# PELD-Cr (OPTN Policy 9 Table 9-1)

PELD-Cr

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/peld_cr`
HTML: https://magentlab.com/docs/peld-cr
Markdown: https://magentlab.com/docs/peld-cr.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Compute the OPTN Policy 9 Table 9-1 PELD-Cr integer from age, albumin, bilirubin, INR, creatinine or dialysis/CVVHD, and a caller-assigned minimum CDC height or weight Z-score.

## When to use

When an agent needs the published PELD-Cr integer and must not invent a listing order, substitute McDiarmid 2002 PELD, or compute CDC LMS Z from height and weight.

## When not to use

- Not a medical device.
- Not a transplant listing or allocation order.
- OPTN Policy 9 Table 9-1 PELD-Cr only. This is not McDiarmid 2002 PELD.
- magent does not compute CDC LMS Z-scores from height or weight; min_cdc_z is caller-assigned.
- Does not assign exception scores, Status 1A, Status 1B, or listing priority.

## Formula

```
PELD = round((sum of OPTN Policy 9 Table 9-1 terms + 1.5287)*10 + 2.82); min 6. Age (fractional years, <12): <1 → -0.1967*1; 1-5.5 → -0.1967*age; >5.5 → -0.1967*5.5. Albumin g/dL (floor 1.0): 1-1.9 → -1.842*ln(albumin); >1.9 → -1.842*ln(1.9). Bilirubin mg/dL (floor 1.0): 1-4 → 0.7854*ln(bilirubin)+0.3434*ln(4); >4-40 → 0.7854*ln(4)+0.3434*ln(bilirubin); >40 → 0.7854*ln(4)+0.3434*ln(40). INR (floor 1.0): 1-2 → 1.981*ln(INR)+0.7298*ln(2); >2-10 → 1.981*ln(2)+0.7298*ln(INR); >10 → 1.981*ln(2)+0.7298*ln(10). Min CDC height/weight Z: <-5 → -0.1807*(-5); -5 to -2.1 → -0.1807*Z; >-2.1 → -0.1807*(-2.1). Creatinine mg/dL (1.3 if >1.3 or dialysis/CVVHD): <0.2 → 1.453*ln(0.2); 0.2-1.3 → 1.453*ln(creatinine); >1.3 → 1.453*ln(1.3)
```

## Citation

[Improving Liver Allocation: MELD, PELD, Status 1A and Status 1B](https://optn.transplant.hrsa.gov/media/3idbp5vq/policy-guid-change_impr-liv-alloc-meld-peld-sta-1a-sta-1b_liv.pdf)
Organ Procurement and Transplantation Network
OPTN Policy 9.1.E / Table 9-1 (policy notice June 2022; implementation 13 Jul 2023)
DOI: none

## Worked example

### Age 2, albumin 2.5, bili 4.0, INR 1.5, creatinine 0.4, Z 0

Given: `age_years=2, albumin_g_dl=2.5, bilirubin_mg_dl=4.0, creatinine_mg_dl=0.4, dialysis_or_cvvhd=false, inr=1.5, min_cdc_z=0.0`

1. Floor albumin, bilirubin, and INR at 1.0. Creatinine 0.4 is between 0.2 and 1.3. Age 2 is in 1-5.5. min_cdc_z 0 is above -2.1 so Z used is -2.1. Albumin 2.5 is above 1.9 so albumin used is 1.9.
2. Sum Table 9-1 terms: age -0.1967*2; albumin -1.842*ln(1.9); bilirubin 0.7854*ln(4)+0.3434*ln(4); INR 1.981*ln(1.5)+0.7298*ln(2); Z -0.1807*(-2.1); creatinine 1.453*ln(0.4).
3. PELD-Cr = round((sum + 1.5287)*10 + 2.82); minimum 6.


