# Thakar ARF score after cardiac surgery Thakar ARF score Status: LIVE Price: $0.005 USDC `GET /api/calc/thakar` HTML: https://magentlab.com/docs/thakar Markdown: https://magentlab.com/docs/thakar.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Thakar 2005 preoperative points for dialysis-requiring acute renal failure after open-heart surgery and return the integer score (max 17) and published category (0–2 / 3–5 / 6–8 / 9–13). ## When to use When an agent has caller-assigned sex, surgery type, preoperative creatinine, and the published boolean risk factors and needs the Thakar 2005 point total. Not a dialysis order. magent does not examine the patient. ## When not to use - Not a medical device and not a dialysis order. - Not AKIN or RIFLE staging of a current creatinine change. This is a preoperative score for dialysis-requiring ARF after open-heart surgery. - magent does not examine the patient. Sex, surgery type, CHF, LVEF <35%, preoperative IABP, COPD requiring medical therapy, insulin-requiring diabetes, previous cardiac surgery, and emergency surgery are caller-assigned. - Creatinine bands follow the Thakar 2005 scoring table: <1.2 mg/dL scores 0; 1.2 to <2.1 scores 2; >=2.1 scores 5. 2.0 mg/dL scores 2. magent does not assay creatinine. - Published categories are 0–2, 3–5, 6–8, and 9–13 (formed arbitrarily in the paper). Scores >=9 map to 9–13; the paper observed no patients above 13. Theoretical max is 17. ## Formula ``` Thakar 2005 = female(1) + congestive_heart_failure(1) + lvef_lt_35(1) + preoperative_iabp(2) + copd(1) + insulin_diabetes(1) + previous_cardiac_surgery(1) + emergency_surgery(2) + surgery_type(cabg 0, valve 1, cabg_valve 2, other 2) + creatinine_mg_dl(<1.2: 0, 1.2 to <2.1: 2, >=2.1: 5); max 17; categories 0-2 / 3-5 / 6-8 / 9-13 ``` ## Citation [A clinical score to predict acute renal failure after cardiac surgery](https://doi.org/10.1681/ASN.2004040331) Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP J Am Soc Nephrol. 2005;16(1):162-168 DOI: [10.1681/ASN.2004040331](https://doi.org/10.1681/ASN.2004040331) ## Worked example ### Male CABG, creatinine 1.0 mg/dL, no flags Given: `congestive_heart_failure=false, copd=false, creatinine_mg_dl=1.0, emergency_surgery=false, insulin_diabetes=false, lvef_lt_35=false, preoperative_iabp=false, previous_cardiac_surgery=false, sex=male, surgery_type=cabg` 1. Male 0; CABG-only 0; creatinine 1.0 <1.2 → 0; all flags false → 0 2. Score = 0 (max 17); thakar_category = 0_to_2 ### Female CABG+valve, creatinine 2.1, IABP, emergency Given: `congestive_heart_failure=false, copd=false, creatinine_mg_dl=2.1, emergency_surgery=true, insulin_diabetes=false, lvef_lt_35=false, preoperative_iabp=true, previous_cardiac_surgery=false, sex=female, surgery_type=cabg_valve` 1. Female +1; CABG+valve +2; creatinine 2.1 >=2.1 → +5; IABP +2; emergency +2 2. Score = 12 (max 17); thakar_category = 9_to_13 ## Also searched as - Thakar score - Thakar ARF score - cardiac surgery ARF score - Thakar 2005 - acute renal failure after cardiac surgery - dialysis risk after open-heart surgery - Thakar renal failure score ## Parameters - `sex` (string, required): female or male (Thakar 2005). Female scores 1. Male scores 0. Assigned by the caller. - `surgery_type` (string, required): cabg (CABG only, reference, 0), valve (valve only, +1), cabg_valve (CABG + valve, +2), or other (other cardiac surgeries such as ventricular aneurysm repair or pericardiectomy, +2). Thakar 2005. Assigned by the caller. - `creatinine_mg_dl` (number, optional): Preoperative serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l, not both. Thakar 2005 scoring table: <1.2 scores 0; 1.2 to <2.1 scores 2; >=2.1 scores 5. 