @@ var biomarkerRangeDefinitions = {
   // método de cálculo, mas a faixa de referência tem respaldo na diretriz
   // SBC 2025.
   VLDL: {
-    default: { max: 30, min: 2, optimalMax: 20, optimalMin: 5, unit: "mg/dL" },
+    default: { max: 30, min: 2, minKind: "display", optimalMax: 20, optimalMin: 5, unit: "mg/dL" },
+    kind: "decision-threshold",
     source: "sbc-lipids-2025"
   },
   WBC: {
     default: { max: 11, min: 4, optimalMax: 8, optimalMin: 5, unit: "K/uL" },
+    kind: "reference-interval",
     source: "pns-hemograma-2019"
   },
   Zinc: {
     default: { max: 120, min: 60, optimalMax: 100, optimalMin: 70, unit: "mcg/dL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   AndroidFatPct: {
-    default: { max: 35, min: 10, optimalMax: 25, optimalMin: 15, unit: "%" },
+    default: { max: 35, min: 10, minKind: "display", optimalMax: 25, optimalMin: 15, unit: "%" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 30, min: 10, optimalMax: 22, optimalMin: 12, unit: "%" },
+        range: { max: 30, min: 10, minKind: "display", optimalMax: 22, optimalMin: 12, unit: "%" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 42, min: 15, optimalMax: 32, optimalMin: 20, unit: "%" },
+        range: { max: 42, min: 15, minKind: "display", optimalMax: 32, optimalMin: 20, unit: "%" },
         sex: "F"
       }
     ]
@@ -6534,6 +6275,7 @@ var biomarkerRangeDefinitions = {
   CalfCircumference: {
     default: { unit: "cm" },
     direction: "higher-better",
+    kind: "decision-threshold",
     source: "ewgsop2-2019",
     // O corte não é específico por sexo na fonte; as duas variantes existem
     // porque `RangeVariant` exige o campo, e carregam o mesmo número.
@@ -6545,38 +6287,76 @@ var biomarkerRangeDefinitions = {
   WaistToHeightRatio: {
     default: { max: 0.5, unit: "" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "browning-ashwell-2010"
   },
   AndroidGynoidRatio: {
-    default: { max: 1.2, min: 0.5, optimalMax: 1, optimalMin: 0.6, unit: "" },
+    default: { max: 1.2, min: 0.5, minKind: "display", optimalMax: 1, optimalMin: 0.6, unit: "" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 1.2, min: 0.6, optimalMax: 1, optimalMin: 0.7, unit: "" },
+        range: {
+          max: 1.2,
+          min: 0.6,
+          minKind: "display",
+          optimalMax: 1,
+          optimalMin: 0.7,
+          unit: ""
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 1, min: 0.4, optimalMax: 0.8, optimalMin: 0.5, unit: "" },
+        range: {
+          max: 1,
+          min: 0.4,
+          minKind: "display",
+          optimalMax: 0.8,
+          optimalMin: 0.5,
+          unit: ""
+        },
         sex: "F"
       }
     ]
   },
   BMC: {
-    default: { max: 3.5, min: 2, optimalMax: 3.2, optimalMin: 2.3, unit: "kg" },
+    default: {
+      max: 3.5,
+      maxKind: "display",
+      min: 2,
+      optimalMax: 3.2,
+      optimalMin: 2.3,
+      unit: "kg"
+    },
     direction: "higher-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 4, min: 2.5, optimalMax: 3.5, optimalMin: 2.8, unit: "kg" },
+        range: {
+          max: 4,
+          maxKind: "display",
+          min: 2.5,
+          optimalMax: 3.5,
+          optimalMin: 2.8,
+          unit: "kg"
+        },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 3, min: 1.8, optimalMax: 2.7, optimalMin: 2, unit: "kg" },
+        range: {
+          max: 3,
+          maxKind: "display",
+          min: 1.8,
+          optimalMax: 2.7,
+          optimalMin: 2,
+          unit: "kg"
+        },
         sex: "F"
       }
     ]
@@ -6584,142 +6364,148 @@ var biomarkerRangeDefinitions = {
   // BodyFatPct — Age-bracketed ranges from Gallagher et al. Am J Clin Nutr 2000;72:694-701
   // (PMID: 10966886) and ACSM Guidelines for Exercise Testing, 11th Ed (2021)
   BodyFatPct: {
-    default: { max: 30, min: 10, optimalMax: 25, optimalMin: 15, unit: "%" },
+    default: { max: 30, min: 10, minKind: "clinical", optimalMax: 25, optimalMin: 15, unit: "%" },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "gallagher-bodyfat-2000",
     variants: [
       // Men — age brackets
       {
         ageMax: 25,
         ageMin: 18,
-        range: { max: 25, min: 5, optimalMax: 20, optimalMin: 10, unit: "%" },
+        range: { max: 25, min: 5, minKind: "clinical", optimalMax: 20, optimalMin: 10, unit: "%" },
         sex: "M"
       },
       {
         ageMax: 35,
         ageMin: 26,
-        range: { max: 26, min: 5, optimalMax: 21, optimalMin: 11, unit: "%" },
+        range: { max: 26, min: 5, minKind: "clinical", optimalMax: 21, optimalMin: 11, unit: "%" },
         sex: "M"
       },
       {
         ageMax: 45,
         ageMin: 36,
-        range: { max: 27, min: 5, optimalMax: 22, optimalMin: 12, unit: "%" },
+        range: { max: 27, min: 5, minKind: "clinical", optimalMax: 22, optimalMin: 12, unit: "%" },
         sex: "M"
       },
       {
         ageMax: 55,
         ageMin: 46,
-        range: { max: 28, min: 5, optimalMax: 23, optimalMin: 13, unit: "%" },
+        range: { max: 28, min: 5, minKind: "clinical", optimalMax: 23, optimalMin: 13, unit: "%" },
         sex: "M"
       },
       {
         ageMin: 56,
-        range: { max: 29, min: 5, optimalMax: 24, optimalMin: 14, unit: "%" },
+        range: { max: 29, min: 5, minKind: "clinical", optimalMax: 24, optimalMin: 14, unit: "%" },
         sex: "M"
       },
       // Women — age brackets
       {
         ageMax: 25,
         ageMin: 18,
-        range: { max: 32, min: 13, optimalMax: 28, optimalMin: 18, unit: "%" },
+        range: { max: 32, min: 13, minKind: "clinical", optimalMax: 28, optimalMin: 18, unit: "%" },
         sex: "F"
       },
       {
         ageMax: 35,
         ageMin: 26,
-        range: { max: 33, min: 13, optimalMax: 29, optimalMin: 18, unit: "%" },
+        range: { max: 33, min: 13, minKind: "clinical", optimalMax: 29, optimalMin: 18, unit: "%" },
         sex: "F"
       },
       {
         ageMax: 45,
         ageMin: 36,
-        range: { max: 34, min: 13, optimalMax: 30, optimalMin: 19, unit: "%" },
+        range: { max: 34, min: 13, minKind: "clinical", optimalMax: 30, optimalMin: 19, unit: "%" },
         sex: "F"
       },
       {
         ageMax: 55,
         ageMin: 46,
-        range: { max: 35, min: 13, optimalMax: 31, optimalMin: 20, unit: "%" },
+        range: { max: 35, min: 13, minKind: "clinical", optimalMax: 31, optimalMin: 20, unit: "%" },
         sex: "F"
       },
       {
         ageMin: 56,
