# MRC-ICU medication-regimen complexity MRC-ICU medication-regimen complexity Status: LIVE Price: $0.005 USDC `GET /api/calc/mrc_icu` HTML: https://magentlab.com/docs/mrc-icu Markdown: https://magentlab.com/docs/mrc-icu.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Gwynn 2019 MRC-ICU printed item weights from caller-assigned medication-class counts and device flags. ## When to use When an agent needs the published MRC-ICU point total and must not invent a pharmacist-staffing ratio or read a medication administration record. ## When not to use - Not a medical device. Not a pharmacist-staffing order, census target, or monitoring protocol. - Counts and flags are caller-assigned. magent does not read the MAR, identify a medication, or decide whether two products are the same class. - A printed × means points times the count of qualifying medications in that class (integer 0-20). Non-multiplier items add the printed weight when the flag is true. - Parenteral-nutrition rows are two printed items (non-pharmacist service 1 point; clinical specialist pharmacist 3 points). Both may be sent; magent does not enforce exclusivity. - This is the Gwynn 2019 39-item table. Later MRC-ICU revisions are not applied. ## Formula ``` MRC-ICU (Gwynn 2019) = sum of 39 printed item weights. Multiplier classes (printed ×) are weight × caller-assigned count of qualifying medications (0-20): aminoglycosides 3, antiarrhythmics 1, anticoagulants 1, anticonvulsants 3, azole_antifungals 2, blood_products 2, chemotherapy 3, ganciclovir_valganciclovir 1, hyperosmolar_fluids 1, immunosuppressants 3, prostacyclins 2, therapeutic_heparins 2, continuous_infusions 1, opioids_sedatives 1, continuous_opioids_sedatives 2, antimicrobials 1, restricted_antimicrobials 2. Flags add the printed weight when present: amphotericin_b 1, argatroban 2, clozapine 3, digoxin 3, lidocaine_infusion 2, lithium 3, theophylline 3, vancomycin_iv 3, warfarin 3, neuromuscular_blockade 2, tpn_non_pharmacist 1, tpn_clinical_pharmacist 3, thromboembolic_prophylaxis 1, stress_ulcer_prophylaxis 1, glycemic_control 1, bowel_regimen 1, chlorhexidine 1, dialysis 2, ecmo 2, iabp 1, lvad 1, mechanical_ventilation 2 ``` ## Citation [Development and validation of a medication regimen complexity scoring tool for critically ill patients](https://doi.org/10.1093/ajhp/zxy054) Gwynn ME, Poisson MO, Waller JL, Newsome AS Am J Health Syst Pharm. 2019;76(Supplement_2):S34-S40 DOI: [10.1093/ajhp/zxy054](https://doi.org/10.1093/ajhp/zxy054) ## Worked example ### No qualifying medications or devices Given: `lithium=false, therapeutic_heparins=0, digoxin=false, chlorhexidine=false, mechanical_ventilation=false, opioids_sedatives=0, tpn_non_pharmacist=false, lidocaine_infusion=false, clozapine=false, continuous_infusions=0, dialysis=false, warfarin=false, argatroban=false, theophylline=false, neuromuscular_blockade=false, thromboembolic_prophylaxis=false, restricted_antimicrobials=0, anticonvulsants=0, anticoagulants=0, antimicrobials=0, continuous_opioids_sedatives=0, ecmo=false, glycemic_control=false, ganciclovir_valganciclovir=0, hyperosmolar_fluids=0, azole_antifungals=0, bowel_regimen=false, aminoglycosides=0, immunosuppressants=0, antiarrhythmics=0, vancomycin_iv=false, stress_ulcer_prophylaxis=false, prostacyclins=0, iabp=false, chemotherapy=0, lvad=false, amphotericin_b=false, blood_products=0, tpn_clinical_pharmacist=false` 1. all counts 0 and all flags false 2. score = 0 ### Intravenous vancomycin only Given: `lithium=false, therapeutic_heparins=0, digoxin=false, chlorhexidine=false, mechanical_ventilation=false, opioids_sedatives=0, tpn_non_pharmacist=false, lidocaine_infusion=false, clozapine=false, continuous_infusions=0, dialysis=false, warfarin=false, argatroban=false, theophylline=false, neuromuscular_blockade=false, thromboembolic_prophylaxis=false, restricted_antimicrobials=0, anticonvulsants=0, anticoagulants=0, antimicrobials=0, continuous_opioids_sedatives=0, ecmo=false, glycemic_control=false, ganciclovir_valganciclovir=0, hyperosmolar_fluids=0, azole_antifungals=0, bowel_regimen=false, aminoglycosides=0, immunosuppressants=0, antiarrhythmics=0, vancomycin_iv=true, stress_ulcer_prophylaxis=false, prostacyclins=0, iabp=false, chemotherapy=0, lvad=false, amphotericin_b=false, blood_products=0, tpn_clinical_pharmacist=false` 1. vancomycin_iv is a 3-point flag 2. score = 3 ### Two aminoglycosides Given: `lithium=false, therapeutic_heparins=0, digoxin=false, chlorhexidine=false, mechanical_ventilation=false, opioids_sedatives=0, tpn_non_pharmacist=false, lidocaine_infusion=false, clozapine=false, continuous_infusions=0, dialysis=false, warfarin=false, argatroban=false, theophylline=false, neuromuscular_blockade=false, thromboembolic_prophylaxis=false, restricted_antimicrobials=0, anticonvulsants=0, anticoagulants=0, antimicrobials=0, continuous_opioids_sedatives=0, ecmo=false, glycemic_control=false, ganciclovir_valganciclovir=0, hyperosmolar_fluids=0, azole_antifungals=0, bowel_regimen=false, aminoglycosides=2, immunosuppressants=0, antiarrhythmics=0, vancomycin_iv=false, stress_ulcer_prophylaxis=false, prostacyclins=0, iabp=false, chemotherapy=0, lvad=false, amphotericin_b=false, blood_products=0, tpn_clinical_pharmacist=false` 1. aminoglycosides printed 3× 2. score = 3 × 2 = 6 ## Also searched as - MRC-ICU - medication regimen complexity ICU - Gwynn 2019 MRC-ICU - ICU medication complexity score - vancomycin aminoglycoside ICU score ## Parameters - `aminoglycosides` (integer, required): Count of aminoglycosides (amikacin, gentamicin, tobramycin) as assigned by the caller (integer 0-20). Gwynn 2019 printed 3×. magent does not read the MAR. - `amphotericin_b` (boolean, required): Amphotericin B or liposomal amphotericin B present as assigned by the caller (Gwynn 2019). true adds 1 point. - `antiarrhythmics` (integer, required): Count of antiarrhythmics (amiodarone, dofetilide, sotalol) as assigned by the caller (integer 0-20). Gwynn 2019 printed 1×. - `anticoagulants` (integer, required): Count of anticoagulants (NOACs/DOACs, fondaparinux) as assigned by the caller (integer 0-20). Gwynn 2019 printed 1×. - `anticonvulsants` (integer, required): Count of anticonvulsants (carbamazepine, phenobarbital, phenytoin, valproic acid) as assigned by the caller (integer 0-20). Gwynn 2019 printed 3×. - `argatroban` (boolean, required): Argatroban present as assigned by the caller (Gwynn 2019). true adds 2 points. - `azole_antifungals` (integer, required): Count of azole antifungals (posaconazole, voriconazole) as assigned by the caller (integer 0-20). Gwynn 2019 printed 2×. - `blood_products` (integer, required): Count of blood products (factor products, antithrombin III) as assigned by the caller (integer 0-20). Gwynn 2019 printed 2×. - `chemotherapy` (integer, required): Count of active inpatient chemotherapy agents as assigned by the caller (integer 0-20). Gwynn 2019 printed 3×. - `clozapine` (boolean, required): Clozapine present as assigned by the caller (Gwynn 2019). true adds 3 points. - `digoxin` (boolean, required): Digoxin present as assigned by the caller (Gwynn 2019). true adds 3 points. - `ganciclovir_valganciclovir` (integer, required): Count of ganciclovir or valganciclovir products as assigned by the caller (integer 0-20). Gwynn 2019 printed 1×. - `hyperosmolar_fluids` (integer, required): Count of hyperosmolar fluids (hypertonic saline 1.5%, 3%, 23.4%; mannitol) as assigned by the caller (integer 0-20). Gwynn 2019 printed 1×. - `immunosuppressants` (integer, required): Count of immunosuppressants (cyclosporine, sirolimus, tacrolimus) as assigned by the caller (integer 0-20). Gwynn 2019 printed 3×. - `lidocaine_infusion` (boolean, required): Lidocaine continuous infusion present as assigned by the