2.0 mg/dL scores 2. magent does not assay creatinine. - `creatinine_umol_l` (number, optional): Preoperative serum creatinine in µmol/L (9-1768). Converted as mg/dL = µmol/L / 88.42. - `congestive_heart_failure` (boolean, required): Congestive heart failure as assigned by the caller (Thakar 2005). true scores 1. true or false. magent does not examine the patient. - `lvef_lt_35` (boolean, required): Left-ventricular ejection fraction <35% as assigned by the caller (Thakar 2005). true scores 1. Flag only; do not send an LVEF number. magent does not measure ejection fraction. - `preoperative_iabp` (boolean, required): Preoperative intra-aortic balloon pump as assigned by the caller (Thakar 2005). true scores 2. true or false. - `copd` (boolean, required): COPD requiring medical therapy as assigned by the caller (Thakar 2005). true scores 1. true or false. - `insulin_diabetes` (boolean, required): Insulin-requiring diabetes as assigned by the caller (Thakar 2005). true scores 1. true or false. - `previous_cardiac_surgery` (boolean, required): Previous cardiac surgery as assigned by the caller (Thakar 2005). true scores 1. true or false. - `emergency_surgery` (boolean, required): Emergency surgery as assigned by the caller (Thakar 2005). true scores 2. true or false. ## 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/thakar` 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": [ { "congestive_heart_failure": "false", "copd": "false", "creatinine_mg_dl": "1.0", "emergency_surgery": "false", "insulin_diabetes": "false", "lvef_lt_35": "false", "preoperative_iabp": "false", "previous_cardiac_surgery": "false", "sex": "male", "surgery_type": "cabg" }, { "congestive_heart_failure": "false", "copd": "false", "creatinine_mg_dl": "1.0", "emergency_surgery": "false", "insulin_diabetes": "false", "lvef_lt_35": "false", "preoperative_iabp": "false", "previous_cardiac_surgery": "false", "sex": "male", "surgery_type": "cabg" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/thakar Example 200: ```json { "count": 2, "path": "/api/calc/thakar", "items": [ { "components": [ { "factor": "female", "points": 0, "present": false }, { "factor": "congestive_heart_failure", "points": 0, "present": false }, { "factor": "lvef_lt_35", "points": 0, "present": false }, { "factor": "preoperative_iabp", "points": 0, "present": false }, { "factor": "copd", "points": 0, "present": false }, { "factor": "insulin_diabetes", "points": 0, "present": false }, { "factor": "previous_cardiac_surgery", "points": 0, "present": false }, { "factor": "emergency_surgery", "points": 0, "present": false }, { "value": "cabg", "factor": "surgery_type", "points": 0, "present": false }, { "value": 1.0, "factor": "creatinine_mg_dl", "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": "Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP", "doi": "10.1681/ASN.2004040331", "id": "thakar-2005", "pmid": "15563569", "source": "J Am Soc Nephrol. 2005;16(1):162-168", "title": "A clinical score to predict acute renal failure after cardiac surgery" }, "formula": "thakar", "formula_expression": "Thakar 2005 = female(1) + congestive_heart_failure(1) + lvef_lt_35(1) + preoperative_iabp(2) + copd(1) + insulin_diabetes(1) + previous_cardiac_surgery(1) + emergency_surgery(2) + surgery_type(cabg 0, valve 1, cabg_valve 2, other 2) + creatinine_mg_dl(<1.2: 0, 1.2 to <2.1: 2, >=2.1: 5); max 17; categories 0-2 / 3-5 / 6-8 / 9-13", "max_score": 17, "score": 0, "creatinine_mg_dl": 1.0, "sex": "male", "surgery_type": "cabg", "thakar_category": "0_to_2" }, { "components": [ { "factor": "female", "points": 0, "present": false }, { "factor": "congestive_heart_failure", "points": 0, "present": false }, { "factor": "lvef_lt_35", "points": 0, "present": false }, { "factor": "preoperative_iabp", "points": 0, "present": false }, { "factor": "copd", "points": 0, "present": false }, { "factor": "insulin_diabetes", "points": 0, "present": false }, { "factor": "previous_cardiac_surgery", "points": 0, "present": false }, { "factor": "emergency_surgery", "points": 0, "present": false }, { "value": "cabg", "factor": "surgery_type", "points": 0, "present": false }, { "value": 1.0, "factor": "creatinine_mg_dl", "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": "Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP", "doi": "10.1681/ASN.2004040331", "id": "thakar-2005", "pmid": "15563569", "source": "J Am Soc Nephrol. 