-        range: { max: 36, min: 13, optimalMax: 32, optimalMin: 20, unit: "%" },
+        range: { max: 36, min: 13, minKind: "clinical", optimalMax: 32, optimalMin: 20, unit: "%" },
         sex: "F"
       }
     ]
   },
   FatFreeMass: {
-    default: { max: 80, min: 40, optimalMax: 70, optimalMin: 45, unit: "kg" },
+    default: { max: 80, maxKind: "display", min: 40, optimalMax: 70, optimalMin: 45, unit: "kg" },
     direction: "higher-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 90, min: 50, optimalMax: 80, optimalMin: 55, unit: "kg" },
+        range: { max: 90, maxKind: "display", min: 50, optimalMax: 80, optimalMin: 55, unit: "kg" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 60, min: 35, optimalMax: 52, optimalMin: 38, unit: "kg" },
+        range: { max: 60, maxKind: "display", min: 35, optimalMax: 52, optimalMin: 38, unit: "kg" },
         sex: "F"
       }
     ]
   },
   FatMass: {
-    default: { max: 30, min: 5, optimalMax: 20, optimalMin: 8, unit: "kg" },
+    default: { max: 30, min: 5, minKind: "clinical", optimalMax: 20, optimalMin: 8, unit: "kg" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 25, min: 5, optimalMax: 18, optimalMin: 7, unit: "kg" },
+        range: { max: 25, min: 5, minKind: "clinical", optimalMax: 18, optimalMin: 7, unit: "kg" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 30, min: 8, optimalMax: 22, optimalMin: 10, unit: "kg" },
+        range: { max: 30, min: 8, minKind: "clinical", optimalMax: 22, optimalMin: 10, unit: "kg" },
         sex: "F"
       }
     ]
   },
   GynoidFatPct: {
-    default: { max: 45, min: 15, optimalMax: 35, optimalMin: 20, unit: "%" },
+    default: { max: 45, min: 15, minKind: "display", optimalMax: 35, optimalMin: 20, unit: "%" },
     direction: "lower-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 35, min: 12, optimalMax: 28, optimalMin: 15, unit: "%" },
+        range: { max: 35, min: 12, minKind: "display", optimalMax: 28, optimalMin: 15, unit: "%" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 50, min: 20, optimalMax: 40, optimalMin: 25, unit: "%" },
+        range: { max: 50, min: 20, minKind: "display", optimalMax: 40, optimalMin: 25, unit: "%" },
         sex: "F"
       }
     ]
   },
   LeanMass: {
-    default: { max: 75, min: 35, optimalMax: 65, optimalMin: 40, unit: "kg" },
+    default: { max: 75, maxKind: "display", min: 35, optimalMax: 65, optimalMin: 40, unit: "kg" },
     direction: "higher-better",
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
         ageMin: 18,
-        range: { max: 85, min: 45, optimalMax: 75, optimalMin: 50, unit: "kg" },
+        range: { max: 85, maxKind: "display", min: 45, optimalMax: 75, optimalMin: 50, unit: "kg" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 55, min: 30, optimalMax: 48, optimalMin: 35, unit: "kg" },
+        range: { max: 55, maxKind: "display", min: 30, optimalMax: 48, optimalMin: 35, unit: "kg" },
         sex: "F"
       }
     ]
   },
   TotalMass: {
     default: { max: 100, min: 50, optimalMax: 85, optimalMin: 55, unit: "kg" },
+    kind: "population",
     source: "kelly-dxa-2009",
     variants: [
       {
@@ -6734,226 +6520,858 @@ var biomarkerRangeDefinitions = {
       }
     ]
   },
-  VATMass: {
-    default: { max: 1.5, min: 0, optimalMax: 0.8, optimalMin: 0, unit: "kg" },
-    direction: "lower-better",
-    source: "ofenheimer-vat-2020",
+  VATMass: {
+    default: { max: 1.5, min: 0, optimalMax: 0.8, optimalMin: 0, unit: "kg" },
+    direction: "lower-better",
+    kind: "population",
+    source: "ofenheimer-vat-2020",
+    variants: [
+      {
+        ageMin: 18,
+        range: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "kg" },
+        sex: "M"
+      },
+      {
+        ageMin: 18,
+        range: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "kg" },
+        sex: "F"
+      }
+    ]
+  },
+  VATVolume: {
+    default: {
+      max: 852,
+      min: 0,
+      optimalMax: 600,
+      optimalMin: 0,
+      unit: "cm\xB3",
+      warningMax: 1837
+    },
+    direction: "lower-better",
+    kind: "decision-threshold",
+    source: "ge-corescan"
+  },
+  BMD_Total: {
+    default: {
+      max: 1.4,
+      maxKind: "display",
+      min: 0.9,
+      optimalMax: 1.3,
+      optimalMin: 1,
+      unit: "g/cm\xB2"
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "who-osteoporosis-1994"
+  },
+  TScore_Total: {
+    default: {
+      max: 4,
+      maxKind: "display",
+      min: -1,
+      optimalMax: 2,
+      optimalMin: -0.5,
+      unit: ""
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "who-osteoporosis-1994"
+  },
+  ZScore_Total: {
+    default: {
+      max: 2,
+      maxKind: "display",
+      min: -2,
+      optimalMax: 1,
+      optimalMin: -1,
+      unit: ""
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "who-osteoporosis-1994"
+  },
+  Amylase: {
+    default: { max: 100, min: 28, optimalMax: 90, optimalMin: 35, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Creatinine_Urine: {
+    default: { max: 300, min: 20, optimalMax: 250, optimalMin: 40, unit: "mg/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
+    variants: [
+      {
+        ageMin: 18,
+        range: { max: 300, min: 40, optimalMax: 260, optimalMin: 60, unit: "mg/dL" },
+        sex: "M"
+      },
+      {
+        ageMin: 18,
+        range: { max: 220, min: 20, optimalMax: 180, optimalMin: 40, unit: "mg/dL" },
+        sex: "F"
+      }
+    ]
+  },
+  IgA: {
+    default: { max: 400, min: 70, optimalMax: 350, optimalMin: 100, unit: "mg/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Lipase: {
+    default: { max: 60, min: 0, optimalMax: 50, optimalMin: 10, unit: "U/L" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  Microalbumin_Urine: {
+    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
+    kind: "decision-threshold",
+    source: "kdigo-ckd-2024"
+  },
+  PSA_Free: {
+    default: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
+    source: "sturgeon-nacb-2008"
+  },
+  // Relação PSA livre/total — `higher-better`: razão maior = menor risco de
+  // câncer de próstata, logo não há limite superior "ruim" (acima do normal é
+  // verde). Faixas alinhadas à tabela clínica: ≥25% baixo risco (verde),
+  // 10–25% atenção — intermediário/moderado (âmbar), <10% alto risco >50%
+  // (vermelho). Limites: `min` (25) é o piso do verde e `warningMin` (10) o
+  // piso do âmbar — o vermelho é estritamente abaixo de 10% (< 10%); 10%
+  // pertence ao âmbar, conforme a faixa "10–15% moderado" da tabela.
