# ORBI STEMI cardiogenic shock score ORBI Status: LIVE Price: $0.005 USDC `GET /api/calc/orbi` HTML: https://magentlab.com/docs/orbi Markdown: https://magentlab.com/docs/orbi.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Auffret 2018 ORBI predictors after STEMI primary PCI and return the integer score (0-36), class I-IV, and derivation-cohort in-hospital cardiogenic-shock percent. ## When to use When an agent needs the published ORBI point total after STEMI treated by primary PCI and must not invent a shock-treatment order, a cath-lab protocol, or the ORBIT bleeding score. ## When not to use - Not a medical device and not a cath-lab, reperfusion, or shock-treatment order. magent does not examine the patient, read the ECG, or assign TIMI flow. - Killip class is i, ii, or iii as assigned by the caller. Killip IV (cardiogenic shock on admission) is rejected because the derivation excluded those patients. - SBP <125 mm Hg and pulse pressure <45 mm Hg is a single caller-assigned boolean (sbp_lt_125_and_pp_lt_45). magent does not take separate SBP or pulse-pressure numbers. - Class percents are the Auffret 2018 derivation-cohort observed in-hospital cardiogenic-shock rates (I 1.3%, II 6.6%, III 11.7%, IV 31.8%). Validation-cohort rates differ and are not returned. - Not the O'Brien 2015 ORBIT bleeding score. Integer weights round the multivariable adjusted odds ratios; theoretical maximum 36. ## Formula ``` ORBI = age_years>70 (2) + prior_stroke_tia (2) + cardiac_arrest_on_admission (3) + anterior_stemi (1) + fmc_to_ppci_gt_90_min (2) + killip_class (i:0, ii:2, iii:6; iv rejected) + heart_rate>90 (3) + sbp_lt_125_and_pp_lt_45 (4) + glucose_gt_10_mmol_l (3) + left_main_culprit (5) + post_ppci_timi_lt_3 (5); Auffret 2018 rounded adjusted ORs; max 36; derivation in-hospital CS class I 0-7 1.3%, II 8-10 6.6%, III 11-12 11.7%, IV >=13 31.8% ``` ## Citation [Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score](https://doi.org/10.1093/eurheartj/ehy127) Auffret V, Cottin Y, Leurent G, et al. Eur Heart J. 2018;39(22):2090-2102 DOI: [10.1093/eurheartj/ehy127](https://doi.org/10.1093/eurheartj/ehy127) ## Worked example ### No risk flags, age 60, Killip I, heart rate 70 Given: `age_years=60, anterior_stemi=false, cardiac_arrest_on_admission=false, fmc_to_ppci_gt_90_min=false, glucose_gt_10_mmol_l=false, heart_rate=70, killip_class=i, left_main_culprit=false, post_ppci_timi_lt_3=false, prior_stroke_tia=false, sbp_lt_125_and_pp_lt_45=false` 1. age_years 60 is not >70 → 0; all boolean flags false → 0; killip i → 0; heart_rate 70 is not >90 → 0 2. score = 0 (max 36); class I; derivation in-hospital CS 1.3% ### All predictors present (theoretical max 36) Given: `age_years=71, anterior_stemi=true, cardiac_arrest_on_admission=true, fmc_to_ppci_gt_90_min=true, glucose_gt_10_mmol_l=true, heart_rate=91, killip_class=iii, left_main_culprit=true, post_ppci_timi_lt_3=true, prior_stroke_tia=true, sbp_lt_125_and_pp_lt_45=true` 1. age_years 71 → 2; stroke/TIA 2; arrest 3; anterior 1; FMC>90 2; killip iii 6; HR>90 3; SBP/PP 4; glucose 3; left main 5; TIMI<3 5 2. score = 36 (max 36); class IV; derivation in-hospital CS 31.8% ## Also searched as - ORBI risk score - Auffret STEMI shock score - STEMI in-hospital cardiogenic shock - ORBI class - primary PCI shock score - FMC to PPCI ORBI - ORBI STEMI PPCI - Auffret 2018 ORBI ## Parameters - `age_years` (integer, required): Age in years (18-120). Auffret 2018: older than 70 scores 2; 70 or younger scores 0. - `prior_stroke_tia` (boolean, required): Prior stroke or TIA (Auffret 2018: 2 points). true or false. - `cardiac_arrest_on_admission` (boolean, required): Cardiac arrest on admission (Auffret 2018: 3 points). true or false. - `anterior_stemi` (boolean, required): Anterior ST-elevation myocardial infarction (Auffret 2018: 1 point). Caller-assigned. magent does not read the ECG. - `fmc_to_ppci_gt_90_min` (boolean, required): First medical contact to primary PCI greater than 90 minutes (Auffret 2018: 2 points). true or false. magent does not compute timestamps. - `killip_class` (string, required): Caller-assigned Killip class