## Also searched as

- PELD-Cr
- PELD Cr
- Pediatric End-Stage Liver Disease creatinine
- OPTN PELD 2023
- PELD creatinine
- updated PELD
- Policy 9 PELD

## Parameters

- `age_years` (number, required): Age in fractional calendar years (0 to under 12). Table 9-1 uses 1.0 below age 1 and 5.5 above 5.5 years. PELD-Cr is for candidates under 12.
- `albumin_g_dl` (number, optional): Serum albumin in g/dL (0.1-6). Provide this or albumin_g_l, not both. Policy floors at 1.0; Table 9-1 uses ln(1.9) above 1.9.
- `albumin_g_l` (number, optional): Serum albumin in g/L (1-60). Converted as g/dL = g/L / 10.
- `bilirubin_mg_dl` (number, optional): Total bilirubin in mg/dL (0.1-80). Provide this or bilirubin_umol_l, not both. Policy floors at 1.0; Table 9-1 knots at 4 and 40.
- `bilirubin_umol_l` (number, optional): Total bilirubin in µmol/L (2-1368). Converted as mg/dL = µmol/L / 17.1.
- `inr` (number, required): INR (0.8-20). Policy floors at 1.0; Table 9-1 knots at 2 and 10.
- `creatinine_mg_dl` (number, optional): Serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l, not both. Table 9-1 floors at 0.2 and assigns 1.3 if >1.3 or dialysis_or_cvvhd is true.
- `creatinine_umol_l` (number, optional): Serum creatinine in µmol/L (9-1768). Converted as mg/dL = µmol/L / 88.42.
- `dialysis_or_cvvhd` (boolean, required): True when the candidate had two or more dialysis treatments in the prior 7 days, or 24 hours of CVVHD in the prior 7 days. Assigns creatinine 1.3 mg/dL.
- `min_cdc_z` (number, required): Caller-assigned minimum of CDC 2000 height or weight Z-score (LMS). magent does not compute Z from height or weight. Table 9-1 clamps -5.0 to -2.1.

## 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/peld_cr`
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": "2",
      "albumin_g_dl": "2.5",
      "bilirubin_mg_dl": "4.0",
      "creatinine_mg_dl": "0.4",
      "dialysis_or_cvvhd": "false",
      "inr": "1.5",
      "min_cdc_z": "0.0"
    },
    {
      "age_years": "2",
      "albumin_g_dl": "2.5",
      "bilirubin_mg_dl": "4.0",
      "creatinine_mg_dl": "0.4",
      "dialysis_or_cvvhd": "false",
      "inr": "1.5",
      "min_cdc_z": "0.0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/peld-cr