+  PSA_FreeRatio: {
+    default: {
+      max: 100,
+      maxKind: "display",
+      min: 25,
+      optimalMax: 100,
+      optimalMin: 30,
+      unit: "%",
+      warningMin: 10
+    },
+    direction: "higher-better",
+    kind: "decision-threshold",
+    source: "sturgeon-nacb-2008"
+  },
+  // BMI - WHO classification: 18.5–24.9 normal, 25–29.9 overweight, ≥30 obese
+  BMI: {
+    default: { max: 30, min: 18.5, optimalMax: 24.9, optimalMin: 18.5, unit: "kg/m2" },
+    kind: "decision-threshold",
+    source: "who-obesity-2000"
+  },
+  // eAG — Estimated Average Glucose, derivada da HbA1c pela fórmula ADAG:
+  // eAG (mg/dL) = 28,7 × HbA1c(%) − 46,7 (NATHAN, D. M. et al. Translating the
+  // A1C assay into estimated average glucose values. Diabetes Care, v. 31, n. 8,
+  // p. 1473-1478, 2008. DOI: 10.2337/dc08-0545).
+  //
+  // As faixas espelham os cortes diagnósticos de HbA1c da SBD (ver entrada
+  // `HbA1c`) convertidos por essa fórmula, mantendo a eAG coerente com o
+  // marcador de origem:
+  //   optimalMax 105  ← HbA1c 5,3 % (teto do controle ótimo)
+  //   max        117  ← HbA1c 5,7 % (teto do não diabético → início do pré-diabetes)
+  //   warningMax 137  ← HbA1c 6,4 % (teto do pré-diabetes → acima disso, diabetes)
+  //   optimalMin  82  ← HbA1c 4,5 % (piso do alvo fisiológico da entrada HbA1c)
+  //   min         11  ← HbA1c 2,0 % (mesmo piso de sanidade da entrada HbA1c)
+  //
+  // O piso era 70 nos dois campos, e não vinha desta conversão: 70 é o limite
+  // inferior clássico da glicemia **de jejum**, transplantado para uma média
+  // estimada de ~3 meses. Pela fórmula, 70 equivale a HbA1c 4,07 % — ou seja,
+  // marcava como alterado exatamente quem a entrada `HbA1c` documenta que não
+  // deve ser sinalizado, já que HbA1c baixa reflete hemólise, perda sanguínea
+  // ou hemoglobinopatia, e não doença do metabolismo glicêmico. Espelhar o piso
+  // do HbA1c mantém as duas entradas coerentes, que é o que o comentário sempre
+  // afirmou fazer.
+  //
+  // Substitui a faixa anterior (optimalMax 126 = corte de glicemia de jejum;
+  // max 154 = meta terapêutica do diabético, HbA1c 7 %), que classificava como
+  // "Normal" valores já pré-diabéticos e diabéticos.
+  eAG: {
+    default: {
+      max: 117,
+      min: 11,
+      minKind: "display",
+      optimalMax: 105,
+      optimalMin: 82,
+      unit: "mg/dL",
+      warningMax: 137
+    },
+    kind: "decision-threshold",
+    source: "sbd-diabetes-2024"
+  },
+  // INR - International Normalized Ratio (non-anticoagulated patients)
+  INR: {
+    default: { max: 1.2, min: 0.8, optimalMax: 1.1, optimalMin: 0.9, unit: "ratio" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  // Prothrombin Time
+  ProthrombinTime: {
+    default: { max: 13.5, min: 11, optimalMax: 13, optimalMin: 11, unit: "seconds" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
+  },
+  // DHT - Dihydrotestosterone (adult male reference; female values are much lower)
+  DHT: {
+    default: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015",
     variants: [
       {
         ageMin: 18,
-        range: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "kg" },
+        range: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
         sex: "M"
       },
       {
         ageMin: 18,
-        range: { max: 1, min: 0, optimalMax: 0.5, optimalMin: 0, unit: "kg" },
+        range: { max: 22, min: 4, optimalMax: 22, optimalMin: 4, unit: "ng/dL" },
         sex: "F"
       }
     ]
   },
-  VATVolume: {
-    default: {
-      max: 852,
-      min: 0,
-      optimalMax: 600,
-      optimalMin: 0,
-      unit: "cm\xB3",
-      warningMax: 1837
-    },
+  // Total IgE - higher values suggest atopy/allergic sensitization
+  IgE_Total: {
+    default: { max: 100, min: 0, optimalMax: 100, optimalMin: 0, unit: "IU/mL" },
     direction: "lower-better",
-    source: "ge-corescan"
-  },
-  BMD_Total: {
-    default: { max: 1.4, min: 0.9, optimalMax: 1.3, optimalMin: 1, unit: "g/cm\xB2" },
-    direction: "higher-better",
-    source: "who-osteoporosis-1994"
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
   },
-  TScore_Total: {
-    default: { max: 4, min: -1, optimalMax: 2, optimalMin: -0.5, unit: "" },
-    direction: "higher-better",
-    source: "who-osteoporosis-1994"
+  // IgG - Immunoglobulin G
+  IgG: {
+    default: { max: 1600, min: 700, optimalMax: 1600, optimalMin: 700, unit: "mg/dL" },
+    kind: "reference-interval",
+    source: "tietz-7ed-2015"
   },
-  ZScore_Total: {
-    default: { max: 2, min: -2, optimalMax: 1, optimalMin: -1, unit: "" },
-    direction: "higher-better",
-    source: "who-osteoporosis-1994"
+  // IgE E1 Cat Dander - Class 0 (≤0.35 kU/L) = negative
+  IgE_E1_CatDander: {
+    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
+    direction: "lower-better",
+    kind: "decision-threshold",
+    source: "tietz-7ed-2015"
   },
-  Amylase: {
-    default: { max: 100, min: 28, optimalMax: 90, optimalMin: 35, unit: "U/L" },
+  // IgE GX1 Grasses - Class 0 (≤0.35 kU/L) = negative
+  IgE_GX1_Grasses: {
+    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
+    direction: "lower-better",
+    kind: "decision-threshold",
     source: "tietz-7ed-2015"
+  }
+};
