# EHMRG 7-day ED mortality score EHMRG Status: LIVE Price: $0.005 USDC `GET /api/calc/ehmrg` HTML: https://magentlab.com/docs/ehmrg Markdown: https://magentlab.com/docs/ehmrg.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute the Lee 2012 Emergency Heart Failure Mortality Risk Grade 7-day emergency-department integer score from age, EMS transport, initial systolic BP, heart rate, oxygen saturation, creatinine, potassium, troponin above ULN, active cancer, and home metolazone. ## When to use When an agent has caller-supplied ED presentation values and needs the published Lee 2012 Table 3 7-day ED model total and derivation risk_group 1/2/3/4/5a/5b, not EHMRG30-ST, not ADHERE CART, and not a discharge or admission order. ## When not to use - Not a medical device. magent does not examine the patient and does not measure vitals or laboratories. - Not a discharge or admission order. This is the Lee 2012 7-day ED integer score only. - This is not EHMRG30-ST and not ADHERE CART. - Dialysis-dependent patients are excluded (Lee 2012 Methods and Table 3 footnote). dialysis_dependent must be false to score. - Unpublished potassium gaps 3.91-3.99 mmol/L pin with the <=3.9 band (+5). Gaps 4.51-4.59 mmol/L pin with the >=4.6 band (+30). magent does not invent extra named potassium classes. - The caller assigns EMS transport, troponin above ULN, active cancer, home metolazone, and dialysis status. magent does not interpret assays or medication lists. ## Formula ``` ehmrg_score = 2*age_years + 60*(ems_transport) - min(systolic_mm_hg, 160) + clamp(heart_rate_bpm, 80, 120) - 2*min(spo2_percent, 92) + 20*creatinine_mg_dl + K(<=3.9:5, 4.0-4.5:0, >=4.6:30) + 60*(troponin_gt_uln) + 45*(active_cancer) + 60*(metolazone) + 12; Lee 2012 Table 3 7-day ED model; dialysis-dependent excluded; risk_group 1 (score <= -49.1), 2 (-49.0 to -15.9), 3 (-15.8 to 17.9), 4 (18.0 to 56.5), 5a (56.6 to 89.3), 5b (>= 89.4) ``` ## Citation [Prediction of heart failure mortality in emergent care: a cohort study](https://doi.org/10.7326/0003-4819-156-11-201206050-00003) Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, Newton GE, Lee JS, Tu JV Ann Intern Med. 2012;156(11):767-775 DOI: [10.7326/0003-4819-156-11-201206050-00003](https://doi.org/10.7326/0003-4819-156-11-201206050-00003) ## Worked example ### Age 70, no EMS, SBP 160, HR 80, SpO2 92, creatinine 1.0 (group 1) Given: `active_cancer=false, age=70, creatinine_mg_dl=1.0, dialysis_dependent=false, ems_transport=false, heart_rate_bpm=80, metolazone=false, potassium_mmol_l=4.2, spo2_percent=92, systolic_mm_hg=160, troponin_gt_uln=false` 1. Age 70 → +140; EMS false → 0; SBP 160 (at cap) → -160; HR 80 (at floor) → +80 2. SpO2 92 (at cap) → -184; creatinine 1.0 → +20; potassium 4.2 → 0 3. Troponin, cancer, and metolazone false → 0; adjustment +12 4. ehmrg_score = 140 - 160 + 80 - 184 + 20 + 12 = -92; risk_group 1 ### Age 85, EMS, SBP 120, HR 110, SpO2 90, creatinine 1.8, troponin above ULN (group 5b) Given: `active_cancer=false, age=85, creatinine_mg_dl=1.8, dialysis_dependent=false, ems_transport=true, heart_rate_bpm=110, metolazone=false, potassium_mmol_l=4.2, spo2_percent=90, systolic_mm_hg=120, troponin_gt_uln=true` 1. Age 85 → +170; EMS true → +60; SBP 120 → -120; HR 110 → +110; SpO2 90 → -180 2. Creatinine 1.8 → +36; potassium 4.2 → 0; troponin above ULN → +60; adjustment +12 3. ehmrg_score = 170 + 60 - 120 + 110 - 180 + 36 + 60 + 12 = 148; risk_group 5b ## Also searched as - EHMRG - Emergency Heart Failure Mortality Risk Grade - Lee 2012 EHMRG - 7-day ED heart failure mortality - EHMRG integer score - heart failure emergency department score ## Parameters - `age` (integer, required): Age in years (integer 18-120). Lee 2012 Table 3 adds +2 per year. magent does not assign age. - `ems_transport` (boolean, required): Transported by EMS as assigned by the caller (true or false). Lee 2012 Table 3: +60 if true. - `systolic_mm_hg` (integer, required): Initial/triage systolic blood pressure in mm Hg (integer 50-250). Lee 2012 Table 3 scores -1 * min(SBP, 160); values above 