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/peld_cr",
  "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": "Organ Procurement and Transplantation Network",
        "id": "optn-2023-peld-cr",
        "source": "OPTN Policy 9.1.E / Table 9-1 (policy notice June 2022; implementation 13 Jul 2023)",
        "title": "Improving Liver Allocation: MELD, PELD, Status 1A and Status 1B"
      },
      "formula": "optn_peld_cr_2023",
      "formula_expression": "PELD = round((sum of OPTN Policy 9 Table 9-1 terms + 1.5287)*10 + 2.82); min 6. Age (fractional years, <12): <1 → -0.1967*1; 1-5.5 → -0.1967*age; >5.5 → -0.1967*5.5. Albumin g/dL (floor 1.0): 1-1.9 → -1.842*ln(albumin); >1.9 → -1.842*ln(1.9). Bilirubin mg/dL (floor 1.0): 1-4 → 0.7854*ln(bilirubin)+0.3434*ln(4); >4-40 → 0.7854*ln(4)+0.3434*ln(bilirubin); >40 → 0.7854*ln(4)+0.3434*ln(40). INR (floor 1.0): 1-2 → 1.981*ln(INR)+0.7298*ln(2); >2-10 → 1.981*ln(2)+0.7298*ln(INR); >10 → 1.981*ln(2)+0.7298*ln(10). Min CDC height/weight Z: <-5 → -0.1807*(-5); -5 to -2.1 → -0.1807*Z; >-2.1 → -0.1807*(-2.1). Creatinine mg/dL (1.3 if >1.3 or dialysis/CVVHD): <0.2 → 1.453*ln(0.2); 0.2-1.3 → 1.453*ln(creatinine); >1.3 → 1.453*ln(1.3)",
      "age_years": 2.0,
      "albumin_g_dl": 2.5,
      "inr": 1.5,
      "bilirubin_mg_dl": 4.0,
      "creatinine_mg_dl": 0.4,
      "bilirubin_used_mg_dl": 4.0,
      "creatinine_used_mg_dl": 0.4,
      "inr_used": 1.5,
      "albumin_used_g_dl": 1.9,
      "age_used_years": 2.0,
      "dialysis_or_cvvhd": false,
      "min_cdc_z": 0.0,
      "min_cdc_z_used": -2.1,
      "peld_cr": 22
    },
    {
      "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": "Organ Procurement and Transplantation Network",
        "id": "optn-2023-peld-cr",
        "source": "OPTN Policy 9.1.E / Table 9-1 (policy notice June 2022; implementation 13 Jul 2023)",
        "title": "Improving Liver Allocation: MELD, PELD, Status 1A and Status 1B"
      },
      "formula": "optn_peld_cr_2023",
      "formula_expression": "PELD = round((sum of OPTN Policy 9 Table 9-1 terms + 1.5287)*10 + 2.82); min 6. Age (fractional years, <12): <1 → -0.1967*1; 1-5.5 → -0.1967*age; >5.5 → -0.1967*5.5. Albumin g/dL (floor 1.0): 1-1.9 → -1.842*ln(albumin); >1.9 → -1.842*ln(1.9). Bilirubin mg/dL (floor 1.0): 1-4 → 0.7854*ln(bilirubin)+0.3434*ln(4); >4-40 → 0.7854*ln(4)+0.3434*ln(bilirubin); >40 → 0.7854*ln(4)+0.3434*ln(40). INR (floor 1.0): 1-2 → 1.981*ln(INR)+0.7298*ln(2); >2-10 → 1.981*ln(2)+0.7298*ln(INR); >10 → 1.981*ln(2)+0.7298*ln(10). Min CDC height/weight Z: <-5 → -0.1807*(-5); -5 to -2.1 → -0.1807*Z; >-2.1 → -0.1807*(-2.1). Creatinine mg/dL (1.3 if >1.3 or dialysis/CVVHD): <0.2 → 1.453*ln(0.2); 0.2-1.3 → 1.453*ln(creatinine); >1.3 → 1.453*ln(1.3)",
      "age_years": 2.0,
      "albumin_g_dl": 2.5,
      "inr": 1.5,
      "bilirubin_mg_dl": 4.0,
      "creatinine_mg_dl": 0.4,
      "bilirubin_used_mg_dl": 4.0,
      "creatinine_used_mg_dl": 0.4,
      "inr_used": 1.5,
      "albumin_used_g_dl": 1.9,
      "age_used_years": 2.0,
      "dialysis_or_cvvhd": false,
      "min_cdc_z": 0.0,
      "min_cdc_z_used": -2.1,
      "peld_cr": 22
    }
  ]
}
```

## Response fields

- `formula` (string): optn_peld_cr_2023
