ACEF II cardiac surgery score (Ranucci 2018)

ACEF II

Compute the Ranucci 2018 ACEF II score from age, left-ventricular ejection fraction, serum creatinine, emergency surgery, and hematocrit.

LIVE $0.005 USDC GET /api/calc/acef_ii

Markdown: /docs/acef-ii.md · Canonical: https://magentlab.com/docs/acef-ii

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Compute the Ranucci 2018 ACEF II score from age, left-ventricular ejection fraction, serum creatinine, emergency surgery, and hematocrit.

When to use

When an agent needs the published Ranucci 2018 ACEF II score for cardiac surgery and must not substitute original ACEF 2009, invent predicted mortality, or issue an operative clearance.

When not to use

Not a medical device. Not an operative clearance, cancellation, or monitoring order.
Ranucci 2018 ACEF II only. This is not original ACEF 2009 (age/EF + 1 if creatinine > 2.0 mg/dL).
Returns the published ACEF II score only. Does not apply a logistic predicted-mortality equation and does not invent risk bands.
Creatinine extra 2.0 only when serum creatinine is strictly greater than 2.0 mg/dL; 2.0 scores 0 extra.
Hematocrit ≥ 36% contributes 0; each percentage point below 36 adds 0.2. magent clamps ejection fraction 10-80, hematocrit 15-60, and age 18-120.
magent does not examine the patient or assign emergency status from an operative note.

Formula

ACEF II = age/EF + 2.0 (if serum creatinine > 2.0 mg/dL) + 3.0 (if emergency surgery) + 0.2 × (HCT points below 36%)

Citation

Title: The ACEF II Risk Score for cardiac surgery: updated but still parsimonious
Authors: Ranucci M, Pistuddi V, Scolletta S, de Vincentiis C, Menicanti L
Source: Eur Heart J. 2018;39(23):2183-2189
DOI: 10.1093/eurheartj/ehx228

Worked example

Age 70, EF 50, creatinine 1.0, elective, HCT 40

Given: age=70creatinine_mg_dl=1.0ejection_fraction_percent=50emergency_surgery=falsehematocrit_percent=40

age/EF = 70/50 = 1.4
creatinine 1.0 is not > 2.0 → 0
emergency_surgery false → 0
HCT 40 ≥ 36 → anaemia term 0
score = 1.4

Age 70, EF 50, creatinine 2.5, emergency, HCT 30

Given: age=70creatinine_mg_dl=2.5ejection_fraction_percent=50emergency_surgery=truehematocrit_percent=30

age/EF = 70/50 = 1.4
creatinine 2.5 > 2.0 → +2.0
emergency_surgery true → +3.0
HCT 30 is 6 points below 36 → 0.2 × 6 = 1.2
score = 1.4 + 2.0 + 3.0 + 1.2 = 7.6

Also searched as

ACEF II
ACEF 2
Ranucci ACEF II
age creatinine ejection fraction II
ACEF II risk score
cardiac surgery ACEF
ACEF II 2018
parsimonious cardiac surgery score

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/acef_ii?age=70&ejection_fraction_percent=50&creatinine_mg_dl=1.0&emergency_surgery=false&hematocrit_percent=40

Full URL: https://api.magentlab.com/api/calc/acef_ii?age=70&ejection_fraction_percent=50&creatinine_mg_dl=1.0&emergency_surgery=false&hematocrit_percent=40

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/acef_ii?age=70&ejection_fraction_percent=50&creatinine_mg_dl=1.0&emergency_surgery=false&hematocrit_percent=40"