caller (Gwynn 2019). true adds 2 points. - `lithium` (boolean, required): Lithium present as assigned by the caller (Gwynn 2019). true adds 3 points. - `prostacyclins` (integer, required): Count of prostacyclins (epoprostenol, iloprost, treprostinil) as assigned by the caller (integer 0-20). Gwynn 2019 printed 2×. - `theophylline` (boolean, required): Theophylline present as assigned by the caller (Gwynn 2019). true adds 3 points. - `therapeutic_heparins` (integer, required): Count of therapeutic heparins (enoxaparin, heparin infusion) as assigned by the caller (integer 0-20). Gwynn 2019 printed 2×. - `vancomycin_iv` (boolean, required): Intravenous vancomycin present as assigned by the caller (Gwynn 2019). true adds 3 points. - `warfarin` (boolean, required): Warfarin present as assigned by the caller (Gwynn 2019). true adds 3 points. - `neuromuscular_blockade` (boolean, required): Neuromuscular blockade present as assigned by the caller (Gwynn 2019). true adds 2 points. - `continuous_infusions` (integer, required): Count of continuous infusions not listed on another Gwynn 2019 row, as assigned by the caller (integer 0-20). Printed 1×. - `tpn_non_pharmacist` (boolean, required): Total parenteral nutrition managed by a non-pharmacist service as assigned by the caller (Gwynn 2019). true adds 1 point. - `tpn_clinical_pharmacist` (boolean, required): Total parenteral nutrition managed by a clinical specialist pharmacist as assigned by the caller (Gwynn 2019). true adds 3 points. - `thromboembolic_prophylaxis` (boolean, required): Thromboembolic prophylaxis present, excluding heparin infusion and therapeutic enoxaparin, as assigned by the caller (Gwynn 2019). true adds 1 point. - `stress_ulcer_prophylaxis` (boolean, required): Stress ulcer prophylaxis present, excluding pantoprazole infusion, as assigned by the caller (Gwynn 2019). true adds 1 point. - `glycemic_control` (boolean, required): Glycemic control with subcutaneous insulin, excluding intravenous insulin, as assigned by the caller (Gwynn 2019). true adds 1 point. - `bowel_regimen` (boolean, required): Bowel regimen present as assigned by the caller (Gwynn 2019). true adds 1 point. - `chlorhexidine` (boolean, required): Chlorhexidine present as assigned by the caller (Gwynn 2019). true adds 1 point. - `opioids_sedatives` (integer, required): Count of scheduled or PRN opioids and sedatives as assigned by the caller (integer 0-20). Gwynn 2019 printed 1×. - `continuous_opioids_sedatives` (integer, required): Count of continuous-infusion opioids and sedatives (propofol, fentanyl, dexmedetomidine, ketamine, benzodiazepines) as assigned by the caller (integer 0-20). Gwynn 2019 printed 2×. - `antimicrobials` (integer, required): Count of antimicrobials including HIV medications and excluding agents listed on other Gwynn 2019 rows, as assigned by the caller (integer 0-20). Printed 1×. - `restricted_antimicrobials` (integer, required): Count of restricted antimicrobials (4th-5th generation cephalosporins, carbapenems, linezolid, daptomycin, colistin/polymyxins) as assigned by the caller (integer 0-20). Gwynn 2019 printed 2×. - `dialysis` (boolean, required): Dialysis present as assigned by the caller (Gwynn 2019). true adds 2 points. - `ecmo` (boolean, required): Extracorporeal membrane oxygenation (ECMO) present as assigned by the caller (Gwynn 2019). true adds 2 points. - `iabp` (boolean, required): Intra-aortic balloon pump (IABP) present as assigned by the caller (Gwynn 2019). true adds 1 point. - `lvad` (boolean, required): Left ventricular assist device (LVAD) present as assigned by the caller (Gwynn 2019). true adds 1 point. - `mechanical_ventilation` (boolean, required): Mechanical ventilation present as assigned by the caller (Gwynn 2019). true adds 2 points. ## 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/mrc_icu` 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": [ { "tpn_clinical_pharmacist": "false", "blood_products": "0", "amphotericin_b": "false", "lvad": "false", "chemotherapy": "0", "iabp": "false", "prostacyclins": "0", "stress_ulcer_prophylaxis": "false", "vancomycin_iv": "false", "antiarrhythmics": "0", "immunosuppressants": "0", "aminoglycosides": "0", "bowel_regimen": "false", "azole_antifungals": "0", "hyperosmolar_fluids": "0", "ganciclovir_valganciclovir": "0", "glycemic_control": "false", "ecmo": "false", "continuous_opioids_sedatives": "0", "antimicrobials": "0", "anticoagulants": "0", "anticonvulsants": "0", "restricted_antimicrobials": "0", "thromboembolic_prophylaxis": "false", "neuromuscular_blockade": "false", "theophylline": "false", "argatroban": "false", "warfarin": "false", "dialysis": "false", "continuous_infusions": "0", "clozapine": "false", "lidocaine_infusion": "false", "tpn_non_pharmacist": "false", "opioids_sedatives": "0", "mechanical_ventilation": "false", "chlorhexidine": "false", "digoxin": "false", "therapeutic_heparins": "0", "lithium": "false" }, { "tpn_clinical_pharmacist": "false", "blood_products": "0", "amphotericin_b": "false", "lvad": "false", "chemotherapy": "0", "iabp": "false", "prostacyclins": "0", "stress_ulcer_prophylaxis": "false", "vancomycin_iv": "false", "antiarrhythmics": "0", "immunosuppressants": "0", "aminoglycosides": "0", "bowel_regimen": "false", "azole_antifungals": "0", "hyperosmolar_fluids": "0", "ganciclovir_valganciclovir": "0", "glycemic_control": "false", "ecmo": "false", "continuous_opioids_sedatives": "0", "antimicrobials": "0", "anticoagulants": "0", "anticonvulsants": "0", "restricted_antimicrobials": "0", "thromboembolic_prophylaxis": "false", "neuromuscular_blockade": "false", "theophylline": "false", "argatroban": "false", "warfarin": "false", "dialysis": "false", "continuous_infusions": "0", "clozapine": "false", "lidocaine_infusion": "false", "tpn_non_pharmacist": "false", "opioids_sedatives": "0", "mechanical_ventilation": "false", "chlorhexidine": "false", "digoxin": "false", "therapeutic_heparins": "0", "lithium": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/mrc-icu Example 200: ```json { "count": 2, "path": "/api/calc/mrc_icu", "items": [ { "components": [ { "value": 0, "factor": "aminoglycosides", "points": 0, "present": false }, { "factor": "amphotericin_b", "points": 0, "present": false }, { "value": 0, "factor": "antiarrhythmics", "points": 0, "present": false }, { "value": 0, "factor": "anticoagulants", "points": 0, "present": false }, { "value": 0, "factor": "anticonvulsants", "points": 0, "present": false }, { "factor": "argatroban", "points": 0, "present": false }, { "value": 0, "factor": "azole_antifungals", "points": 0, "present": false }, { "value": 0, "factor": "blood_products", "points": 0, "present": false }, { "value": 0, "factor": "chemotherapy", "points": 0, "present": false }, { "factor": "clozapine", "points": 0, "present": false }, { "factor": "digoxin", "points": 0, "present": false }, { "value": 0, "factor": "ganciclovir_valganciclovir", "points": 0, "present": false }, { "value": 0, "factor": "hyperosmolar_fluids", "points": 0, "present": false }, { "value": 0, "factor": "immunosuppressants", "points": 0, "present": false }, { "factor": "lidocaine_infusion", "points": 0, "present": false }, { "factor": "lithium", "points": 0, "present": false }, { "value": 0, "factor": "prostacyclins", "points": 0, "present": false }, { "factor": "theophylline", "points": 0, "present": false }, { "value": 0, "factor": "therapeutic_heparins", "points": 0, "present": false }, { "factor": "vancomycin_iv", "points": 0, "present": false }, { "factor": "warfarin", "points": 0, "present": false }, { "factor": "neuromuscular_blockade", "points": 0, "present": false }, { "value": 0, "factor": "continuous_infusions", "points": 0, "present": false }, { "factor": "tpn_non_pharmacist", "points": 