- `formula_expression` (string): Exact Table 9-1 expression used
- `age_years` (number): Input age in years
- `albumin_g_dl` (number): Input albumin in g/dL
- `bilirubin_mg_dl` (number): Input bilirubin in mg/dL
- `inr` (number): Input INR
- `creatinine_mg_dl` (number): Input creatinine in mg/dL
- `dialysis_or_cvvhd` (boolean): Dialysis or 24h CVVHD flag
- `min_cdc_z` (number): Caller-assigned minimum CDC height or weight Z
- `age_used_years` (number): Age after Table 9-1 1.0-5.5 bounds
- `albumin_used_g_dl` (number): Albumin after 1.0 floor and 1.9 Table 9-1 cap
- `bilirubin_used_mg_dl` (number): Bilirubin after 1.0 floor and 40 cap
- `inr_used` (number): INR after 1.0 floor and 10 cap
- `creatinine_used_mg_dl` (number): Creatinine after 0.2 floor; 1.3 if >1.3 or dialysis/CVVHD
- `min_cdc_z_used` (number): Minimum CDC Z after Table 9-1 -5.0 to -2.1 clamp
- `peld_cr` (integer): OPTN Policy 9 PELD-Cr, nearest integer, minimum 6
- `citation` (object): OPTN Policy 9 PELD-Cr 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": "Organ Procurement and Transplantation Network",
    "id": "optn-2023-peld-cr",
    "source": "OPTN Policy 9.1.E / Table 9-1 (policy notice June 2022; implementation 13 Jul 2023)",
    "title": "Improving Liver Allocation: MELD, PELD, Status 1A and Status 1B"
  },
  "formula": "optn_peld_cr_2023",
  "formula_expression": "PELD = round((sum of OPTN Policy 9 Table 9-1 terms + 1.5287)*10 + 2.82); min 6. Age (fractional years, <12): <1 → -0.1967*1; 1-5.5 → -0.1967*age; >5.5 → -0.1967*5.5. Albumin g/dL (floor 1.0): 1-1.9 → -1.842*ln(albumin); >1.9 → -1.842*ln(1.9). Bilirubin mg/dL (floor 1.0): 1-4 → 0.7854*ln(bilirubin)+0.3434*ln(4); >4-40 → 0.7854*ln(4)+0.3434*ln(bilirubin); >40 → 0.7854*ln(4)+0.3434*ln(40). INR (floor 1.0): 1-2 → 1.981*ln(INR)+0.7298*ln(2); >2-10 → 1.981*ln(2)+0.7298*ln(INR); >10 → 1.981*ln(2)+0.7298*ln(10). Min CDC height/weight Z: <-5 → -0.1807*(-5); -5 to -2.1 → -0.1807*Z; >-2.1 → -0.1807*(-2.1). Creatinine mg/dL (1.3 if >1.3 or dialysis/CVVHD): <0.2 → 1.453*ln(0.2); 0.2-1.3 → 1.453*ln(creatinine); >1.3 → 1.453*ln(1.3)",
  "age_years": 2.0,
  "albumin_g_dl": 2.5,
  "inr": 1.5,
  "bilirubin_mg_dl": 4.0,
  "creatinine_mg_dl": 0.4,
  "bilirubin_used_mg_dl": 4.0,
  "creatinine_used_mg_dl": 0.4,
  "inr_used": 1.5,
  "albumin_used_g_dl": 1.9,
  "age_used_years": 2.0,
  "dialysis_or_cvvhd": false,
  "min_cdc_z": 0.0,
  "min_cdc_z_used": -2.1,
  "peld_cr": 22
}
```

## Errors

- HTTP 400 `invalid_peld_cr`: PELD-Cr inputs must match OPTN Policy 9 age under 12, albumin, bilirubin, INR, creatinine or dialysis, and caller-assigned minimum CDC height or weight Z-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

- [PELD](https://magentlab.com/docs/peld) — Compute the McDiarmid 2002 Pediatric End-Stage Liver Disease listing arithmetic from bilirubin, INR, albumin, age, and growth failure.
- [MELD 3.0](https://magentlab.com/docs/meld-3) — Compute the Kim 2021 MELD 3.0 integer from sex, bilirubin, INR, creatinine, sodium, albumin, and dialysis.
- [MELD-Na](https://magentlab.com/docs/meld-na) — Compute OPTN/UNOS 2016 MELD and MELD-Na from creatinine, bilirubin, INR, sodium, and dialysis.

## 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.