+var defaultReferenceRanges = Object.fromEntries(
+  Object.entries(biomarkerRangeDefinitions).map(([code, def]) => [
+    code,
+    {
+      ...def.default,
+      ...def.kind && { kind: def.kind },
+      ...def.source && { source: def.source }
+    }
+  ])
+);
+function getReferenceRange(testCode, context) {
+  const definition = biomarkerRangeDefinitions[testCode];
+  if (!definition) return void 0;
+  const withSource = (range2, kind = definition.kind) => ({
+    ...range2,
+    ...kind && { kind },
+    ...definition.source && { source: definition.source }
+  });
+  if (!context || !definition.variants || definition.variants.length === 0) {
+    return withSource(definition.default);
+  }
+  const { age, biologicalSex, pregnancyTrimester, pregnant } = context;
+  const hasPregnancyVariant = definition.variants.some((v) => v.pregnant === true);
+  for (const variant of definition.variants) {
+    if (variant.pregnant === true) {
+      if (!pregnant) continue;
+      if (variant.pregnancyTrimester !== void 0 && variant.pregnancyTrimester !== pregnancyTrimester) {
+        continue;
+      }
+    } else if (pregnant && hasPregnancyVariant) {
+      continue;
+    }
+    if (variant.sex !== "all" && variant.sex !== biologicalSex) {
+      continue;
+    }
+    if (variant.ageMin !== void 0 && (age === void 0 || age < variant.ageMin)) {
+      continue;
+    }
+    if (variant.ageMax !== void 0 && (age === void 0 || age > variant.ageMax)) {
+      continue;
+    }
+    return withSource(variant.range, variant.kind ?? definition.kind);
+  }
+  return withSource(definition.default);
+}
+function getRangeDirection(testCode) {
+  return biomarkerRangeDefinitions[testCode]?.direction ?? "range";
+}
+function referenceRangeMeaning(kind) {
+  const system = "http://terminology.hl7.org/CodeSystem/referencerange-meaning";
+  if (kind === "reference-interval") return { code: "normal", display: "Normal Range", system };
+  if (kind === "decision-threshold") {
+    return { code: "recommended", display: "Recommended Range", system };
+  }
+  return void 0;
+}
+
+// src/converter.ts
+function interpretationCode(flag) {
+  switch (flag) {
+    case "H":
+      return "H";
+    // High
+    case "L":
+      return "L";
+    // Low
+    default:
+      return "N";
+  }
+}
+function interpretationDisplay(flag) {
+  switch (flag) {
+    case "H":
+      return "High";
+    case "L":
+      return "Low";
+    default:
+      return "Normal";
+  }
+}
+var SEX_CODING = {
+  female: {
+    code: "female",
+    display: "Female",
+    system: "http://hl7.org/fhir/administrative-gender"
   },
-  Creatinine_Urine: {
-    default: { max: 300, min: 20, optimalMax: 250, optimalMin: 40, unit: "mg/dL" },
-    source: "tietz-7ed-2015",
-    variants: [
+  male: { code: "male", display: "Male", system: "http://hl7.org/fhir/administrative-gender" }
+};
+var buildReferenceRanges = (observation, quantity) => {
+  const toRanges = (low, high, sex) => {
+    if (low === void 0 && high === void 0) return [];
+    return [
       {
-        ageMin: 18,
-        range: { max: 300, min: 40, optimalMax: 260, optimalMin: 60, unit: "mg/dL" },
-        sex: "M"
-      },
+        ...sex === void 0 ? {} : { appliesTo: [{ coding: [SEX_CODING[sex]] }] },
+        ...high === void 0 ? {} : { high: quantity(high) },
+        ...low === void 0 ? {} : { low: quantity(low) }
+      }
+    ];
+  };
+  if (observation.referenceRanges && observation.referenceRanges.length > 0) {
+    return observation.referenceRanges.flatMap((r) => toRanges(r.low, r.high, r.appliesTo));
+  }
+  const meaning = observation.referenceKind && referenceRangeMeaning(observation.referenceKind);
+  return toRanges(observation.referenceMin, observation.referenceMax).map(
+    (range2) => meaning ? { ...range2, type: { coding: [meaning] } } : range2
+  );
+};
+function labObservationToFHIR(observation, patientId, laboratoryName) {
+  const methodLoinc = observation.methodLoinc && methodVariantOf(observation.biomarkerCode, observation.methodLoinc) ? observation.methodLoinc : void 0;
+  const loincCode = methodLoinc ?? codeToLoinc(observation.biomarkerCode);
+  const sourceUnit = observation.unit || getDefaultUnit(observation.biomarkerCode) || observation.unit;
+  const ucumUnit = resolveUcum(sourceUnit, observation.biomarkerCode);
+  const quantity = (value) => ({
+    ...ucumUnit ? { code: ucumUnit, system: "http://unitsofmeasure.org" } : {},
+    ...sourceUnit ? { unit: sourceUnit } : {},
+    value
+  });
+  const isQualitative = observation.isQualitative || typeof observation.value === "string";
+  const fhirObs = {
+    category: [
+      {
+        coding: [
+          {
+            code: "laboratory",
+            display: "Laboratory",
+            system: "http://terminology.hl7.org/CodeSystem/observation-category"
+          }
+        ]
+      }
+    ],
+    code: {
+      // Sem LOINC, o coding LOINC simplesmente não sai. Antes ia `99999-9`,
+      // que não é código LOINC nenhum: publicava sob `http://loinc.org` uma
+      // afirmação falsa, e quem consumisse o bundle confiando no system
+      // trataria aquilo como código de verdade. Composição corporal, densidade
+      // óssea e escore de cálcio não têm LOINC, e o certo é a lacuna explícita.
