# 2023 Duke-ISCVID criteria for infective endocarditis Duke-ISCVID Status: LIVE Price: $0.005 USDC `GET /api/calc/duke_iscvid` HTML: https://magentlab.com/docs/duke-iscvid Markdown: https://magentlab.com/docs/duke-iscvid.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the 2023 Duke-ISCVID (Fowler) criteria for infective endocarditis and return definite, possible, or rejected from caller-assigned pathologic, major (microbiologic, imaging, surgical), minor, and rejected flags. ## When to use When an agent already has caller-assigned 2023 Duke-ISCVID pathologic, major, minor, and rejected flags and needs the published definite / possible / rejected classification. magent does not examine the patient, read imaging, or interpret cultures. ## When not to use - Not a medical device and not a diagnosis of infective endocarditis. - 2023 Duke-ISCVID (Fowler) only. Not Durack 1994 original Duke. Not Li 2000 modified Duke. - magent does not examine the patient, read an echocardiogram, cardiac CT, or 18F-FDG PET/CT, or interpret cultures. Organism lists and imaging modalities are caller-assigned into the major and minor flags. - Possible requires 1 major plus 1 minor or 3 minor. Findings that meet neither definite nor possible are rejected. Rejected flags apply only when definite does not hold. ## Formula ``` definite iff pathologic_definite or clinical_definite; clinical_definite iff major_count >= 2 or (major_count >= 1 and minor_count >= 3) or minor_count >= 5; possible iff not definite and ((major_count >= 1 and minor_count >= 1) or minor_count >= 3); rejected iff not definite and not possible, or (not definite and any rejected flag); definite is not overridden by rejected flags (Fowler 2023 Duke-ISCVID). minor_microbiologic is not counted when major_microbiologic is true. Majors are caller-assigned microbiologic, imaging, and surgical domains. Not Durack 1994. Not Li 2000 ``` ## Citation [The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria](https://doi.org/10.1093/cid/ciad271) Fowler VG Jr, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis JG, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fortes CQ, Fosbøl E, Hannan MM, Hasse B, Hoen B, Iversen K, et al. Clin Infect Dis. 2023;77(4):518-526 DOI: [10.1093/cid/ciad271](https://doi.org/10.1093/cid/ciad271) ## Worked example ### Two major criteria Given: `major_imaging=true, major_microbiologic=true, major_surgical=false, minor_fever=false, minor_immunologic=false, minor_microbiologic=false, minor_predisposition=false, minor_vascular=false, pathologic_definite=false, rejected_firm_alternate_diagnosis=false, rejected_no_pathology_le_4_days_antibiotics=false, rejected_resolved_le_4_days_antibiotics=false` 1. major_microbiologic is true 2. major_imaging is true 3. major_count is 2 and minor_count is 0 4. clinical_definite holds, so classification is definite ### No criteria (rejected leftover) Given: `major_imaging=false, major_microbiologic=false, major_surgical=false, minor_fever=false, minor_immunologic=false, minor_microbiologic=false, minor_predisposition=false, minor_vascular=false, pathologic_definite=false, rejected_firm_alternate_diagnosis=false, rejected_no_pathology_le_4_days_antibiotics=false, rejected_resolved_le_4_days_antibiotics=false` 1. all flags are false 2. major_count is 0 and minor_count is 0 3. clinical_definite does not hold and possible does not hold 4. classification is rejected (not Durack 1994 leftover possible) ## Also searched as - Duke-ISCVID - 2023 Duke criteria - ISCVID endocarditis - Fowler 2023 Duke - Duke-ISCVID IE criteria - 2023 Duke-ISCVID - infective endocarditis 2023 criteria - surgical major IE ## Parameters - `pathologic_definite` (boolean, required): Microorganisms or histopathology of active IE in a vegetation, embolus, or intracardiac abscess, including 2023 molecular or tissue methods, as assigned by the caller (Fowler 2023 pathologic definite). true or false. magent does not examine tissue. - `major_microbiologic` (boolean, required): Fowler 2023 microbiologic major as assigned by the caller (typical organisms from two or more sets, or another published microbiologic major including Coxiella or Bartonella serology). true or false. magent does not interpret cultures. - `major_imaging` (boolean, required): Fowler 2023 imaging major as assigned by the caller (echocardiogram, cardiac CT, or 18F-FDG PET/CT meeting the 2023 imaging major). true or false. magent does not read imaging. - `major_surgical` (boolean, required): Fowler 2023 surgical major as assigned by the caller (intraoperative inspection or subsequent histology or microbiology documenting IE). true or false. New 2023 major domain. magent does not examine the operative field. - `minor_predisposition` (boolean, required): Predisposing heart condition or intravenous drug use (Fowler 2023 minor). true or false as assigned by the caller. magent does not take a history. - `minor_fever` (boolean, required): Fever ≥38.0 C (Fowler 2023 minor). true or false as assigned by the caller. magent does not measure temperature. - `minor_vascular` (boolean, required): Vascular phenomena (Fowler 2023 minor) as assigned by the caller. true or false. magent does not examine the