@precisa-saude/fhir 0.33.0 → 0.35.0

package/dist/{chunk-WXCX5TJJ.js → chunk-O3FXUPW3.js}

@@ -1,35 +1,42 @@
 import {
   getCanonicalUnit
-} from "./chunk-Q3H5C6UR.js";
+} from "./chunk-U2XW6DY4.js";
 
 // 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"
   },
   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: [
       {
@@ -46,6 +53,7 @@ var biomarkerRangeDefinitions = {
   },
   ALT: {
     default: { max: 35, min: 0, optimalMax: 25, optimalMin: 0, unit: "U/L" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -68,6 +76,7 @@ var biomarkerRangeDefinitions = {
   // 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: [
       {
@@ -103,14 +112,17 @@ 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
@@ -118,23 +130,28 @@ 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 =
@@ -147,16 +164,19 @@ 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: [
       {
@@ -175,6 +195,7 @@ 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" },
@@ -183,6 +204,7 @@ 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
@@ -192,23 +214,28 @@ 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).
@@ -219,14 +246,17 @@ 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
@@ -234,44 +264,53 @@ 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
@@ -296,6 +335,7 @@ 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" } }
@@ -303,6 +343,7 @@ 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,
@@ -310,6 +351,7 @@ 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)
@@ -317,6 +359,7 @@ 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: [
       {
@@ -333,22 +376,27 @@ 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: {
@@ -360,10 +408,12 @@ 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
@@ -389,10 +439,12 @@ 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
@@ -406,6 +458,7 @@ 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
@@ -419,10 +472,12 @@ 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: [
       {
@@ -463,20 +518,30 @@ 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" },
@@ -485,18 +550,22 @@ 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: [
       {
@@ -519,6 +588,7 @@ 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
@@ -528,6 +598,7 @@ 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
@@ -560,14 +631,17 @@ 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: [
       {
@@ -591,26 +665,29 @@ 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
@@ -633,6 +710,7 @@ 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
@@ -654,10 +732,12 @@ 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.
@@ -667,11 +747,13 @@ 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: [
       {
@@ -693,18 +775,40 @@ 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"
       }
     ]
@@ -712,12 +816,21 @@ 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.
@@ -773,19 +886,23 @@ 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: {
@@ -797,10 +914,12 @@ 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: [
       {
@@ -817,6 +936,7 @@ 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
@@ -828,6 +948,7 @@ 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: [
       {
@@ -845,59 +966,109 @@ 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: [
       {
@@ -920,6 +1091,7 @@ 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
@@ -931,12 +1103,14 @@ 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" },
@@ -945,40 +1119,49 @@ 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" },
@@ -987,11 +1170,13 @@ 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`,
@@ -1015,6 +1200,7 @@ 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" },
@@ -1024,22 +1210,27 @@ 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
@@ -1049,39 +1240,55 @@ 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.
@@ -1092,6 +1299,7 @@ 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: [
       {
@@ -1118,6 +1326,7 @@ var biomarkerRangeDefinitions = {
   },
   Prolactin: {
     default: { max: 18, min: 2, optimalMax: 15, optimalMin: 4, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "tietz-7ed-2015",
     variants: [
       {
@@ -1134,6 +1343,7 @@ var biomarkerRangeDefinitions = {
   },
   PSA: {
     default: { max: 4, min: 0, optimalMax: 2.5, optimalMin: 0, unit: "ng/mL" },
+    kind: "reference-interval",
     source: "sturgeon-nacb-2008",
     variants: [
       {
@@ -1163,6 +1373,7 @@ 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: [
       {
@@ -1179,22 +1390,27 @@ 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: [
       {
@@ -1211,34 +1427,42 @@ 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: [
       {
@@ -1261,12 +1485,14 @@ 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: [
       {
@@ -1289,22 +1515,27 @@ 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: [
       {
