vigilcare-clinical/VigilCareClinicalAPI.Tests/SofaScoringTests.cs

using FluentAssertions;
using Microsoft.EntityFrameworkCore;
using Microsoft.Extensions.DependencyInjection;
using StackExchange.Redis;

[Collection("Integration")]
public class SofaScoringTests : IAsyncLifetime
{
    private readonly ApiFixture _fixture;
    private Guid _encounterId;
    private Guid _patientId;

    public SofaScoringTests(ApiFixture fixture) => _fixture = fixture;

    public async Task InitializeAsync()
    {
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        await DbResetHelper.ResetAsync(db);

        var patient = new Patient
        {
            Id = Guid.NewGuid(), Mrn = "MRN-SOFA-001", FirstName = "SOFA", LastName = "Test",
            DateOfBirth = new DateOnly(1960, 1, 1), Gender = "M",
            CreatedAt = DateTimeOffset.UtcNow
        };
        var encounter = new Encounter
        {
            Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
            Status = EncounterStatus.Active, Department = Department.Icu,
            AttendingPhysician = "Dr. SOFA", AdmittedAt = DateTimeOffset.UtcNow,
            CreatedAt = DateTimeOffset.UtcNow
        };
        db.Patients.Add(patient);
        db.Encounters.Add(encounter);
        await db.SaveChangesAsync();

        _patientId = patient.Id;
        _encounterId = encounter.Id;
    }

    public Task DisposeAsync() => Task.CompletedTask;

    private async Task<SofaScoringResult> ScoreObsAsync(string code, decimal value)
    {
        using var scope = _fixture.Services.CreateScope();
        var detector = scope.ServiceProvider.GetRequiredService<SofaDetector>();
        return await detector.ProcessObservationAsync(
            _encounterId, _patientId, code, value, DateTimeOffset.UtcNow);
    }

    [Fact]
    public async Task RespiratoryScore_PaO2FiO2Ratio()
    {
        await ScoreObsAsync("FIO2_PCT", 40m);
        var result = await ScoreObsAsync("PAO2_MMHG", 80m);
        result.Score!.Respiratory.Should().Be(2);
    }

    [Fact]
    public async Task RespiratoryScore_SpO2Fallback()
    {
        await ScoreObsAsync("FIO2_PCT", 40m);
        await ScoreObsAsync("SPO2", 94m);
        var result = await ScoreObsAsync("PLATELET_K_UL", 180m);
        result.Score!.Respiratory.Should().Be(1);
    }

    [Fact]
    public async Task CoagulationScore_LowPlatelets()
    {
        var result = await ScoreObsAsync("PLATELET_K_UL", 45m);
        result.Score!.Coagulation.Should().Be(3);
    }

    [Fact]
    public async Task LiverScore_ElevatedBilirubin()
    {
        var result = await ScoreObsAsync("BILIRUBIN_MG_DL", 3.5m);
        result.Score!.Liver.Should().Be(2);
    }

    [Fact]
    public async Task CardiovascularScore_LowMAP()
    {
        await ScoreObsAsync("SYSTOLIC_BP", 85m);
        var result = await ScoreObsAsync("DIASTOLIC_BP", 50m);
        result.Score!.Cardiovascular.Should().Be(1);
    }

    [Fact]
    public async Task CardiovascularScore_Vasopressor()
    {
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var resolver = scope.ServiceProvider.GetRequiredService<SofaVasopressorResolver>();
        var detector = scope.ServiceProvider.GetRequiredService<SofaDetector>();

        var med = new MedicationAdministration
        {
            Id = Guid.NewGuid(),
            EncounterId = _encounterId,
            DrugName = "NOREPINEPHRINE",
            Dose = 0.05m,
            DoseUnit = "mcg/kg/min",
            Route = "IV",
            AdministeredAt = DateTimeOffset.UtcNow,
            AdministeredBy = "RN Test"
        };
        db.MedicationAdministrations.Add(med);
        await db.SaveChangesAsync();
        await resolver.CacheFromAdministrationAsync(med, CancellationToken.None);

        var result = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "SYSTOLIC_BP", 120m, DateTimeOffset.UtcNow);
        result.Score!.Cardiovascular.Should().BeGreaterThanOrEqualTo(2);
    }

