# ATLAS C. difficile infection score

ATLAS

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/atlas`
HTML: https://magentlab.com/docs/atlas
Markdown: https://magentlab.com/docs/atlas.md

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

## What it computes

Sum the Miller 2013 five-component ATLAS bedside score (age, systemic antibiotics during CDI therapy, leukocyte count, albumin, serum creatinine) and return the published predicted-cure percent.

## When to use

When an agent has age, concurrent systemic antibiotics, WBC, albumin, and creatinine and needs the published Miller 2013 ATLAS total and predicted-cure percent, not a Clostridioides difficile diagnosis and not a metronidazole, vancomycin, or fidaxomicin order.

## When not to use

- Not a medical device. Not a Clostridioides difficile (C. difficile) diagnosis and not a metronidazole, vancomycin, or fidaxomicin order. magent does not culture stool.
- Miller 2013 five-component ATLAS only (Age, Treatment with systemic antibiotics, Leukocyte count, Albumin, Serum creatinine). Temperature was a Table 1 candidate and is not scored; the final ATLAS dropped it. magent does not assay labs.
- Predicted cure percent is 100 − 5.08 × score from the paper regression, rounded to one decimal (score 0 is 100.0). The paper reports eleven score categories 0–10; this tool does not invent mild/moderate/severe bands.

## Formula

```
ATLAS = age (<60 0, 60–79 1, ≥80 2) + systemic_antibiotics (false 0, true 2) + leukocyte (<16 ×10^9/L 0, 16–25 1, >25 2) + albumin (>35 g/L 0, 26–35 1, ≤25 2) + creatinine (≤120 µmol/L 0, 121–179 1, ≥180 2); Miller 2013 Table 1 five-component ATLAS; max 10; predicted_cure_percent = 100 − 5.08 × score (1 decimal)
```

## Citation

[Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy](https://doi.org/10.1186/1471-2334-13-148)
Miller MA, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, Kean Y, Sears P
BMC Infect Dis. 2013;13:148
DOI: [10.1186/1471-2334-13-148](https://doi.org/10.1186/1471-2334-13-148)

## Worked example

### All components 0

Given: `age=40, albumin_g_l=40, creatinine_umol_l=80, systemic_antibiotics=false, wbc_k_ul=8`

1. Age 40 <60 → 0; no systemic antibiotics → 0; WBC 8 ×10^9/L <16 → 0; albumin 40 g/L >35 → 0; creatinine 80 µmol/L ≤120 → 0
2. Score = 0 (max 10); predicted_cure_percent = 100.0


### Systemic antibiotics during CDI therapy

Given: `age=40, albumin_g_l=40, creatinine_umol_l=80, systemic_antibiotics=true, wbc_k_ul=8`

1. Systemic antibiotics true → 2; remaining components 0
2. Score = 2; predicted_cure_percent = 100 − 5.08 × 2 = 89.8


## Also searched as

- atlas c diff
- cdi atlas
- clostridioides difficile
- ATLAS score
- C. difficile ATLAS
- Clostridium difficile ATLAS
- Miller ATLAS
- CDI bedside score