after STEMI (Auffret 2018): i (0), ii (2), or iii (6). Killip IV is rejected because the derivation excluded cardiogenic shock on admission. magent does not examine the patient. - `heart_rate` (integer, required): Heart rate in beats per minute (integer 30-220). Auffret 2018: greater than 90 scores 3. - `sbp_lt_125_and_pp_lt_45` (boolean, required): Whether systolic BP is <125 mm Hg and pulse pressure is <45 mm Hg together (Auffret 2018: 4 points). Single caller-assigned boolean; magent does not take separate SBP or pulse-pressure numbers. - `glucose_gt_10_mmol_l` (boolean, required): Admission glucose >10 mmol/L (Auffret 2018: 3 points). true or false. magent does not convert units. - `left_main_culprit` (boolean, required): Whether the culprit lesion is the left main coronary artery (Auffret 2018: 5 points). Caller-assigned. magent does not read the angiogram. - `post_ppci_timi_lt_3` (boolean, required): Whether post-primary-PCI TIMI flow is <3 (Auffret 2018: 5 points). Caller-assigned. magent does not assign TIMI flow. ## 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/orbi` 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_years": "60", "anterior_stemi": "false", "cardiac_arrest_on_admission": "false", "fmc_to_ppci_gt_90_min": "false", "glucose_gt_10_mmol_l": "false", "heart_rate": "70", "killip_class": "i", "left_main_culprit": "false", "post_ppci_timi_lt_3": "false", "prior_stroke_tia": "false", "sbp_lt_125_and_pp_lt_45": "false" }, { "age_years": "60", "anterior_stemi": "false", "cardiac_arrest_on_admission": "false", "fmc_to_ppci_gt_90_min": "false", "glucose_gt_10_mmol_l": "false", "heart_rate": "70", "killip_class": "i", "left_main_culprit": "false", "post_ppci_timi_lt_3": "false", "prior_stroke_tia": "false", "sbp_lt_125_and_pp_lt_45": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/orbi Example 200: ```json { "count": 2, "path": "/api/calc/orbi", "items": [ { "components": [ { "value": 60, "factor": "age_years", "points": 0, "present": false }, { "value": "i", "factor": "killip_class", "points": 0, "present": false }, { "value": 70, "factor": "heart_rate", "points": 0, "present": false }, { "factor": "prior_stroke_tia", "points": 0, "present": false }, { "factor": "cardiac_arrest_on_admission", "points": 0, "present": false }, { "factor": "anterior_stemi", "points": 0, "present": false }, { "factor": "fmc_to_ppci_gt_90_min", "points": 0, "present": false }, { "factor": "sbp_lt_125_and_pp_lt_45", "points": 0, "present": false }, { "factor": "glucose_gt_10_mmol_l", "points": 0, "present": false }, { "factor": "left_main_culprit", "points": 0, "present": false }, { "factor": "post_ppci_timi_lt_3", "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": "Auffret V, Cottin Y, Leurent G, et al.", "doi": "10.1093/eurheartj/ehy127", "id": "auffret-2018", "pmid": "29554243", "source": "Eur Heart J. 2018;39(22):2090-2102", "title": "Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score" }, "formula": "orbi", "formula_expression": "ORBI = age_years>70 (2) + prior_stroke_tia (2) + cardiac_arrest_on_admission (3) + anterior_stemi (1) + fmc_to_ppci_gt_90_min (2) + killip_class (i:0, ii:2, iii:6; iv rejected) + heart_rate>90 (3) + sbp_lt_125_and_pp_lt_45 (4) + glucose_gt_10_mmol_l (3) + left_main_culprit (5) + post_ppci_timi_lt_3 (5); Auffret 2018 rounded adjusted ORs; max 36; derivation in-hospital CS class I 0-7 1.3%, II 8-10 6.6%, III 11-12 11.7%, IV >=13 31.8%", "max_score": 36, "score": 0, "age_years": 60, "killip_class": "i", "heart_rate": 70, "in_hospital_cs_percent": 1.3, "orbi_class": "I" }, { "components": [ { "value": 60, "factor": "age_years", "points": 0, "present": false }, { "value": "i", "factor": "killip_class", "points": 0, "present": false }, { "value": 70, "factor": "heart_rate", "points": 0, "present": false }, { "factor": "prior_stroke_tia", "points": 0, "present": false }, { "factor": "cardiac_arrest_on_admission", "points": 0, "present": false }, { "factor": "anterior_stemi", "points": 0, "present": false }, { "factor": "fmc_to_ppci_gt_90_min", "points": 0, "present": false }, { "factor": "sbp_lt_125_and_pp_lt_45", "points": 