    [Fact]
    public async Task CnsScore_FromGcs()
    {
        using var scope = _fixture.Services.CreateScope();
        var gcs = scope.ServiceProvider.GetRequiredService<GcsDetector>();
        await gcs.ProcessObservationAsync(_encounterId, _patientId, "GCS_EYE", 2m);
        await gcs.ProcessObservationAsync(_encounterId, _patientId, "GCS_VERBAL", 3m);
        await gcs.ProcessObservationAsync(_encounterId, _patientId, "GCS_MOTOR", 4m);

        var sofa = scope.ServiceProvider.GetRequiredService<SofaDetector>();
        var result = await sofa.ProcessGcsScoredAsync(_encounterId, _patientId);
        result.Score!.Cns.Should().Be(3);
    }

    [Fact]
    public async Task RenalScore_ElevatedCreatinine()
    {
        var result = await ScoreObsAsync("CREATININE_MG_DL", 4.0m);
        result.Score!.Renal.Should().Be(3);
    }

    [Fact]
    public async Task BaselineEstablished_OnFirstCompleteScore()
    {
        await SeedBaselineInputsAsync();
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var baseline = await db.SofaScores.FirstAsync(s => s.IsBaseline);
        baseline.IsBaseline.Should().BeTrue();
    }

    [Fact]
    public async Task DeltaTwo_CreatesSofaSepsisAlert()
    {
        await SeedBaselineInputsAsync(totalOffset: 0);
        await ScoreObsAsync("PLATELET_K_UL", 20m);
        await ScoreObsAsync("CREATININE_MG_DL", 4.5m);

        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var alert = await db.ClinicalAlerts.SingleAsync(a => a.AlertType == AlertType.SofaSepsis);
        alert.Severity.Should().Be(AlertSeverity.Critical);
    }

    [Fact]
    public async Task DeltaOne_CreatesWarning()
    {
        await SeedBaselineInputsAsync(totalOffset: 0);
        await ScoreObsAsync("PLATELET_K_UL", 120m);

        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var alert = await db.ClinicalAlerts.SingleAsync(a => a.AlertType == AlertType.SofaWarning);
        alert.Severity.Should().Be(AlertSeverity.Warning);
    }

    [Fact]
    public async Task NoDelta_NoAlert()
    {
        await SeedBaselineInputsAsync();
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        (await db.ClinicalAlerts.CountAsync()).Should().Be(0);
    }

    [Fact]
    public async Task CarryForward_WithinWindow()
    {
        using var scope = _fixture.Services.CreateScope();
        var cache = scope.ServiceProvider.GetRequiredService<SofaLabCache>();
        await cache.StoreAsync(_encounterId, "PLATELET_K_UL", 180m,
            DateTimeOffset.UtcNow.AddHours(-8));

        var result = await ScoreObsAsync("FIO2_PCT", 40m);
        result.Score!.Coagulation.Should().Be(0);
    }

    private async Task SeedBaselineInputsAsync(int totalOffset = 0)
    {
        await ScoreObsAsync("PAO2_MMHG", 100m);
        await ScoreObsAsync("FIO2_PCT", 40m);
        await ScoreObsAsync("PLATELET_K_UL", 180m - totalOffset);
        await ScoreObsAsync("BILIRUBIN_MG_DL", 1.0m);
        await ScoreObsAsync("SYSTOLIC_BP", 120m);
        await ScoreObsAsync("DIASTOLIC_BP", 80m);
        await ScoreObsAsync("CREATININE_MG_DL", 1.0m);
        await ScoreObsAsync("URINE_OUTPUT_ML_H", 50m);
    }
}