160 mm Hg are capped. magent does not measure blood pressure. - `heart_rate_bpm` (integer, required): Heart rate in beats/min (integer 30-220). Lee 2012 Table 3 scores +1 * clamp(HR, 80, 120): floor 80, ceiling 120. magent does not measure heart rate. - `spo2_percent` (number, required): Lowest initial/triage oxygen saturation percent (50-100). Lee 2012 Table 3 scores -2 * min(SpO2, 92); values above 92% are capped. magent does not measure saturation. - `creatinine_mg_dl` (number, optional): Serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l, not both. Lee 2012 Table 3 adds +20 per mg/dL. magent does not measure creatinine. - `creatinine_umol_l` (number, optional): Serum creatinine in µmol/L (9-1768). Converted as mg/dL = µmol/L / 88.42. Provide this or creatinine_mg_dl, not both. - `potassium_mmol_l` (number, required): Serum potassium in mmol/L (1.5-8.0). Lee 2012 Table 3: 4.0-4.5 inclusive → 0; >=4.6 → +30; <=3.9 → +5. Unpublished 3.91-3.99 pin with <=3.9; 4.51-4.59 pin with >=4.6. magent does not measure potassium. - `troponin_gt_uln` (boolean, required): Troponin above the local upper limit of normal as assigned by the caller (true or false). Lee 2012 Table 3: +60 if true. - `active_cancer` (boolean, required): Active cancer as assigned by the caller (true or false). Lee 2012 Table 3: +45 if true. - `metolazone` (boolean, required): Metolazone at home as assigned by the caller (true or false). Lee 2012 Table 3: +60 if true. - `dialysis_dependent` (boolean, required): Dialysis dependence as assigned by the caller (true or false). Lee 2012 excludes dialysis-dependent patients; true returns HTTP 400. magent does not determine dialysis status. ## 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/ehmrg` 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": [ { "active_cancer": "false", "age": "70", "creatinine_mg_dl": "1.0", "dialysis_dependent": "false", "ems_transport": "false", "heart_rate_bpm": "80", "metolazone": "false", "potassium_mmol_l": "4.2", "spo2_percent": "92", "systolic_mm_hg": "160", "troponin_gt_uln": "false" }, { "active_cancer": "false", "age": "70", "creatinine_mg_dl": "1.0", "dialysis_dependent": "false", "ems_transport": "false", "heart_rate_bpm": "80", "metolazone": "false", "potassium_mmol_l": "4.2", "spo2_percent": "92", "systolic_mm_hg": "160", "troponin_gt_uln": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/ehmrg Example 200: ```json { "count": 2, "path": "/api/calc/ehmrg", "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": "Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, Newton GE, Lee JS, Tu JV", "doi": "10.7326/0003-4819-156-11-201206050-00003", "id": "lee-2012", "pmid": "22665814", "source": "Ann Intern Med. 2012;156(11):767-775", "title": "Prediction of heart failure mortality in emergent care: a cohort study" }, "formula": "ehmrg", "formula_expression": "ehmrg_score = 2*age_years + 60*(ems_transport) - min(systolic_mm_hg, 160) + clamp(heart_rate_bpm, 80, 120) - 2*min(spo2_percent, 92) + 20*creatinine_mg_dl + K(<=3.9:5, 4.0-4.5:0, >=4.6:30) + 60*(troponin_gt_uln) + 45*(active_cancer) + 60*(metolazone) + 12; Lee 2012 Table 3 7-day ED model; dialysis-dependent excluded; risk_group 1 (score <= -49.1), 2 (-49.0 to -15.9), 3 (-15.8 to 17.9), 4 (18.0 to 56.5), 5a (56.6 to 89.3), 5b (>= 89.4)", "age_years": 70, "systolic_mm_hg": 160, "creatinine_mg_dl": 1.0, "heart_rate_bpm": 80, "potassium_mmol_l": 4.2, "active_cancer": false, "dialysis_dependent": false, "ehmrg_score": -92.0, "ems_transport": false, "metolazone": false, "risk_group": "1", "spo2_percent": 92.0, "troponin_gt_uln": 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": "Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, Newton GE, Lee JS, Tu JV", "doi": "10.7326/0003-4819-156-11-201206050-00003", "id": "lee-2012", "pmid": "22665814", "source": "Ann Intern Med. 2012;156(11):767-775", "title": "Prediction of heart failure mortality in emergent care: a cohort study" }, "formula": "ehmrg", "formula_expression": "ehmrg_score = 2*age_years + 60*(ems_transport) - min(systolic_mm_hg, 