+      coding: [
+        ...loincCode ? [
+          {
+            code: loincCode,
+            display: observation.biomarkerName,
+            system: LOINC_SYSTEM
+          }
+        ] : [],
+        {
+          code: observation.biomarkerCode,
+          display: observation.biomarkerName,
+          system: BIOMARKER_CODE_SYSTEM
+        }
+      ],
+      text: observation.biomarkerName
+    },
+    effectiveDateTime: observation.collectionDate,
+    id: `${observation.reportId}-${observation.biomarkerCode}`,
+    interpretation: [
+      {
+        coding: [
+          {
+            code: interpretationCode(observation.flag),
+            display: interpretationDisplay(observation.flag),
+            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
+          }
+        ]
+      }
+    ],
+    performer: laboratoryName ? [{ display: laboratoryName }] : void 0,
+    resourceType: "Observation",
+    status: "final",
+    subject: {
+      reference: `Patient/${patientId}`
+    }
+  };
+  if (isQualitative) {
+    fhirObs.valueString = String(observation.value);
+  } else {
+    fhirObs.valueQuantity = quantity(observation.value);
+    const referenceRange = buildReferenceRanges(observation, quantity);
+    if (referenceRange.length > 0) fhirObs.referenceRange = referenceRange;
+  }
+  return fhirObs;
+}
+function labReportToFHIR(report, patientId, observationIds) {
+  let status;
+  switch (report.processingStatus) {
+    case "complete":
+      status = "final";
+      break;
+    case "partial":
+      status = "partial";
+      break;
+    case "pending_review":
+      status = "preliminary";
+      break;
+    default:
+      status = "final";
+  }
+  return {
+    category: [
+      {
+        coding: [
+          {
+            code: "LAB",
+            display: "Laboratory",
+            system: "http://terminology.hl7.org/CodeSystem/v2-0074"
+          }
+        ]
+      }
+    ],
+    code: {
+      coding: [
+        {
+          code: "11502-2",
+          // Laboratory report
+          display: "Laboratory report",
+          system: "http://loinc.org"
+        }
+      ],
+      text: "Laboratory Results"
+    },
+    conclusion: report.overallStatus === "NORMAL" ? "All results within normal limits" : "One or more abnormal results detected",
+    conclusionCode: report.overallStatus === "ANORMAL" ? [
       {
-        ageMin: 18,
-        range: { max: 220, min: 20, optimalMax: 180, optimalMin: 40, unit: "mg/dL" },
-        sex: "F"
+        coding: [
+          {
+            code: "A",
+            display: "Abnormal",
+            system: "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation"
+          }
+        ]
       }
-    ]
-  },
-  IgA: {
-    default: { max: 400, min: 70, optimalMax: 350, optimalMin: 100, unit: "mg/dL" },
-    source: "tietz-7ed-2015"
-  },
-  Lipase: {
-    default: { max: 60, min: 0, optimalMax: 50, optimalMin: 10, unit: "U/L" },
-    source: "tietz-7ed-2015"
-  },
-  Microalbumin_Urine: {
-    default: { max: 30, min: 0, optimalMax: 20, optimalMin: 0, unit: "mg/L" },
-    source: "kdigo-ckd-2024"
-  },
-  PSA_Free: {
-    default: { max: 1.5, min: 0, optimalMax: 1, optimalMin: 0, unit: "ng/mL" },
-    source: "sturgeon-nacb-2008"
-  },
-  // Relação PSA livre/total — `higher-better`: razão maior = menor risco de
-  // câncer de próstata, logo não há limite superior "ruim" (acima do normal é
-  // verde). Faixas alinhadas à tabela clínica: ≥25% baixo risco (verde),
-  // 10–25% atenção — intermediário/moderado (âmbar), <10% alto risco >50%
-  // (vermelho). Limites: `min` (25) é o piso do verde e `warningMin` (10) o
-  // piso do âmbar — o vermelho é estritamente abaixo de 10% (< 10%); 10%
-  // pertence ao âmbar, conforme a faixa "10–15% moderado" da tabela.
-  PSA_FreeRatio: {
-    default: { max: 100, min: 25, optimalMax: 100, optimalMin: 30, unit: "%", warningMin: 10 },
-    direction: "higher-better",
-    source: "sturgeon-nacb-2008"
-  },
-  // BMI - WHO classification: 18.5–24.9 normal, 25–29.9 overweight, ≥30 obese
-  BMI: {
-    default: { max: 30, min: 18.5, optimalMax: 24.9, optimalMin: 18.5, unit: "kg/m2" },
-    source: "who-obesity-2000"
-  },
-  // eAG — Estimated Average Glucose, derivada da HbA1c pela fórmula ADAG:
-  // eAG (mg/dL) = 28,7 × HbA1c(%) − 46,7 (NATHAN, D. M. et al. Translating the
-  // A1C assay into estimated average glucose values. Diabetes Care, v. 31, n. 8,
-  // p. 1473-1478, 2008. DOI: 10.2337/dc08-0545).
-  //
-  // As faixas espelham os cortes diagnósticos de HbA1c da SBD (ver entrada
-  // `HbA1c`) convertidos por essa fórmula, mantendo a eAG coerente com o
-  // marcador de origem:
-  //   optimalMax 105  ← HbA1c 5,3 % (teto do controle ótimo)
-  //   max        117  ← HbA1c 5,7 % (teto do não diabético → início do pré-diabetes)
-  //   warningMax 137  ← HbA1c 6,4 % (teto do pré-diabetes → acima disso, diabetes)
-  //   optimalMin  82  ← HbA1c 4,5 % (piso do alvo fisiológico da entrada HbA1c)
-  //   min         11  ← HbA1c 2,0 % (mesmo piso de sanidade da entrada HbA1c)
-  //
-  // O piso era 70 nos dois campos, e não vinha desta conversão: 70 é o limite
-  // inferior clássico da glicemia **de jejum**, transplantado para uma média
-  // estimada de ~3 meses. Pela fórmula, 70 equivale a HbA1c 4,07 % — ou seja,
-  // marcava como alterado exatamente quem a entrada `HbA1c` documenta que não
-  // deve ser sinalizado, já que HbA1c baixa reflete hemólise, perda sanguínea
-  // ou hemoglobinopatia, e não doença do metabolismo glicêmico. Espelhar o piso
-  // do HbA1c mantém as duas entradas coerentes, que é o que o comentário sempre
-  // afirmou fazer.
-  //
-  // Substitui a faixa anterior (optimalMax 126 = corte de glicemia de jejum;
-  // max 154 = meta terapêutica do diabético, HbA1c 7 %), que classificava como
-  // "Normal" valores já pré-diabéticos e diabéticos.
