# LENT score (malignant pleural effusion) LENT Status: LIVE Price: $0.005 USDC `GET /api/calc/lent` HTML: https://magentlab.com/docs/lent Markdown: https://magentlab.com/docs/lent.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Clive 2014 Table 3 LENT score (pleural fluid LDH, ECOG, serum NLR, tumour type) and return low (0-1), moderate (2-4), or high (5-7). ## When to use When an agent already has pleural fluid LDH, a caller-assigned ECOG 0-4, a serum NLR number, and a Clive tumour token, and must not invent a diagnosis, treatment order, or survival assignment. magent does not observe the patient or compute NLR from percents. ## When not to use - Not a medical device and not a diagnosis or treatment order. magent does not observe the patient. - Clive 2014 Table 3 writes <1500 vs >1500 and <9 vs >9 with no equals. LDH 1500 and NLR 9 are not scored. - Median survivals 319 / 130 / 44 days are Clive 2014 paper numbers only, not a prognosis assignment. - Oken 1982 ECOG 0-4 only. Grade 5 (dead) is not scored. The caller assigns ecog; magent does not convert Karnofsky. - nlr is a number. magent does not compute NLR from neutrophil or lymphocyte percents. ## Formula ``` LENT = L (pleural LDH IU/L: <1500 → 0, >1500 → 1) + E (ECOG 0→0, 1→1, 2→2, 3-4→3) + N (serum NLR: <9 → 0, >9 → 1) + T (mesothelioma/haematological → 0; breast/gynaecological/renal_cell → 1; lung/other → 2); Clive 2014 Table 3; max 7; 0-1 low, 2-4 moderate, 5-7 high ``` ## Citation [Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score](https://doi.org/10.1136/thoraxjnl-2014-205285) Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ETH, Tobin CL, Medford ARL, Harvey JE, van den Heuvel MM, Lee YCG, Maskell NA Thorax. 2014;69(12):1098-1104 DOI: [10.1136/thoraxjnl-2014-205285](https://doi.org/10.1136/thoraxjnl-2014-205285) ## Worked example ### LDH 1000, ECOG 0, NLR 5, mesothelioma Given: `ecog=0, nlr=5, pleural_ldh_u_l=1000, tumor_type=mesothelioma` 1. L: pleural LDH 1000 < 1500 → 0 2. E: ECOG 0 → 0 3. N: NLR 5 < 9 → 0 4. T: mesothelioma → 0 5. score = 0 (max 7); risk = low ### LDH 1000, ECOG 4, NLR 5, lung Given: `ecog=4, nlr=5, pleural_ldh_u_l=1000, tumor_type=lung` 1. L: 1000 < 1500 → 0; E: ECOG 4 → 3; N: 5 < 9 → 0; T: lung → 2 2. score = 5 (max 7); risk = high ## Also searched as - LENT score - LENT prognostic score - malignant pleural effusion score - Clive LENT - pleural LDH ECOG NLR - MPE LENT - LENT survival score ## Parameters - `pleural_ldh_u_l` (number, required): Pleural fluid LDH in IU/L (1-20000, not 1500). Clive 2014 Table 3: <1500 scores 0, >1500 scores 1. Equality at 1500 is not scored. - `ecog` (integer, required): Oken 1982 ECOG performance status 0-4 as assigned by the caller. Clive 2014: 0→0, 1→1, 2→2, 3-4→3. Grade 5 (dead) is not scored. magent does not observe the patient. - `nlr` (number, required): Serum neutrophil-to-lymphocyte ratio as a number (0.05-200, not 9). Clive 2014 Table 3: <9 scores 0, >9 scores 1. Equality at 9 is not scored. Pass nlr; magent does not compute it from percents. - `tumor_type` (string, required): Clive 2014 tumour type. mesothelioma or haematological (also hematological) scores 0; breast, gynaecological (also gynecological), or renal_cell scores 1; lung or other scores 2. magent does not assign tumour type from histology text. ## 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/lent` 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": [ { "ecog": "0", "nlr": "5", "pleural_ldh_u_l": "1000", "tumor_type": "mesothelioma" }, { "ecog": "0", "nlr": "5", "pleural_ldh_u_l": "1000", "tumor_type": "mesothelioma" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/lent Example 200: ```json { "count": 2, "path": "/api/calc/lent", "items": [ { "components": [ { "value": 1.0e3, "factor": "pleural_ldh", "points": 0, "present": false }, { "value": 0, "factor": "ecog", "points": 0, "present": true }, { "value": 5.0, "factor": "nlr", "points": 0, "present": false }, { "value": "mesothelioma", "factor": "tumor_type", "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": "Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ETH, Tobin CL, Medford ARL, Harvey JE, van den Heuvel MM, Lee YCG, Maskell NA", "doi": "10.1136/thoraxjnl-2014-205285", "id": "clive-2014", "pmid": "25100651", "source": "Thorax. 