# ADHERE CART in-hospital mortality risk ADHERE Status: LIVE Price: $0.005 USDC `GET /api/calc/adhere` HTML: https://magentlab.com/docs/adhere Markdown: https://magentlab.com/docs/adhere.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Fonarow 2005 ADHERE classification and regression tree for in-hospital mortality risk in acutely decompensated heart failure from admission BUN, systolic blood pressure, and serum creatinine. ## When to use When an agent has caller-supplied admission BUN, systolic BP, and creatinine and needs the published ADHERE CART terminal group, not the paper's logistic regression, not GWTG-HF, and not a treatment or ICU order. ## When not to use - Not a medical device. magent does not examine the patient and does not measure BUN, blood pressure, or creatinine. - Not a heart-failure diagnosis or treatment/ICU order. This is the Fonarow 2005 CART bedside tree only, not the paper's logistic regression. - This is not GWTG-HF. ## Formula ``` high: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl >= 2.75; intermediate_1: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl < 2.75; intermediate_2: bun_mg_dl >= 43 AND systolic_bp_mm_hg >= 115; intermediate_3: bun_mg_dl < 43 AND systolic_bp_mm_hg < 115; low: bun_mg_dl < 43 AND systolic_bp_mm_hg >= 115 (Fonarow 2005 CART) ``` ## Citation [Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis](https://doi.org/10.1001/jama.293.5.572) Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators JAMA. 2005;293(5):572-580 DOI: [10.1001/jama.293.5.572](https://doi.org/10.1001/jama.293.5.572) ## Worked example ### BUN 20 mg/dL, SBP 140 mm Hg, creatinine 1.0 mg/dL Given: `bun_mg_dl=20, creatinine_mg_dl=1.0, systolic_bp_mm_hg=140` 1. BUN 20 mg/dL is < 43 and SBP 140 mm Hg is >= 115 2. Creatinine is not consulted 3. low ### BUN 50 mg/dL, SBP 100 mm Hg, creatinine 3.0 mg/dL Given: `bun_mg_dl=50, creatinine_mg_dl=3.0, systolic_bp_mm_hg=100` 1. BUN 50 mg/dL is >= 43, SBP 100 mm Hg is < 115, and creatinine 3.0 mg/dL is >= 2.75 2. high ## Also searched as - ADHERE CART - ADHERE risk tree - Fonarow 2005 ADHERE - acutely decompensated heart failure mortality - ADHERE BUN SBP creatinine - in-hospital mortality heart failure CART - ADHERE classification tree - Fonarow heart failure tree ## Parameters - `bun_mg_dl` (number, required): Admission blood urea nitrogen in mg/dL (1-200). Fonarow 2005 CART first split is BUN >= 43. magent does not measure BUN. - `systolic_bp_mm_hg` (integer, required): Admission systolic blood pressure in mm Hg (integer 50-250). Fonarow 2005 CART second split is SBP < 115. magent does not measure blood pressure. - `creatinine_mg_dl` (number, optional): Admission serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l, not both. Fonarow 2005 CART consults creatinine only when BUN >= 43 and SBP < 115; the split is creatinine >= 2.75. magent does not measure creatinine. - `creatinine_umol_l` (number, optional): Admission serum creatinine in µmol/L (9-1768). Converted as mg/dL = µmol/L / 88.42. Provide this or creatinine_mg_dl, not both. ## 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. Method: `POST /api/calc/adhere` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: 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: ```json { "items": [ { "bun_mg_dl": "20", "creatinine_mg_dl": "1.0", "systolic_bp_mm_hg": "140" }, { "bun_mg_dl": "20", "creatinine_mg_dl": "1.0", "systolic_bp_mm_hg": "140" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/adhere Example 200: ```json { "count": 2, "path": "/api/calc/adhere", "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": "Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators", "doi": "10.1001/jama.293.5.572", "id": "fonarow-2005", "pmid": "15687312", "source": "JAMA. 2005;293(5):572-580", "title": "Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis" }, "formula": "adhere", "formula_expression": "high: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl >= 2.75; intermediate_1: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl < 2.75; intermediate_2: bun_mg_dl >= 43 AND systolic_bp_mm_hg >= 115; intermediate_3: bun_mg_dl < 43 AND systolic_bp_mm_hg < 115; low: bun_mg_dl < 43 AND systolic_bp_mm_hg >= 115 (Fonarow 2005 CART)", "creatinine_mg_dl": 1.0, "adhere_risk": "low", "bun_mg_dl": 20.0, "systolic_bp_mm_hg": 140 }, { "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": "Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators", "doi": "10.1001/jama.293.5.572", "id": "fonarow-2005", "pmid": "15687312", "source": "JAMA. 2005;293(5):572-580", "title": "Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis" }, "formula": "adhere", "formula_expression": "high: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl >= 2.75; intermediate_1: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl < 2.75; intermediate_2: bun_mg_dl >= 43 AND systolic_bp_mm_hg >= 115; intermediate_3: bun_mg_dl < 43 AND systolic_bp_mm_hg < 115; low: bun_mg_dl < 43 AND systolic_bp_mm_hg >= 115 (Fonarow 2005 CART)", "creatinine_mg_dl": 1.0, "adhere_risk": "low", "bun_mg_dl": 20.0, "systolic_bp_mm_hg": 140 } ] } ``` ## Response fields - `formula` (string): adhere - `formula_expression` (string): Fonarow 2005 ADHERE CART bedside-tree terminal groups in paper units - `bun_mg_dl` (number): Admission BUN used in mg/dL - `systolic_bp_mm_hg` (integer): Admission systolic blood pressure used in mm Hg - `creatinine_mg_dl` (number): Admission serum creatinine used in mg/dL (after µmol/L conversion when supplied) - `adhere_risk` (string): high, intermediate_1, intermediate_2, intermediate_3, or low (Fonarow 2005 CART). Not a logistic-model score. - `citation` (object): Fonarow 2005 JAMA citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "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": "Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators", "doi": "10.1001/jama.293.5.572", "id": "fonarow-2005", "pmid": "15687312", "source": "JAMA. 2005;293(5):572-580", "title": "Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis" }, "formula": "adhere", "formula_expression": "high: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl >= 2.75; intermediate_1: bun_mg_dl >= 43 AND systolic_bp_mm_hg < 115 AND creatinine_mg_dl < 2.75; intermediate_2: bun_mg_dl >= 43 AND systolic_bp_mm_hg >= 115; intermediate_3: bun_mg_dl < 43 AND systolic_bp_mm_hg < 115; low: bun_mg_dl < 43 AND systolic_bp_mm_hg >= 115 (Fonarow 2005 CART)", "creatinine_mg_dl": 1.0, "adhere_risk": "low", "bun_mg_dl": 20.0, "systolic_bp_mm_hg": 140 } ``` ## Errors - HTTP 400 `invalid_bun`: bun_mg_dl must be a number from 1 to 200. Returned before settlement; you are not charged. - HTTP 400 `invalid_systolic_bp`: systolic_mm_hg or systolic_bp_mm_hg must be a number from 50 to 250. Returned before settlement; you are not charged. - HTTP 400 `invalid_creatinine`: creatinine_mg_dl (0.1-20) or creatinine_umol_l (9-1768) is required Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [CPO](https://magentlab.com/docs/cpo) — Compute Fincke 2004 cardiac power output in watts from mean arterial pressure and cardiac output. - [Diastolic shock index](https://magentlab.com/docs/dsi) — Compute the Ospina-Tascón diastolic shock index as heart rate in bpm divided by cuff diastolic pressure in mm Hg. ## 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. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/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. - 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.