Parameters

Name	Type	Required	Description
`age`	integer	required	Age in years (18-120). magent clamp; Ranucci 2018 uses age in years.
`ejection_fraction_percent`	number	required	Left-ventricular ejection fraction in percent (10-80). magent clamp. Denominator of age/EF.
`creatinine_mg_dl`	number	optional	Serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l, not both. Extra 2.0 only when strictly greater than 2.0 mg/dL (Ranucci 2018).
`creatinine_umol_l`	number	optional	Serum creatinine in µmol/L (9-1768). Converted as mg/dL = µmol/L / 88.42.
`emergency_surgery`	boolean	required	true if the operation is emergency cardiac surgery (Ranucci 2018 +3.0). true or false.
`hematocrit_percent`	number	required	Preoperative hematocrit in percent (15-60). magent clamp. HCT ≥ 36 contributes 0; each percentage point below 36 adds 0.2.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/acef_ii Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "age": "70",
      "creatinine_mg_dl": "1.0",
      "ejection_fraction_percent": "50",
      "emergency_surgery": "false",
      "hematocrit_percent": "40"
    },
    {
      "age": "70",
      "creatinine_mg_dl": "1.0",
      "ejection_fraction_percent": "50",
      "emergency_surgery": "false",
      "hematocrit_percent": "40"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/acef_ii",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Ranucci M, Pistuddi V, Scolletta S, de Vincentiis C, Menicanti L",
        "doi": "10.1093/eurheartj/ehx228",
        "id": "ranucci-2018",
        "pmid": "28498904",
        "source": "Eur Heart J. 2018;39(23):2183-2189",
        "title": "The ACEF II Risk Score for cardiac surgery: updated but still parsimonious"
      },
      "formula": "acef_ii",
      "formula_expression": "ACEF II = age/EF + 2.0 (if serum creatinine > 2.0 mg/dL) + 3.0 (if emergency surgery) + 0.2 × (HCT points below 36%)",
      "age_years": 70,
      "score": 1.4,
      "creatinine_mg_dl": 1.0,
      "ejection_fraction_percent": 50.0,
      "emergency_surgery": false,
      "hematocrit_percent": 40.0
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Ranucci M, Pistuddi V, Scolletta S, de Vincentiis C, Menicanti L",
        "doi": "10.1093/eurheartj/ehx228",
        "id": "ranucci-2018",
        "pmid": "28498904",
        "source": "Eur Heart J. 2018;39(23):2183-2189",
        "title": "The ACEF II Risk Score for cardiac surgery: updated but still parsimonious"
      },
      "formula": "acef_ii",
      "formula_expression": "ACEF II = age/EF + 2.0 (if serum creatinine > 2.0 mg/dL) + 3.0 (if emergency surgery) + 0.2 × (HCT points below 36%)",
      "age_years": 70,
      "score": 1.4,
      "creatinine_mg_dl": 1.0,
      "ejection_fraction_percent": 50.0,
      "emergency_surgery": false,
      "hematocrit_percent": 40.0
    }
  ]
}

Response

Field	Type	Description
`formula`	string	acef_ii
`formula_expression`	string	Exact expression used
`age_years`	integer	Age used in years
`ejection_fraction_percent`	number	Left-ventricular ejection fraction used, percent
`creatinine_mg_dl`	number	Serum creatinine used in mg/dL (after conversion)
`emergency_surgery`	boolean	true if emergency cardiac surgery
`hematocrit_percent`	number	Preoperative hematocrit used, percent
`score`	number	Ranucci 2018 ACEF II score, 4 decimal places. Not a mortality percent.
`citation`	object	Ranucci 2018 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Ranucci M, Pistuddi V, Scolletta S, de Vincentiis C, Menicanti L",
    "doi": "10.1093/eurheartj/ehx228",
    "id": "ranucci-2018",
    "pmid": "28498904",
    "source": "Eur Heart J. 2018;39(23):2183-2189",
    "title": "The ACEF II Risk Score for cardiac surgery: updated but still parsimonious"
  },
  "formula": "acef_ii",
  "formula_expression": "ACEF II = age/EF + 2.0 (if serum creatinine > 2.0 mg/dL) + 3.0 (if emergency surgery) + 0.2 × (HCT points below 36%)",
  "age_years": 70,
  "score": 1.4,
  "creatinine_mg_dl": 1.0,
  "ejection_fraction_percent": 50.0,
  "emergency_surgery": false,
  "hematocrit_percent": 40.0
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_acef_ii`	ejection_fraction_percent 10-80, creatinine_mg_dl 0.1-20, and hematocrit_percent 15-60 (Ranucci 2018; magent clamps). Returned before settlement; you are not charged.
400	`invalid_age`	age must be an integer from 18 to 120 Returned before settlement; you are not charged.
400	`invalid_creatinine`	creatinine_mg_dl (0.1-20) or creatinine_umol_l (9-1768) is required Returned before settlement; you are not charged.
400	`invalid_flag`	boolean clinical flags must be true or false Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

RCRI — Sum the six Lee 1999 revised cardiac risk index factors and return class I–IV.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.