@@ -1332,16 +1563,19 @@ 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
@@ -1351,6 +1585,7 @@ 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
@@ -1399,10 +1634,12 @@ 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: [
       {
@@ -1419,50 +1656,62 @@ 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:
@@ -1479,6 +1728,7 @@ 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: [
       {
@@ -1490,10 +1740,12 @@ 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
@@ -1502,30 +1754,34 @@ 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"
       }
     ]
@@ -1576,6 +1832,7 @@ 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.
@@ -1587,38 +1844,76 @@ 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"
       }
     ]
@@ -1626,142 +1921,148 @@ 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: [
       {
@@ -1779,6 +2080,7 @@ var biomarkerRangeDefinitions = {
   VATMass: {
     default: { max: 1.5, min: 0, optimalMax: 0.8, optimalMin: 0, unit: "kg" },
     direction: "lower-better",
+    kind: "population",
     source: "ofenheimer-vat-2020",
     variants: [
       {
@@ -1803,29 +2105,56 @@ var biomarkerRangeDefinitions = {
       warningMax: 1837
     },
     direction: "lower-better",
+    kind: "decision-threshold",
     source: "ge-corescan"
   },
   BMD_Total: {
-    default: { max: 1.4, min: 0.9, optimalMax: 1.3, optimalMin: 1, unit: "g/cm\xB2" },
+    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, min: -1, optimalMax: 2, optimalMin: -0.5, unit: "" },
+    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, min: -2, optimalMax: 1, optimalMin: -1, unit: "" },
+    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: [
       {
@@ -1842,18 +2171,22 @@ var biomarkerRangeDefinitions = {
   },
   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
@@ -1864,13 +2197,23 @@ var biomarkerRangeDefinitions = {
   // 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 },
+    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:
@@ -1900,22 +2243,34 @@ var biomarkerRangeDefinitions = {
   // 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 },
+    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: [
       {
@@ -1934,36 +2289,48 @@ var biomarkerRangeDefinitions = {
   IgE_Total: {
     default: { max: 100, min: 0, optimalMax: 100, optimalMin: 0, unit: "IU/mL" },
     direction: "lower-better",
+    kind: "reference-interval",
     source: "tietz-7ed-2015"
   },
   // IgG - Immunoglobulin G
   IgG: {
     default: { max: 1600, min: 700, optimalMax: 1600, optimalMin: 700, unit: "mg/dL" },
+    kind: "reference-interval",
     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",
+    kind: "decision-threshold",
     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",
+    kind: "decision-threshold",
     source: "tietz-7ed-2015"
   }
 };
 var defaultReferenceRanges = Object.fromEntries(
   Object.entries(biomarkerRangeDefinitions).map(([code, def]) => [
     code,
-    def.source ? { ...def.default, source: def.source } : def.default
+    {
+      ...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 = (range) => definition.source ? { ...range, source: definition.source } : range;
+  const withSource = (range, kind = definition.kind) => ({
+    ...range,
+    ...kind && { kind },
+    ...definition.source && { source: definition.source }
+  });
   if (!context || !definition.variants || definition.variants.length === 0) {
     return withSource(definition.default);
   }
@@ -1987,13 +2354,28 @@ function getReferenceRange(testCode, context) {
     if (variant.ageMax !== void 0 && (age === void 0 || age > variant.ageMax)) {
       continue;
     }
-    return withSource(variant.range);
+    return withSource(variant.range, variant.kind ?? definition.kind);
   }
   return withSource(definition.default);
 }
 function getRangeDirection(testCode) {
   return biomarkerRangeDefinitions[testCode]?.direction ?? "range";
 }
+function flagAgainstCatalogRange(testCode, value, context) {
+  const range = getReferenceRange(testCode, context);
+  if (!range) return "";
+  if (range.max !== void 0 && range.maxKind !== "display" && value > range.max) return "H";
+  if (range.min !== void 0 && range.minKind !== "display" && value < range.min) return "L";
+  return "";
+}
+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;
+}
 function getFallbackReferenceRange(biomarkerCode) {
   const definition = biomarkerRangeDefinitions[biomarkerCode];
   if (!definition || definition.default.min === void 0 || definition.default.max === void 0) {
@@ -2035,7 +2417,9 @@ export {
   defaultReferenceRanges,
   getReferenceRange,
   getRangeDirection,
+  flagAgainstCatalogRange,
+  referenceRangeMeaning,
   getFallbackReferenceRange,
   applyFallbackReferenceRanges
 };
-//# sourceMappingURL=chunk-WXCX5TJJ.js.map
+//# sourceMappingURL=chunk-O3FXUPW3.js.map