0, "present": false }, { "factor": "glucose_gt_10_mmol_l", "points": 0, "present": false }, { "factor": "left_main_culprit", "points": 0, "present": false }, { "factor": "post_ppci_timi_lt_3", "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": "Auffret V, Cottin Y, Leurent G, et al.", "doi": "10.1093/eurheartj/ehy127", "id": "auffret-2018", "pmid": "29554243", "source": "Eur Heart J. 2018;39(22):2090-2102", "title": "Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score" }, "formula": "orbi", "formula_expression": "ORBI = age_years>70 (2) + prior_stroke_tia (2) + cardiac_arrest_on_admission (3) + anterior_stemi (1) + fmc_to_ppci_gt_90_min (2) + killip_class (i:0, ii:2, iii:6; iv rejected) + heart_rate>90 (3) + sbp_lt_125_and_pp_lt_45 (4) + glucose_gt_10_mmol_l (3) + left_main_culprit (5) + post_ppci_timi_lt_3 (5); Auffret 2018 rounded adjusted ORs; max 36; derivation in-hospital CS class I 0-7 1.3%, II 8-10 6.6%, III 11-12 11.7%, IV >=13 31.8%", "max_score": 36, "score": 0, "age_years": 60, "killip_class": "i", "heart_rate": 70, "in_hospital_cs_percent": 1.3, "orbi_class": "I" } ] } ``` ## Response fields - `formula` (string): orbi - `formula_expression` (string): Exact expression used - `score` (integer): ORBI points 0-36 - `max_score` (integer): 36 - `orbi_class` (string): Auffret 2018 class I (0-7), II (8-10), III (11-12), or IV (>=13) - `in_hospital_cs_percent` (number): Derivation-cohort observed in-hospital cardiogenic-shock percent: 1.3, 6.6, 11.7, or 31.8 - `age_years` (integer): Age in years used - `killip_class` (string): Caller-assigned Killip i, ii, or iii - `heart_rate` (integer): Heart rate used, beats per minute - `components` (array): Per-factor points - `citation` (object): Auffret et al. Eur Heart J 2018 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 60, "factor": "age_years", "points": 0, "present": false }, { "value": "i", "factor": "killip_class", "points": 0, "present": false }, { "value": 70, "factor": "heart_rate", "points": 0, "present": false }, { "factor": "prior_stroke_tia", "points": 0, "present": false }, { "factor": "cardiac_arrest_on_admission", "points": 0, "present": false }, { "factor": "anterior_stemi", "points": 0, "present": false }, { "factor": "fmc_to_ppci_gt_90_min", "points": 0, "present": false }, { "factor": "sbp_lt_125_and_pp_lt_45", "points": 0, "present": false }, { "factor": "glucose_gt_10_mmol_l", "points": 0, "present": false }, { "factor": "left_main_culprit", "points": 0, "present": false }, { "factor": "post_ppci_timi_lt_3", "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": "Auffret V, Cottin Y, Leurent G, et al.", "doi": "10.1093/eurheartj/ehy127", "id": "auffret-2018", "pmid": "29554243", "source": "Eur Heart J. 2018;39(22):2090-2102", "title": "Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score" }, "formula": "orbi", "formula_expression": "ORBI = age_years>70 (2) + prior_stroke_tia (2) + cardiac_arrest_on_admission (3) + anterior_stemi (1) + fmc_to_ppci_gt_90_min (2) + killip_class (i:0, ii:2, iii:6; iv rejected) + heart_rate>90 (3) + sbp_lt_125_and_pp_lt_45 (4) + glucose_gt_10_mmol_l (3) + left_main_culprit (5) + post_ppci_timi_lt_3 (5); Auffret 2018 rounded adjusted ORs; max 36; derivation in-hospital CS class I 0-7 1.3%, II 8-10 6.6%, III 11-12 11.7%, IV >=13 31.8%", "max_score": 36, "score": 0, "age_years": 60, "killip_class": "i", "heart_rate": 70, "in_hospital_cs_percent": 1.3, "orbi_class": "I" } ``` ## Errors - HTTP 400 `invalid_orbi`: ORBI needs Auffret 2018 STEMI shock predictors (Killip I–III, hemodynamics, lesion, TIMI) in published ranges. 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 - [Killip](https://magentlab.com/docs/killip) — Return the Killip and Kimball 1967 myocardial-infarction heart-failure class 1-4 from a caller-assigned integer, with the published class description and 1967 CCU hospital mortality. - [Shock index](https://magentlab.com/docs/shock-index) — Compute the Allgöwer–Burri shock index as heart rate in bpm divided by cuff systolic pressure in mm Hg. ## 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.