patient. - `minor_immunologic` (boolean, required): Immunologic phenomena (Fowler 2023 minor) as assigned by the caller. true or false. magent does not examine the patient. - `minor_microbiologic` (boolean, required): Microbiologic evidence not meeting the microbiologic major (Fowler 2023 minor). true or false as assigned by the caller. Not counted in minor_count when major_microbiologic is true. magent does not interpret cultures. - `rejected_firm_alternate_diagnosis` (boolean, required): Firm alternate diagnosis explaining evidence of IE (Fowler 2023 rejected). true or false as assigned by the caller. Classification is rejected only when definite does not hold. - `rejected_resolved_le_4_days_antibiotics` (boolean, required): Manifestations of IE resolved with antibiotic therapy for 4 days or less (Fowler 2023 rejected). true or false as assigned by the caller. - `rejected_no_pathology_le_4_days_antibiotics` (boolean, required): No pathologic evidence of IE at surgery or autopsy after antibiotic therapy for 4 days or less (Fowler 2023 rejected). true or false as assigned by the caller. magent does not examine tissue. ## 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/duke_iscvid` 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": [ { "major_imaging": "true", "major_microbiologic": "true", "major_surgical": "false", "minor_fever": "false", "minor_immunologic": "false", "minor_microbiologic": "false", "minor_predisposition": "false", "minor_vascular": "false", "pathologic_definite": "false", "rejected_firm_alternate_diagnosis": "false", "rejected_no_pathology_le_4_days_antibiotics": "false", "rejected_resolved_le_4_days_antibiotics": "false" }, { "major_imaging": "true", "major_microbiologic": "true", "major_surgical": "false", "minor_fever": "false", "minor_immunologic": "false", "minor_microbiologic": "false", "minor_predisposition": "false", "minor_vascular": "false", "pathologic_definite": "false", "rejected_firm_alternate_diagnosis": "false", "rejected_no_pathology_le_4_days_antibiotics": "false", "rejected_resolved_le_4_days_antibiotics": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/duke-iscvid Example 200: ```json { "count": 2, "path": "/api/calc/duke_iscvid", "items": [ { "rejected": 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": "Fowler VG Jr, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis JG, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fortes CQ, Fosbøl E, Hannan MM, Hasse B, Hoen B, Iversen K, et al.", "doi": "10.1093/cid/ciad271", "id": "fowler-2023", "pmid": "37138445", "source": "Clin Infect Dis. 2023;77(4):518-526", "title": "The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria" }, "formula": "duke_iscvid", "formula_expression": "definite iff pathologic_definite or clinical_definite; clinical_definite iff major_count >= 2 or (major_count >= 1 and minor_count >= 3) or minor_count >= 5; possible iff not definite and ((major_count >= 1 and minor_count >= 1) or minor_count >= 3); rejected iff not definite and not possible, or (not definite and any rejected flag); definite is not overridden by rejected flags (Fowler 2023 Duke-ISCVID). minor_microbiologic is not counted when major_microbiologic is true. Majors are caller-assigned microbiologic, imaging, and surgical domains. Not Durack 1994. Not Li 2000", "criteria": [ { "factor": "pathologic_definite", "met": false }, { "factor": "major_microbiologic", "met": true }, { "factor": "major_imaging", "met": true }, { "factor": "major_surgical", "met": false }, { "factor": "minor_predisposition", "met": false }, { "factor": "minor_fever", "met": false }, { "factor": "minor_vascular", "met": false }, { "factor": "minor_immunologic", "met": false }, { "factor": "minor_microbiologic", "met": false }, { "factor": "rejected_firm_alternate_diagnosis", "met": false }, { "factor": "rejected_resolved_le_4_days_antibiotics", "met": false }, { "factor": "rejected_no_pathology_le_4_days_antibiotics", "met": false }, { "factor": "clinical_definite", "met": true }, { "factor": "rejected", "met": false } ], "major_count": 2, "minor_count": 0, "classification": "definite", "definite": true, "pathologic_definite": false, "possible": false }, { "rejected": 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": "Fowler VG Jr, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis JG, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fortes CQ, Fosbøl E, Hannan MM, Hasse B, Hoen B, Iversen K, et al.", "doi": "10.1093/cid/ciad271", "id": "fowler-2023", "pmid": "37138445", "source": "Clin Infect Dis. 2023;77(4):518-526", "title": "The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria" }, "formula": "duke_iscvid", "formula_expression": "definite iff pathologic_definite or clinical_definite; clinical_definite iff major_count >= 2 or (major_count >= 1 and minor_count >= 3) or minor_count >= 5; possible iff not definite and ((major_count >= 1 and minor_count >= 1) or minor_count >= 3); rejected iff not definite and not possible, or (not definite and any rejected flag); definite is not overridden by rejected flags (Fowler 2023 Duke-ISCVID). minor_microbiologic is not counted when major_microbiologic is true. Majors are caller-assigned microbiologic, imaging, and