160) + clamp(heart_rate_bpm, 80, 120) - 2*min(spo2_percent, 92) + 20*creatinine_mg_dl + K(<=3.9:5, 4.0-4.5:0, >=4.6:30) + 60*(troponin_gt_uln) + 45*(active_cancer) + 60*(metolazone) + 12; Lee 2012 Table 3 7-day ED model; dialysis-dependent excluded; risk_group 1 (score <= -49.1), 2 (-49.0 to -15.9), 3 (-15.8 to 17.9), 4 (18.0 to 56.5), 5a (56.6 to 89.3), 5b (>= 89.4)", "age_years": 70, "systolic_mm_hg": 160, "creatinine_mg_dl": 1.0, "heart_rate_bpm": 80, "potassium_mmol_l": 4.2, "active_cancer": false, "dialysis_dependent": false, "ehmrg_score": -92.0, "ems_transport": false, "metolazone": false, "risk_group": "1", "spo2_percent": 92.0, "troponin_gt_uln": false } ] } ``` ## Response fields - `formula` (string): ehmrg - `formula_expression` (string): Exact expression used - `ehmrg_score` (number): Lee 2012 Table 3 7-day ED integer-score sum. Exact arithmetic; may be a float when creatinine is a float. - `risk_group` (string): Lee 2012 derivation cutpoints: 1 if score <= -49.1; 2 if -49.0 to -15.9; 3 if -15.8 to 17.9; 4 if 18.0 to 56.5; 5a if 56.6 to 89.3; 5b if >= 89.4 - `age_years` (integer): Age used, years - `ems_transport` (boolean): EMS transport flag used - `systolic_mm_hg` (integer): Initial/triage systolic BP used, mm Hg (capped at 160 for scoring) - `heart_rate_bpm` (integer): Heart rate used, bpm (scored after clamp 80-120) - `spo2_percent` (number): Oxygen saturation used, percent (capped at 92 for scoring) - `creatinine_mg_dl` (number): Serum creatinine used in mg/dL (after µmol/L conversion when supplied) - `potassium_mmol_l` (number): Serum potassium used, mmol/L - `troponin_gt_uln` (boolean): Troponin above ULN flag used - `active_cancer` (boolean): Active cancer flag used - `metolazone` (boolean): Home metolazone flag used - `dialysis_dependent` (boolean): Always false on HTTP 200; true is excluded - `citation` (object): Lee 2012 Annals 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": "Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, Newton GE, Lee JS, Tu JV", "doi": "10.7326/0003-4819-156-11-201206050-00003", "id": "lee-2012", "pmid": "22665814", "source": "Ann Intern Med. 2012;156(11):767-775", "title": "Prediction of heart failure mortality in emergent care: a cohort study" }, "formula": "ehmrg", "formula_expression": "ehmrg_score = 2*age_years + 60*(ems_transport) - min(systolic_mm_hg, 160) + clamp(heart_rate_bpm, 80, 120) - 2*min(spo2_percent, 92) + 20*creatinine_mg_dl + K(<=3.9:5, 4.0-4.5:0, >=4.6:30) + 60*(troponin_gt_uln) + 45*(active_cancer) + 60*(metolazone) + 12; Lee 2012 Table 3 7-day ED model; dialysis-dependent excluded; risk_group 1 (score <= -49.1), 2 (-49.0 to -15.9), 3 (-15.8 to 17.9), 4 (18.0 to 56.5), 5a (56.6 to 89.3), 5b (>= 89.4)", "age_years": 70, "systolic_mm_hg": 160, "creatinine_mg_dl": 1.0, "heart_rate_bpm": 80, "potassium_mmol_l": 4.2, "active_cancer": false, "dialysis_dependent": false, "ehmrg_score": -92.0, "ems_transport": false, "metolazone": false, "risk_group": "1", "spo2_percent": 92.0, "troponin_gt_uln": 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_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_heart_rate`: heart_rate_bpm must be an integer from 30 to 220 Returned before settlement; you are not charged. - HTTP 400 `invalid_spo2`: spo2_percent must be a number from 50 to 100. 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_potassium`: potassium_mmol_l must be a number from 1.5 to 8.0. Returned before settlement; you are not charged. - HTTP 400 `invalid_ehmrg_dialysis`: EHMRG is not for dialysis-dependent patients (Lee 2012). dialysis_dependent must be false to score. 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 - [LACE](https://magentlab.com/docs/lace) — Sum van Walraven 2010 Table 3 LACE points from length of stay, acute (emergent) admission, a caller-supplied Charlson integer, and ED visits in the previous 6 months. - [ADHERE](https://magentlab.com/docs/adhere) — 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. ## 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.