-  eAG: {
-    default: { max: 117, min: 11, optimalMax: 105, optimalMin: 82, unit: "mg/dL", warningMax: 137 },
-    source: "sbd-diabetes-2024"
-  },
-  // INR - International Normalized Ratio (non-anticoagulated patients)
-  INR: {
-    default: { max: 1.2, min: 0.8, optimalMax: 1.1, optimalMin: 0.9, unit: "ratio" },
-    source: "tietz-7ed-2015"
-  },
-  // Prothrombin Time
-  ProthrombinTime: {
-    default: { max: 13.5, min: 11, optimalMax: 13, optimalMin: 11, unit: "seconds" },
-    source: "tietz-7ed-2015"
-  },
-  // DHT - Dihydrotestosterone (adult male reference; female values are much lower)
-  DHT: {
-    default: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
-    source: "tietz-7ed-2015",
-    variants: [
+    ] : void 0,
+    effectiveDateTime: report.collectionDate,
+    id: report.reportId,
+    issued: report.createdAt,
+    performer: report.laboratoryName ? [{ display: report.laboratoryName }] : void 0,
+    resourceType: "DiagnosticReport",
+    result: observationIds.map((id) => ({ reference: `Observation/${id}` })),
+    status,
+    subject: {
+      reference: `Patient/${patientId}`
+    }
+  };
+}
+function userProfileToFHIR(profile) {
+  const nameParts = profile.name.split(" ");
+  const given = nameParts.slice(0, -1);
+  const family = nameParts[nameParts.length - 1] || "";
+  return {
+    address: profile.address ? [
       {
-        ageMin: 18,
-        range: { max: 85, min: 30, optimalMax: 85, optimalMin: 30, unit: "ng/dL" },
-        sex: "M"
-      },
+        city: profile.address.city,
+        country: profile.address.country || "BR",
+        line: [
+          profile.address.street && profile.address.number ? `${profile.address.street}, ${profile.address.number}` : profile.address.street,
+          profile.address.complement
+        ].filter(Boolean),
+        postalCode: profile.address.postalCode,
+        state: profile.address.state
+      }
+    ] : void 0,
+    birthDate: profile.birthDate,
+    gender: profile.gender,
+    id: profile.userId,
+    name: [
       {
-        ageMin: 18,
-        range: { max: 22, min: 4, optimalMax: 22, optimalMin: 4, unit: "ng/dL" },
-        sex: "F"
+        family,
+        given: given.length > 0 ? given : void 0,
+        text: profile.name
       }
-    ]
-  },
-  // Total IgE - higher values suggest atopy/allergic sensitization
-  IgE_Total: {
-    default: { max: 100, min: 0, optimalMax: 100, optimalMin: 0, unit: "IU/mL" },
-    direction: "lower-better",
-    source: "tietz-7ed-2015"
-  },
-  // IgG - Immunoglobulin G
-  IgG: {
-    default: { max: 1600, min: 700, optimalMax: 1600, optimalMin: 700, unit: "mg/dL" },
-    source: "tietz-7ed-2015"
-  },
-  // IgE E1 Cat Dander - Class 0 (≤0.35 kU/L) = negative
-  IgE_E1_CatDander: {
-    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
-    direction: "lower-better",
-    source: "tietz-7ed-2015"
-  },
-  // IgE GX1 Grasses - Class 0 (≤0.35 kU/L) = negative
-  IgE_GX1_Grasses: {
-    default: { max: 0.35, min: 0, optimalMax: 0.35, optimalMin: 0, unit: "kU/L" },
-    direction: "lower-better",
-    source: "tietz-7ed-2015"
+    ],
+    resourceType: "Patient",
+    telecom: [
+      ...profile.email ? [{ system: "email", value: profile.email }] : [],
+      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
+    ].length > 0 ? [
+      ...profile.email ? [{ system: "email", value: profile.email }] : [],
+      ...profile.phone ? [{ system: "phone", value: profile.phone }] : []
+    ] : void 0
+  };
+}
+function labResultToFHIRBundle(report, observations, userProfile) {
+  const patientId = userProfile.userId;
+  const fhirObservations = observations.map((obs) => {
+    const resource = labObservationToFHIR(
+      { ...obs, collectionDate: report.collectionDate },
+      patientId,
+      report.laboratoryName
+    );
+    return { fullUrl: entryFullUrl(resource), resource };
+  });
+  const observationIds = fhirObservations.map((entry) => entry.resource.id);
+  const diagnosticReport = labReportToFHIR(report, patientId, observationIds);
+  const fhirPatient = userProfileToFHIR(userProfile);
+  return {
+    entry: [
+      { fullUrl: entryFullUrl(fhirPatient), resource: fhirPatient },
+      { fullUrl: entryFullUrl(diagnosticReport), resource: diagnosticReport },
+      ...fhirObservations
+    ],
+    resourceType: "Bundle",
+    type: "collection"
+  };
+}
+
+// src/cli/commands/convert.ts
+async function convert(args, json) {
+  const raw = await getInput(args[0]);
+  const data = parseJson(
+    raw,
+    "JSON inv\xE1lido. Forne\xE7a um objeto com { report, observations, profile }."