surgical domains. Not Durack 1994. Not Li 2000", "criteria": [ { "factor": "pathologic_definite", "met": false }, { "factor": "major_microbiologic", "met": true }, { "factor": "major_imaging", "met": true }, { "factor": "major_surgical", "met": false }, { "factor": "minor_predisposition", "met": false }, { "factor": "minor_fever", "met": false }, { "factor": "minor_vascular", "met": false }, { "factor": "minor_immunologic", "met": false }, { "factor": "minor_microbiologic", "met": false }, { "factor": "rejected_firm_alternate_diagnosis", "met": false }, { "factor": "rejected_resolved_le_4_days_antibiotics", "met": false }, { "factor": "rejected_no_pathology_le_4_days_antibiotics", "met": false }, { "factor": "clinical_definite", "met": true }, { "factor": "rejected", "met": false } ], "major_count": 2, "minor_count": 0, "classification": "definite", "definite": true, "pathologic_definite": false, "possible": false } ] } ``` ## Response fields - `formula` (string): duke_iscvid - `formula_expression` (string): Fowler 2023 Duke-ISCVID: definite if pathologic_definite or clinical_definite (2 major, or 1 major plus 3 minor, or 5 minor); possible if not definite and (1 major plus 1 minor or 3 minor); rejected if neither, or if a rejected flag is true and definite does not hold. minor_microbiologic is not double-counted with major_microbiologic. Not Durack 1994. Not Li 2000. - `classification` (string): definite, possible, or rejected (Fowler 2023 Duke-ISCVID). Not Durack 1994 leftover possible. Not a diagnosis. - `definite` (boolean): true iff classification is definite (pathologic_definite or clinical_definite) - `possible` (boolean): true iff classification is possible (1 major plus 1 minor, or 3 minor, and not definite and no rejected flag) - `rejected` (boolean): true iff classification is rejected. Rejected flags do not override definite. - `major_count` (integer): Count of true Fowler 2023 major flags among major_microbiologic, major_imaging, and major_surgical (0-3) - `minor_count` (integer): Count of counted Fowler 2023 minor flags (0-5). minor_microbiologic is omitted when major_microbiologic is true - `pathologic_definite` (boolean): Caller-assigned Fowler 2023 pathologic definite flag. true is sufficient for classification definite. - `criteria` (array): Per-flag rows for pathologic_definite, three majors, five minors, and three rejected flags, plus clinical_definite and rejected aggregates (factor and met) - `citation` (object): Fowler 2023 Clin Infect Dis citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "rejected": 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": "Fowler VG Jr, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis JG, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fortes CQ, Fosbøl E, Hannan MM, Hasse B, Hoen B, Iversen K, et al.", "doi": "10.1093/cid/ciad271", "id": "fowler-2023", "pmid": "37138445", "source": "Clin Infect Dis. 2023;77(4):518-526", "title": "The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria" }, "formula": "duke_iscvid", "formula_expression": "definite iff pathologic_definite or clinical_definite; clinical_definite iff major_count >= 2 or (major_count >= 1 and minor_count >= 3) or minor_count >= 5; possible iff not definite and ((major_count >= 1 and minor_count >= 1) or minor_count >= 3); rejected iff not definite and not possible, or (not definite and any rejected flag); definite is not overridden by rejected flags (Fowler 2023 Duke-ISCVID). minor_microbiologic is not counted when major_microbiologic is true. Majors are caller-assigned microbiologic, imaging, and surgical domains. Not Durack 1994. Not Li 2000", "criteria": [ { "factor": "pathologic_definite", "met": false }, { "factor": "major_microbiologic", "met": true }, { "factor": "major_imaging", "met": true }, { "factor": "major_surgical", "met": false }, { "factor": "minor_predisposition", "met": false }, { "factor": "minor_fever", "met": false }, { "factor": "minor_vascular", "met": false }, { "factor": "minor_immunologic", "met": false }, { "factor": "minor_microbiologic", "met": false }, { "factor": "rejected_firm_alternate_diagnosis", "met": false }, { "factor": "rejected_resolved_le_4_days_antibiotics", "met": false }, { "factor": "rejected_no_pathology_le_4_days_antibiotics", "met": false }, { "factor": "clinical_definite", "met": true }, { "factor": "rejected", "met": false } ], "major_count": 2, "minor_count": 0, "classification": "definite", "definite": true, "pathologic_definite": false, "possible": false } ``` ## Errors - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false 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 - [Duke](https://magentlab.com/docs/duke) — Apply the Durack 1994 original Duke criteria for infective endocarditis and return definite, possible, or rejected from caller-assigned pathologic, major, minor, and rejected flags. - [IE mortality](https://magentlab.com/docs/ie-mortality) — Compute the Park 2016 ICE simplified risk score for 6-month mortality in infective endocarditis from age and caller-assigned Table 5 flags, and return the score, quadratic 6-month mortality percent, and whether score >= 8. ## 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.