2005;16(1):162-168", "title": "A clinical score to predict acute renal failure after cardiac surgery" }, "formula": "thakar", "formula_expression": "Thakar 2005 = female(1) + congestive_heart_failure(1) + lvef_lt_35(1) + preoperative_iabp(2) + copd(1) + insulin_diabetes(1) + previous_cardiac_surgery(1) + emergency_surgery(2) + surgery_type(cabg 0, valve 1, cabg_valve 2, other 2) + creatinine_mg_dl(<1.2: 0, 1.2 to <2.1: 2, >=2.1: 5); max 17; categories 0-2 / 3-5 / 6-8 / 9-13", "max_score": 17, "score": 0, "creatinine_mg_dl": 1.0, "sex": "male", "surgery_type": "cabg", "thakar_category": "0_to_2" } ] } ``` ## Response fields - `formula` (string): thakar - `formula_expression` (string): Thakar 2005 scoring-table integer expression - `score` (integer): Thakar points 0-17 - `max_score` (integer): 17 - `thakar_category` (string): Published Thakar 2005 risk category: 0_to_2, 3_to_5, 6_to_8, or 9_to_13. Scores >=9 map to 9_to_13. Not a dialysis order. - `sex` (string): female or male used - `surgery_type` (string): cabg, valve, cabg_valve, or other used - `creatinine_mg_dl` (number): Preoperative serum creatinine used in mg/dL (after conversion) - `components` (array): Per-factor Thakar 2005 points - `citation` (object): Thakar 2005 JASN citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "female", "points": 0, "present": false }, { "factor": "congestive_heart_failure", "points": 0, "present": false }, { "factor": "lvef_lt_35", "points": 0, "present": false }, { "factor": "preoperative_iabp", "points": 0, "present": false }, { "factor": "copd", "points": 0, "present": false }, { "factor": "insulin_diabetes", "points": 0, "present": false }, { "factor": "previous_cardiac_surgery", "points": 0, "present": false }, { "factor": "emergency_surgery", "points": 0, "present": false }, { "value": "cabg", "factor": "surgery_type", "points": 0, "present": false }, { "value": 1.0, "factor": "creatinine_mg_dl", "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": "Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP", "doi": "10.1681/ASN.2004040331", "id": "thakar-2005", "pmid": "15563569", "source": "J Am Soc Nephrol. 2005;16(1):162-168", "title": "A clinical score to predict acute renal failure after cardiac surgery" }, "formula": "thakar", "formula_expression": "Thakar 2005 = female(1) + congestive_heart_failure(1) + lvef_lt_35(1) + preoperative_iabp(2) + copd(1) + insulin_diabetes(1) + previous_cardiac_surgery(1) + emergency_surgery(2) + surgery_type(cabg 0, valve 1, cabg_valve 2, other 2) + creatinine_mg_dl(<1.2: 0, 1.2 to <2.1: 2, >=2.1: 5); max 17; categories 0-2 / 3-5 / 6-8 / 9-13", "max_score": 17, "score": 0, "creatinine_mg_dl": 1.0, "sex": "male", "surgery_type": "cabg", "thakar_category": "0_to_2" } ``` ## Errors - HTTP 400 `invalid_thakar_surgery`: surgery_type must be cabg, valve, cabg_valve, or other (Thakar 2005; CABG-only is the reference). Returned before settlement; you are not charged. - HTTP 400 `invalid_sex`: sex must be female or male 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_flag`: boolean clinical flags must be true or false 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 - [AKIN](https://magentlab.com/docs/akin) — Apply Mehta 2007 Table 2 AKIN staging and return stage 0-3 as the worse of the creatinine and urine-output limbs, with initiated renal replacement therapy mapping to stage 3. - [RIFLE](https://magentlab.com/docs/rifle) — Apply Bellomo 2004 Fig. 1 RIFLE classification and return the worse of the creatinine and urine-output limbs (none, risk, injury, failure), with persistent ARF beyond 4 weeks mapping to loss and ESRD beyond 3 months mapping to esrd. - [Mehran CIN risk score](https://magentlab.com/docs/mehran) — Sum the Mehran 2004 eGFR model B integer score for contrast-induced nephropathy after PCI and return low (≤5), moderate (6–10), high (11–15), or very_high (≥16) with the development-set CIN percent. ## 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.