## Parameters

- `age` (integer, required): Age in years (18-120). Miller 2013 Table 1: <60 scores 0; 60–79 inclusive scores 1; ≥80 scores 2.
- `systemic_antibiotics` (boolean, required): Systemic antibiotics on one or more days of CDI therapy (Miller 2013). true scores 2; false scores 0. There is no 1-point cell. magent does not review the medication list.
- `wbc_k_ul` (number, optional): Total leukocyte count in 10^3/µL (same as ×10^9/L). Provide wbc_k_ul or wbc_ul, not both. Range 0.01-500. Miller 2013: <16 scores 0; 16–25 inclusive scores 1; >25 scores 2.
- `wbc_ul` (number, optional): Total leukocyte count in cells/µL. Provide wbc_k_ul or wbc_ul, not both. Range 10-500000. Miller 2013: <16000 scores 0; 16000–25000 inclusive scores 1; >25000 scores 2.
- `albumin_g_l` (number, optional): Serum albumin in g/L (10-60). Provide this or albumin_g_dl, not both. Miller 2013: >35 scores 0; 26–35 inclusive scores 1; ≤25 scores 2. magent does not assay albumin.
- `albumin_g_dl` (number, optional): Serum albumin in g/dL (1-6). Converted as g/L = g/dL × 10. Provide this or albumin_g_l, not both.
- `creatinine_umol_l` (number, optional): Serum creatinine in µmol/L (9-1768). Provide this or creatinine_mg_dl, not both. Miller 2013: ≤120 scores 0; 121–179 inclusive scores 1; ≥180 scores 2. magent does not assay creatinine.
- `creatinine_mg_dl` (number, optional): Serum creatinine in mg/dL (0.1-20). Converted as µmol/L = mg/dL × 88.42. Provide this or creatinine_umol_l, 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/atlas`
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": [
    {
      "age": "40",
      "albumin_g_l": "40",
      "creatinine_umol_l": "80",
      "systemic_antibiotics": "false",
      "wbc_k_ul": "8"
    },
    {
      "age": "40",
      "albumin_g_l": "40",
      "creatinine_umol_l": "80",
      "systemic_antibiotics": "false",
      "wbc_k_ul": "8"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/atlas