0, "present": false }, { "factor": "tpn_clinical_pharmacist", "points": 0, "present": false }, { "factor": "thromboembolic_prophylaxis", "points": 0, "present": false }, { "factor": "stress_ulcer_prophylaxis", "points": 0, "present": false }, { "factor": "glycemic_control", "points": 0, "present": false }, { "factor": "bowel_regimen", "points": 0, "present": false }, { "factor": "chlorhexidine", "points": 0, "present": false }, { "value": 0, "factor": "opioids_sedatives", "points": 0, "present": false }, { "value": 0, "factor": "continuous_opioids_sedatives", "points": 0, "present": false }, { "value": 0, "factor": "antimicrobials", "points": 0, "present": false }, { "value": 0, "factor": "restricted_antimicrobials", "points": 0, "present": false }, { "factor": "dialysis", "points": 0, "present": false }, { "factor": "ecmo", "points": 0, "present": false }, { "factor": "iabp", "points": 0, "present": false }, { "factor": "lvad", "points": 0, "present": false }, { "factor": "mechanical_ventilation", "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": "Gwynn ME, Poisson MO, Waller JL, Newsome AS", "doi": "10.1093/ajhp/zxy054", "id": "gwynn-2019", "pmid": "31067298", "source": "Am J Health Syst Pharm. 2019;76(Supplement_2):S34-S40", "title": "Development and validation of a medication regimen complexity scoring tool for critically ill patients" }, "formula": "mrc_icu", "formula_expression": "MRC-ICU (Gwynn 2019) = sum of 39 printed item weights. Multiplier classes (printed ×) are weight × caller-assigned count of qualifying medications (0-20): aminoglycosides 3, antiarrhythmics 1, anticoagulants 1, anticonvulsants 3, azole_antifungals 2, blood_products 2, chemotherapy 3, ganciclovir_valganciclovir 1, hyperosmolar_fluids 1, immunosuppressants 3, prostacyclins 2, therapeutic_heparins 2, continuous_infusions 1, opioids_sedatives 1, continuous_opioids_sedatives 2, antimicrobials 1, restricted_antimicrobials 2. Flags add the printed weight when present: amphotericin_b 1, argatroban 2, clozapine 3, digoxin 3, lidocaine_infusion 2, lithium 3, theophylline 3, vancomycin_iv 3, warfarin 3, neuromuscular_blockade 2, tpn_non_pharmacist 1, tpn_clinical_pharmacist 3, thromboembolic_prophylaxis 1, stress_ulcer_prophylaxis 1, glycemic_control 1, bowel_regimen 1, chlorhexidine 1, dialysis 2, ecmo 2, iabp 1, lvad 1, mechanical_ventilation 2", "score": 0 }, { "components": [ { "value": 0, "factor": "aminoglycosides", "points": 0, "present": false }, { "factor": "amphotericin_b", "points": 0, "present": false }, { "value": 0, "factor": "antiarrhythmics", "points": 0, "present": false }, { "value": 0, "factor": "anticoagulants", "points": 0, "present": false }, { "value": 0, "factor": "anticonvulsants", "points": 0, "present": false }, { "factor": "argatroban", "points": 0, "present": false }, { "value": 0, "factor": "azole_antifungals", "points": 0, "present": false }, { "value": 0, "factor": "blood_products", "points": 0, "present": false }, { "value": 0, "factor": "chemotherapy", "points": 0, "present": false }, { "factor": "clozapine", "points": 0, "present": false }, { "factor": "digoxin", "points": 0, "present": false }, { "value": 0, "factor": "ganciclovir_valganciclovir", "points": 0, "present": false }, { "value": 0, "factor": "hyperosmolar_fluids", "points": 0, "present": false }, { "value": 0, "factor": "immunosuppressants", "points": 0, "present": false }, { "factor": "lidocaine_infusion", "points": 0, "present": false }, { "factor": "lithium", "points": 0, "present": false }, { "value": 0, "factor": "prostacyclins", "points": 0, "present": false }, { "factor": "theophylline", "points": 0, "present": false }, { "value": 0, "factor": "therapeutic_heparins", "points": 0, "present": false }, { "factor": "vancomycin_iv", "points": 0, "present": false }, { "factor": "warfarin", "points": 0, "present": false }, { "factor": "neuromuscular_blockade", "points": 0, "present": false }, { "value": 0, "factor": "continuous_infusions", "points": 0, "present": false }, { "factor": "tpn_non_pharmacist", "points": 0, "present": false }, { "factor": "tpn_clinical_pharmacist", "points": 0, "present": false }, { "factor": "thromboembolic_prophylaxis", "points": 0, "present": false }, { "factor": "stress_ulcer_prophylaxis", "points": 0, "present": false }, { "factor": "glycemic_control", "points": 0, "present": false }, { "factor": "bowel_regimen", "points": 0, "present": false }, { "factor": "chlorhexidine", "points": 0, "present": false }, { "value": 0, "factor": "opioids_sedatives", "points": 0, "present": false }, { "value": 0, "factor": "continuous_opioids_sedatives", "points": 0, "present": false }, { "value": 0, "factor": "antimicrobials", "points": 0, "present": false }, { "value": 0, "factor": "restricted_antimicrobials", "points": 0, "present": false }, { "factor": "dialysis", "points": 0, "present": false }, { "factor": "ecmo", "points": 0, "present": false }, { "factor": "iabp", "points": 0, "present": false }, { "factor": "lvad", "points": 0, "present": false }, { "factor": "mechanical_ventilation", "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": "Gwynn ME, Poisson MO, Waller JL, Newsome AS", "doi": "10.1093/ajhp/zxy054", "id": "gwynn-2019", "pmid": "31067298", "source": "Am J Health Syst Pharm. 2019;76(Supplement_2):S34-S40", "title": "Development and validation of a medication regimen complexity scoring tool for critically ill patients" }, "formula": "mrc_icu", "formula_expression": "MRC-ICU (Gwynn 2019) = sum of 39 printed item weights. Multiplier classes (printed ×) are weight × caller-assigned count of qualifying medications (0-20): aminoglycosides 3, antiarrhythmics 1, anticoagulants 1, anticonvulsants 3, azole_antifungals 2, blood_products 2, chemotherapy 3, ganciclovir_valganciclovir 1, hyperosmolar_fluids 1, immunosuppressants 3, prostacyclins 2, therapeutic_heparins 2, continuous_infusions 1, opioids_sedatives 1, continuous_opioids_sedatives 2, antimicrobials 1, restricted_antimicrobials 2. Flags add the printed weight when present: amphotericin_b 1, argatroban 2, clozapine 3, digoxin 3, lidocaine_infusion 2, lithium 3, theophylline 3, vancomycin_iv 3, warfarin 3, neuromuscular_blockade 2, tpn_non_pharmacist 1, tpn_clinical_pharmacist 3, thromboembolic_prophylaxis 1, stress_ulcer_prophylaxis 1, glycemic_control 1, bowel_regimen 1, chlorhexidine 1, dialysis 2, ecmo 2, iabp 1, lvad 1, mechanical_ventilation 2", "score": 0 } ] } ``` ## Response fields - `formula` (string): mrc_icu - `formula_expression` (string): Exact Gwynn 2019 expression used - `score` (integer): MRC-ICU point total - `components` (array): Per-item points in printed table order - `citation` (object): Gwynn et al. AJHP 2019 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 0, "factor": "aminoglycosides", "points": 0, "present": false }, { "factor": "amphotericin_b", "points": 0, "present": false }, { "value": 0, "factor": "antiarrhythmics", "points": 0, "present": false }, { "value": 0, "factor": "anticoagulants", "points": 0, "present": false }, { "value": 0, "factor": "anticonvulsants", "points": 0, "present": false }, { "factor": "argatroban", "points": 0, "present": false }, { "value": 0, "factor": "azole_antifungals", "points": 0, "present": false }, { "value": 0, "factor": "blood_products", "points": 0, "present": false }, { "value": 0, "factor": "chemotherapy", "points": 0, "present": false }, { "factor": "clozapine", "points": 0, "present": false }, { "factor": "digoxin", "points": 0, "present": false }, { "value": 0, "factor": "ganciclovir_valganciclovir", "points": 0, "present": false }, { "value": 0, "factor": "hyperosmolar_fluids", "points": 0, "present": false }, { "value": 0, "factor": "immunosuppressants", "points": 0, "present": false }, { "factor": "lidocaine_infusion", "points": 0, "present": false }, { "factor": "lithium", "points": 0, "present": false }, { "value": 0, "factor": "prostacyclins", "points": 0, "present": false }, { "factor": "theophylline", "points": 0, "present": false }, { "value": 0, "factor": "therapeutic_heparins", "points": 0, "present": false }, { "factor": "vancomycin_iv", "points": 0, "present": false }, { "factor": "warfarin", "points": 0, "present": false }, { "factor": "neuromuscular_blockade", "points": 0, "present": false }, { "value": 0, "factor": "continuous_infusions", "points": 0, "present": false }, { "factor": "tpn_non_pharmacist", "points": 0, "present": false }, { "factor": "tpn_clinical_pharmacist", "points": 0, "present": false }, { "factor": "thromboembolic_prophylaxis", "points": 0, "present": false }, { "factor": "stress_ulcer_prophylaxis", "points": 0, "present": false }, { "factor": "glycemic_control", "points": 0, "present": false }, { "factor": "bowel_regimen", "points": 0, "present": false }, { "factor": "chlorhexidine", "points": 0, "present": false }, { "value": 0, "factor": "opioids_sedatives", "points": 0, "present": false }, { "value": 0, "factor": "continuous_opioids_sedatives", "points": 0, "present": false }, { "value": 0, "factor": "antimicrobials", "points": 0, "present": false }, { "value": 0, "factor": "restricted_antimicrobials", "points": 0, "present": false }, { "factor": "dialysis", "points": 0, "present": false }, { "factor": "ecmo", "points": 0, "present": false }, { "factor": "iabp", "points": 0, "present": false }, { "factor": "lvad", "points": 0, "present": false }, { "factor": "mechanical_ventilation", "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": "Gwynn ME, Poisson MO, Waller JL, Newsome AS", "doi": "10.1093/ajhp/zxy054", "id": "gwynn-2019", "pmid": "31067298", "source": "Am J Health Syst Pharm. 2019;76(Supplement_2):S34-S40", "title": "Development and validation of a medication regimen complexity scoring tool for critically ill patients" }, "formula": "mrc_icu", "formula_expression": "MRC-ICU (Gwynn 2019) = sum of 39 printed item weights. Multiplier classes (printed ×) are weight × caller-assigned count of qualifying medications (0-20): aminoglycosides 3, antiarrhythmics 1, anticoagulants 1, anticonvulsants 3, azole_antifungals 2, blood_products 2, chemotherapy 3, ganciclovir_valganciclovir 1, hyperosmolar_fluids 1, immunosuppressants 3, prostacyclins 2, therapeutic_heparins 2, continuous_infusions 1, opioids_sedatives 1, continuous_opioids_sedatives 2, antimicrobials 1, restricted_antimicrobials 2. Flags add the printed weight when present: amphotericin_b 1, argatroban 2, clozapine 3, digoxin 3, lidocaine_infusion 2, lithium 3, theophylline 3, vancomycin_iv 3, warfarin 3, neuromuscular_blockade 2, tpn_non_pharmacist 1, tpn_clinical_pharmacist 3, thromboembolic_prophylaxis 1, stress_ulcer_prophylaxis 1, glycemic_control 1, bowel_regimen 1, chlorhexidine 1, dialysis 2, ecmo 2, iabp 1, lvad 1, mechanical_ventilation 2", "score": 0 } ``` ## Errors - HTTP 400 `invalid_mrc_icu`: Gwynn 2019 MRC-ICU inputs must match that scoring tool's item counts and device flags. 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 - [APACHE II](https://magentlab.com/docs/apache-ii) — Compute the Knaus 1985 APACHE II integer from 12 Acute Physiology Score items, age points, and chronic-health points. - [mSOFA](https://magentlab.com/docs/msofa) — Compute the Grissom 2010 modified SOFA (mSOFA) total from SpO2/FiO2, caller-assigned scleral icterus or jaundice, MAP and adrenergic agents, caller-assigned GCS, and creatinine. - [SAPS II](https://magentlab.com/docs/saps-ii) — Compute the Le Gall 1993 SAPS II integer from 12 physiology variables, age, type of admission, and one chronic disease, then the paper's logit hospital-mortality probability. ## 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.