+  );
+  if (!data.report || !data.observations || !data.profile) {
+    exitWithError(
+      'Formato esperado: { "report": LabReportData, "observations": LabObservationData[], "profile": UserProfileData }'
+    );
   }
-};
-var defaultReferenceRanges = Object.fromEntries(
-  Object.entries(biomarkerRangeDefinitions).map(([code, def]) => [
-    code,
-    def.source ? { ...def.default, source: def.source } : def.default
-  ])
-);
-function getReferenceRange(testCode, context) {
-  const definition = biomarkerRangeDefinitions[testCode];
-  if (!definition) return void 0;
-  const withSource = (range2) => definition.source ? { ...range2, source: definition.source } : range2;
-  if (!context || !definition.variants || definition.variants.length === 0) {
-    return withSource(definition.default);
+  const bundle = labResultToFHIRBundle(data.report, data.observations, data.profile);
+  if (json) {
+    outputJson(bundle);
+  } else {
+    outputText(JSON.stringify(bundle, null, 2));
+  }
+}
+
+// src/validators.ts
+function validateFHIRImportBundle(data) {
+  const errors = [];
+  if (!data || typeof data !== "object") {
+    errors.push({ details: "Input must be a JSON object", field: "root" });
+    return errors;
+  }
+  const bundle = data;
+  if (bundle.resourceType !== "Bundle") {
+    errors.push({
+      details: `Expected resourceType "Bundle", got "${String(bundle.resourceType)}"`,
+      field: "resourceType"
+    });
+  }
+  if (!Array.isArray(bundle.entry)) {
+    errors.push({ details: 'Bundle must contain an "entry" array', field: "entry" });
+  } else if (bundle.entry.length === 0) {
+    errors.push({ details: "Bundle entry array is empty", field: "entry" });
+  }
+  return errors;
+}
+
+// src/importer.ts
+var MAX_OBSERVATIONS = 5e3;
+var MAX_FILE_SIZE = 15 * 1024 * 1024;
+function resolveBiomarkerCode(observation) {
+  const coding = observation.code?.coding ?? [];
+  const loincCode = coding.find((c) => c.system === LOINC_SYSTEM)?.code;
+  const declaredCode = coding.find((c) => c.system === BIOMARKER_CODE_SYSTEM)?.code;
+  const seenCodes = [
+    ...loincCode ? [`LOINC ${loincCode}`] : [],
+    ...declaredCode ? [`biomarker code ${declaredCode}`] : []
+  ];
+  let reason;
+  if (seenCodes.length > 0) {
+    reason = `Unknown code: ${seenCodes.join(", ")}`;
+  } else if (coding.length > 0) {
+    const systems = [...new Set(coding.map((c) => c.system ?? "(sem system)"))];
+    reason = `No code in a supported system (found: ${systems.join(", ")})`;
+  } else {
+    reason = "No code found in observation coding";
   }
-  const { age, biologicalSex, pregnancyTrimester, pregnant } = context;
-  const hasPregnancyVariant = definition.variants.some((v) => v.pregnant === true);
-  for (const variant of definition.variants) {
-    if (variant.pregnant === true) {
-      if (!pregnant) continue;
-      if (variant.pregnancyTrimester !== void 0 && variant.pregnancyTrimester !== pregnancyTrimester) {
-        continue;
-      }
-    } else if (pregnant && hasPregnancyVariant) {
+  const fromLoinc = loincCode ? loincToCode(loincCode) : void 0;
+  if (fromLoinc) return { internalCode: fromLoinc, loincCode, reason };
+  if (declaredCode && isValidCode(declaredCode)) {
+    const canonical = normalizeCode(declaredCode);
+    return { internalCode: canonical, loincCode: codeToLoinc(canonical), reason };
+  }
+  return { loincCode, reason };
+}
+function extractFlag(observation) {
+  const code = observation.interpretation?.[0]?.coding?.[0]?.code;
+  if (code === "H" || code === "HH") return "H";
+  if (code === "L" || code === "LL") return "L";
+  return "";
+}
+function extractObservationsFromBundle(bundle) {
+  const observations = [];
+  const skipped = [];
+  for (let i = 0; i < bundle.entry.length; i++) {
+    const entry = bundle.entry[i];
+    if (!entry.resource) {
+      skipped.push({ index: i, reason: "Entry has no resource" });
       continue;
     }
-    if (variant.sex !== "all" && variant.sex !== biologicalSex) {
+    if (entry.resource.resourceType !== "Observation") {
       continue;
     }
-    if (variant.ageMin !== void 0 && (age === void 0 || age < variant.ageMin)) {
+    if (observations.length >= MAX_OBSERVATIONS) {
+      skipped.push({ index: i, reason: `Maximum of ${MAX_OBSERVATIONS} observations exceeded` });
       continue;
     }
-    if (variant.ageMax !== void 0 && (age === void 0 || age > variant.ageMax)) {
-      continue;
+    observations.push(entry.resource);
+  }
+  return { observations, skipped };
+}
+function mapFHIRObservationToInternal(observation, index) {
+  const { internalCode, loincCode, reason } = resolveBiomarkerCode(observation);
+  if (!internalCode) {
+    return {
+      skipped: { index, loincCode, reason, resourceType: "Observation" }
+    };
+  }
+  const definition = getDefinitionByCode(internalCode);
+  let value;
+  let unit = "";
+  let isQualitative = false;
+  if (observation.valueQuantity?.value !== void 0) {
+    value = observation.valueQuantity.value;
+    unit = observation.valueQuantity.unit || observation.valueQuantity.code || "";
+  } else if (observation.valueString) {
+    value = observation.valueString;
+    isQualitative = true;
+  } else {
+    return {
+      skipped: {
+        index,
+        loincCode,
+        reason: "Observation has no value (valueQuantity or valueString)",
+        resourceType: "Observation"
+      }
+    };
+  }
+  const collectionDate = observation.effectiveDateTime || observation.effectivePeriod?.start || "";
+  if (!collectionDate) {
+    return {
+      skipped: {
+        index,
+        loincCode,
+        reason: "Observation has no effectiveDateTime or effectivePeriod.start",
+        resourceType: "Observation"
+      }
+    };
+  }
+  let referenceMin;
+  let referenceMax;
+  let referenceKind;
+  if (observation.referenceRange?.[0]) {
+    referenceMin = observation.referenceRange[0].low?.value;
+    referenceMax = observation.referenceRange[0].high?.value;
+    const meaning = observation.referenceRange[0].type?.coding?.find(
+      (c) => c.system === "http://terminology.hl7.org/CodeSystem/referencerange-meaning"
+    )?.code;
+    if (meaning === "normal") referenceKind = "reference-interval";
+    else if (meaning === "recommended") referenceKind = "decision-threshold";
+  }
+  const imported = {
+    biomarkerCode: internalCode,
+    biomarkerName: definition?.names.pt[0] || definition?.names.en[0] || observation.code.text || internalCode,
+    collectionDate,
+    flag: extractFlag(observation),
+    isQualitative,
+    loincCode,