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/atlas",
  "items": [
    {
      "components": [
        {
          "value": 40,
          "factor": "age",
          "points": 0,
          "present": false
        },
        {
          "factor": "systemic_antibiotics",
          "points": 0,
          "present": false
        },
        {
          "value": 8.0e3,
          "factor": "leukocyte",
          "points": 0,
          "present": false
        },
        {
          "value": 40.0,
          "factor": "albumin",
          "points": 0,
          "present": false
        },
        {
          "value": 80.0,
          "factor": "creatinine",
          "points": 0,
          "present": false
        }
      ],
      "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": "Miller MA, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, Kean Y, Sears P",
        "doi": "10.1186/1471-2334-13-148",
        "id": "miller-2013",
        "pmid": "23530807",
        "source": "BMC Infect Dis. 2013;13:148",
        "title": "Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy"
      },
      "formula": "atlas",
      "formula_expression": "ATLAS = age (<60 0, 60–79 1, ≥80 2) + systemic_antibiotics (false 0, true 2) + leukocyte (<16 ×10^9/L 0, 16–25 1, >25 2) + albumin (>35 g/L 0, 26–35 1, ≤25 2) + creatinine (≤120 µmol/L 0, 121–179 1, ≥180 2); Miller 2013 Table 1 five-component ATLAS; max 10; predicted_cure_percent = 100 − 5.08 × score (1 decimal)",
      "age_years": 40,
      "max_score": 10,
      "score": 0,
      "wbc_per_ul": 8.0e3,
      "albumin_g_l": 40.0,
      "atlas_score": 0,
      "creatinine_umol_l": 80.0,
      "predicted_cure_percent": 100.0,
      "systemic_antibiotics": false
    },
    {
      "components": [
        {
          "value": 40,
          "factor": "age",
          "points": 0,
          "present": false
        },
        {
          "factor": "systemic_antibiotics",
          "points": 0,
          "present": false
        },
        {
          "value": 8.0e3,
          "factor": "leukocyte",
          "points": 0,
          "present": false
        },
        {
          "value": 40.0,
          "factor": "albumin",
          "points": 0,
          "present": false
        },
        {
          "value": 80.0,
          "factor": "creatinine",
          "points": 0,
          "present": false
        }
      ],
      "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": "Miller MA, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, Kean Y, Sears P",
        "doi": "10.1186/1471-2334-13-148",
        "id": "miller-2013",
        "pmid": "23530807",
        "source": "BMC Infect Dis. 2013;13:148",
        "title": "Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy"
      },
      "formula": "atlas",
      "formula_expression": "ATLAS = age (<60 0, 60–79 1, ≥80 2) + systemic_antibiotics (false 0, true 2) + leukocyte (<16 ×10^9/L 0, 16–25 1, >25 2) + albumin (>35 g/L 0, 26–35 1, ≤25 2) + creatinine (≤120 µmol/L 0, 121–179 1, ≥180 2); Miller 2013 Table 1 five-component ATLAS; max 10; predicted_cure_percent = 100 − 5.08 × score (1 decimal)",
      "age_years": 40,
      "max_score": 10,
      "score": 0,
      "wbc_per_ul": 8.0e3,
      "albumin_g_l": 40.0,
      "atlas_score": 0,
      "creatinine_umol_l": 80.0,
      "predicted_cure_percent": 100.0,
      "systemic_antibiotics": false
    }
  ]
}
```

## Response fields

- `formula` (string): atlas
- `formula_expression` (string): Exact expression used
- `score` (integer): ATLAS points 0-10
- `atlas_score` (integer): Same integer as score
- `max_score` (integer): 10
- `predicted_cure_percent` (number): Miller 2013 regression 100 − 5.08 × score, rounded to 1 decimal. Score 0 is 100.0. Not a named severity band.
- `age_years` (integer): Age in years used
- `systemic_antibiotics` (boolean): Systemic-antibiotics-during-CDI-therapy flag used
- `wbc_per_ul` (number): Leukocyte count in cells/µL used
- `albumin_g_l` (number): Serum albumin used in g/L (after g/dL conversion when supplied)
- `creatinine_umol_l` (number): Serum creatinine used in µmol/L (after mg/dL conversion when supplied)
- `components` (array): Per-factor Miller 2013 points
- `citation` (object): Miller et al. BMC Infect Dis 2013 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": 40,
      "factor": "age",
      "points": 0,
      "present": false
    },
    {
      "factor": "systemic_antibiotics",
      "points": 0,
      "present": false
    },
    {
      "value": 8.0e3,
      "factor": "leukocyte",
      "points": 0,
      "present": false
    },
    {
      "value": 40.0,
      "factor": "albumin",
      "points": 0,
      "present": false
    },
    {
      "value": 80.0,
      "factor": "creatinine",
      "points": 0,
      "present": false
    }
  ],
  "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": "Miller MA, Louie T, Mullane K, Weiss K, Lentnek A, Golan Y, Kean Y, Sears P",
    "doi": "10.1186/1471-2334-13-148",
    "id": "miller-2013",
    "pmid": "23530807",
    "source": "BMC Infect Dis. 2013;13:148",
    "title": "Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy"
  },
  "formula": "atlas",
  "formula_expression": "ATLAS = age (<60 0, 60–79 1, ≥80 2) + systemic_antibiotics (false 0, true 2) + leukocyte (<16 ×10^9/L 0, 16–25 1, >25 2) + albumin (>35 g/L 0, 26–35 1, ≤25 2) + creatinine (≤120 µmol/L 0, 121–179 1, ≥180 2); Miller 2013 Table 1 five-component ATLAS; max 10; predicted_cure_percent = 100 − 5.08 × score (1 decimal)",
  "age_years": 40,
  "max_score": 10,
  "score": 0,
  "wbc_per_ul": 8.0e3,
  "albumin_g_l": 40.0,
  "atlas_score": 0,
  "creatinine_umol_l": 80.0,
  "predicted_cure_percent": 100.0,
  "systemic_antibiotics": false
}
```

## Errors

- HTTP 400 `invalid_age`: age must be an integer from 18 to 120 Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_wbc`: wbc_k_ul (0.01-500) or wbc_ul (10-500000) is required Returned before settlement; you are not charged.
- HTTP 400 `invalid_albumin`: albumin_g_dl (1-6) or albumin_g_l (10-60) is required 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

- None

## 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. 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.