2014;69(12):1098-1104", "title": "Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score" }, "formula": "lent", "formula_expression": "LENT = L (pleural LDH IU/L: <1500 → 0, >1500 → 1) + E (ECOG 0→0, 1→1, 2→2, 3-4→3) + N (serum NLR: <9 → 0, >9 → 1) + T (mesothelioma/haematological → 0; breast/gynaecological/renal_cell → 1; lung/other → 2); Clive 2014 Table 3; max 7; 0-1 low, 2-4 moderate, 5-7 high", "max_score": 7, "score": 0, "ecog": 0, "pleural_ldh_u_l": 1.0e3, "nlr": 5.0, "risk": "low", "tumor_type": "mesothelioma" }, { "components": [ { "value": 1.0e3, "factor": "pleural_ldh", "points": 0, "present": false }, { "value": 0, "factor": "ecog", "points": 0, "present": true }, { "value": 5.0, "factor": "nlr", "points": 0, "present": false }, { "value": "mesothelioma", "factor": "tumor_type", "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": "Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ETH, Tobin CL, Medford ARL, Harvey JE, van den Heuvel MM, Lee YCG, Maskell NA", "doi": "10.1136/thoraxjnl-2014-205285", "id": "clive-2014", "pmid": "25100651", "source": "Thorax. 2014;69(12):1098-1104", "title": "Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score" }, "formula": "lent", "formula_expression": "LENT = L (pleural LDH IU/L: <1500 → 0, >1500 → 1) + E (ECOG 0→0, 1→1, 2→2, 3-4→3) + N (serum NLR: <9 → 0, >9 → 1) + T (mesothelioma/haematological → 0; breast/gynaecological/renal_cell → 1; lung/other → 2); Clive 2014 Table 3; max 7; 0-1 low, 2-4 moderate, 5-7 high", "max_score": 7, "score": 0, "ecog": 0, "pleural_ldh_u_l": 1.0e3, "nlr": 5.0, "risk": "low", "tumor_type": "mesothelioma" } ] } ``` ## Response fields - `formula` (string): lent - `formula_expression` (string): Clive 2014 Table 3 LENT rule - `score` (integer): LENT points 0-7 - `max_score` (integer): 7 - `risk` (string): low when score is 0-1, moderate when 2-4, high when 5-7 (Clive 2014). Not a diagnosis or treatment order. Paper median survivals 319 / 130 / 44 days are table numbers only. - `pleural_ldh_u_l` (number): Pleural fluid LDH used, IU/L - `ecog` (integer): Caller-assigned Oken 1982 ECOG grade 0-4 - `nlr` (number): Serum NLR used (caller-supplied number) - `tumor_type` (string): Canonical Clive 2014 tumour token used for T - `components` (array): L, E, N, and T points - `citation` (object): Clive 2014 Thorax citation - `disclaimer` (string): Not a medical device ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 1.0e3, "factor": "pleural_ldh", "points": 0, "present": false }, { "value": 0, "factor": "ecog", "points": 0, "present": true }, { "value": 5.0, "factor": "nlr", "points": 0, "present": false }, { "value": "mesothelioma", "factor": "tumor_type", "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": "Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ETH, Tobin CL, Medford ARL, Harvey JE, van den Heuvel MM, Lee YCG, Maskell NA", "doi": "10.1136/thoraxjnl-2014-205285", "id": "clive-2014", "pmid": "25100651", "source": "Thorax. 2014;69(12):1098-1104", "title": "Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score" }, "formula": "lent", "formula_expression": "LENT = L (pleural LDH IU/L: <1500 → 0, >1500 → 1) + E (ECOG 0→0, 1→1, 2→2, 3-4→3) + N (serum NLR: <9 → 0, >9 → 1) + T (mesothelioma/haematological → 0; breast/gynaecological/renal_cell → 1; lung/other → 2); Clive 2014 Table 3; max 7; 0-1 low, 2-4 moderate, 5-7 high", "max_score": 7, "score": 0, "ecog": 0, "pleural_ldh_u_l": 1.0e3, "nlr": 5.0, "risk": "low", "tumor_type": "mesothelioma" } ``` ## Errors - HTTP 400 `invalid_lent_ldh`: pleural_ldh_u_l must be a number from 1 to 20000 and not 1500 (Clive 2014 LENT uses <1500 vs >1500). Returned before settlement; you are not charged. - HTTP 400 `invalid_ecog_ps`: ecog must be an integer from 0 to 4 (Oken 1982). Grade 5 (dead) is not scored. Returned before settlement; you are not charged. - HTTP 400 `invalid_lent_nlr`: nlr must be a number from 0.05 to 200 and not 9 (Clive 2014 LENT uses <9 vs >9). Returned before settlement; you are not charged. - HTTP 400 `invalid_lent_tumor`: tumor_type must be mesothelioma, haematological, breast, gynaecological, renal_cell, lung, or other (Clive 2014 LENT). 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 - [Light's criteria](https://magentlab.com/docs/lights) — Apply Light 1972 pleural fluid criteria from protein ratio, LDH ratio, and pleural LDH versus two-thirds the laboratory LDH upper limit of normal. - [NLR](https://magentlab.com/docs/nlr) — Compute the Zahorec 2001 neutrophil-to-lymphocyte ratio from relative neutrophil and lymphocyte percents. - [ECOG](https://magentlab.com/docs/ecog) — Return the Oken 1982 ECOG performance status grade 0-4 from a caller-assigned integer, with a stable label. ## 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.