+    ...loincCode && methodVariantOf(internalCode, loincCode) && { methodLoinc: loincCode },
+    ...referenceKind && { referenceKind },
+    referenceMax,
+    referenceMin,
+    unit: unit || definition?.unit || "",
+    value
+  };
+  return { observation: imported };
+}
+function processImportBundle(data) {
+  const validationErrors = validateFHIRImportBundle(data);
+  if (validationErrors.length > 0) {
+    return {
+      errors: validationErrors,
+      imported: [],
+      skipped: [],
+      totalProcessed: 0
+    };
+  }
+  const bundle = data;
+  const { observations, skipped } = extractObservationsFromBundle(bundle);
+  const imported = [];
+  const allSkipped = [...skipped];
+  for (let i = 0; i < observations.length; i++) {
+    const result = mapFHIRObservationToInternal(observations[i], i);
+    if ("observation" in result) {
+      imported.push(result.observation);
+    } else {
+      allSkipped.push(result.skipped);
     }
-    return withSource(variant.range);
   }
-  return withSource(definition.default);
+  return {
+    errors: [],
+    imported,
+    skipped: allSkipped,
+    totalProcessed: observations.length
+  };
 }
-function getRangeDirection(testCode) {
-  return biomarkerRangeDefinitions[testCode]?.direction ?? "range";
+
+// src/cli/commands/import.ts
+async function importBundle(args, json) {
+  const raw = await getInput(args[0]);
+  const bundle = parseJson(raw, "JSON inv\xE1lido.");
+  const result = processImportBundle(bundle);
+  if (json) {
+    outputJson(result);
+    return;
+  }
+  outputText(`Processados: ${result.totalProcessed}`);
+  outputText(`Importados:  ${result.imported.length}`);
+  outputText(`Ignorados:   ${result.skipped.length}`);
+  outputText(`Erros:       ${result.errors.length}`);
+  if (result.imported.length > 0) {
+    outputText("\nObserva\xE7\xF5es importadas:");
+    for (const obs of result.imported) {
+      outputText(`  ${obs.biomarkerCode} (${obs.loincCode}): ${obs.value} ${obs.unit}`);
+    }
+  }
+  if (result.errors.length > 0) {
+    outputText("\nErros:");
+    for (const err of result.errors) {
+      outputText(`  ${err.field}: ${err.details}`);
+    }
+  }
+}
+
+// src/cli/commands/list.ts
+import { parseArgs } from "util";
+async function list(args, json) {
+  const { values } = parseArgs({
+    args,
+    options: {
+      category: { type: "string" },
+      visible: { default: false, type: "boolean" }
+    },
+    strict: false
+  });
+  let defs;
+  if (values.category) {
+    defs = getBiomarkersByCategory(values.category);
+    if (defs.length === 0) {
+      exitWithError(`Categoria n\xE3o encontrada ou vazia: ${values.category}`);
+    }
+  } else if (values.visible) {
+    defs = getVisibleDefinitions();
+  } else {
+    defs = getAllDefinitions();
+  }
+  if (json) {
+    outputJson(defs);
+    return;
+  }
+  const rows = defs.map((d) => [
+    d.code,
+    d.loinc ?? "\u2014",
+    d.names.pt[0] ?? "",
+    d.unit ?? "\u2014",
+    Array.isArray(d.category) ? d.category.join(", ") : d.category
+  ]);
+  outputText(formatTable(["C\xF3digo", "LOINC", "Nome (pt)", "Unidade", "Categoria"], rows));
+  outputText(`
+Total: ${defs.length} biomarcadores`);
+}
+
+// src/cli/commands/loinc-map.ts
+async function loincMap(_args, json) {
+  const defs = getAllDefinitions().filter((d) => d.loinc);
+  if (json) {
+    const map = Object.fromEntries(defs.map((d) => [d.loinc, d.code]));
+    outputJson(map);
+    return;
+  }
+  const rows = defs.map((d) => [d.loinc, d.code, d.names.pt[0] ?? d.names.en[0] ?? ""]);
+  outputText(formatTable(["LOINC", "C\xF3digo", "Nome (pt)"], rows));
+  outputText(`
+Total: ${rows.length} mapeamentos`);
+}
+
+// src/cli/commands/lookup.ts
+function displayDefinition(def) {
+  const cat = Array.isArray(def.category) ? def.category.join(", ") : def.category;
+  outputText(
+    [
+      `Biomarcador: ${def.code}`,
+      `  LOINC:      ${def.loinc ?? "\u2014"}`,
+      `  Nomes (pt): ${def.names.pt.join(", ")}`,
+      `  Nomes (en): ${def.names.en.join(", ")}`,
+      `  Categoria:  ${cat}`,
+      `  Unidade:    ${def.unit ?? "\u2014"}`,
+      `  Sexo:       ${def.sex ?? "ambos"}`,
+      `  Vis\xEDvel:    ${def.hidden ? "n\xE3o" : "sim"}`
+    ].join("\n")
+  );
+}
+async function lookup(args, json) {
+  const code = args[0];
+  if (!code) exitWithError("Uso: fhir-bio lookup <c\xF3digo>");
+  const def = getDefinitionByCode(code);
+  if (!def) exitWithError(`Biomarcador n\xE3o encontrado: ${code}`);
+  if (json) {
+    outputJson(def);
+  } else {
+    displayDefinition(def);
+  }
+}
+async function lookupLoinc(args, json) {
+  const loinc = args[0];
+  if (!loinc) exitWithError("Uso: fhir-bio lookup-loinc <loinc>");
+  const def = getDefinitionByLoinc(loinc);
+  if (!def) exitWithError(`Biomarcador n\xE3o encontrado para LOINC: ${loinc}`);
+  if (json) {
+    outputJson(def);
+  } else {
+    displayDefinition(def);
+  }
 }
 
 // src/cli/commands/range.ts
+import { parseArgs as parseArgs2 } from "util";
 async function range(args, json) {
   const { positionals, values } = parseArgs2({
     allowPositionals: true,
@@ -6990,11 +7408,18 @@ async function range(args, json) {
   const sexLabel = ctx.biologicalSex === "M" ? "Homem" : ctx.biologicalSex === "F" ? "Mulher" : "Geral";
   const ageLabel = ctx.age !== void 0 ? `, ${ctx.age} anos` : "";
   const fmt = (v) => v !== void 0 ? String(v) : "\u2014";
+  const desenho = (kind) => kind === "display" ? "  (desenho, n\xE3o \xE9 corte)" : "";
+  const tipos = {
+    "decision-threshold": "limiar de decis\xE3o",
+    population: "distribui\xE7\xE3o populacional",
+    "reference-interval": "intervalo de refer\xEAncia"
+  };
   outputText(
     [
       `Faixa de Refer\xEAncia: ${code} (${sexLabel}${ageLabel})`,
-      `  M\xEDnimo:       ${fmt(ref.min)} ${ref.unit}`,
-      `  M\xE1ximo:       ${fmt(ref.max)} ${ref.unit}`,
+      `  Tipo:         ${ref.kind ? tipos[ref.kind] : "\u2014"}`,
+      `  M\xEDnimo:       ${fmt(ref.min)} ${ref.unit}${desenho(ref.minKind)}`,
+      `  M\xE1ximo:       ${fmt(ref.max)} ${ref.unit}${desenho(ref.maxKind)}`,
       `  \xD3timo (m\xEDn):  ${fmt(ref.optimalMin)} ${ref.unit}`,
       `  \xD3timo (m\xE1x):  ${fmt(ref.optimalMax)} ${ref.unit}`,
       `  Alerta (m\xE1x): ${fmt(ref.warningMax)} ${ref.unit}`,
@@ -7487,7 +7912,7 @@ var COMMANDS = {
 async function main() {
   const { command, help, json, resto, version } = dividirArgv(process.argv.slice(2));
   if (version) {
-    process.stdout.write(`${"0.33.0"}
+    process.stdout.write(`${"0.35.0"}
 `);
     return;
   }