ACEF and ACEF II (Cardiac Surgery Mortality Risk)
The ACEF and ACEF II RISK SCORES for cardiac surgery (Ranucci and colleagues 2009 and 2018), both returned from the same inputs.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Age
- 70 years
- Left ventricular ejection fraction
- 35 %
- Serum creatinine
- 2.5 mg/dL
- Emergency surgery
- Yes
- Hematocrit
- 26 %
Result: 9
The tool opens with these values already filled in. Replace them with your own.
What the result means
- ACEF
- age / ejection fraction + 1 if creatinine above 2.0 mg/dL. Derived in ELECTIVE cardiac surgery.
- ACEF II
- Same ratio + 2 for that creatinine + 3 for emergency surgery + 0.2 per hematocrit point below 36.
- No maximum
- A RATIO, not a sum of points. There is no ceiling and no "x of y" - do not invent bands.
- Nonlinear
- Ejection fraction is a DENOMINATOR: halving it DOUBLES the score. At 70, EF 30 gives 2.33 and EF 60 gives 1.17.
- Creatinine
- The weight DOUBLES between versions (1 vs 2). A value cannot be carried between them.
- Operator
- Renderings of the original differ at EXACTLY 2.0 ("or more" vs "above"). ACEF II is consistently "above", applied to both.
- Hematocrit
- CONTINUOUS and ONE-SIDED: nothing above 36; a hematocrit of 26 adds 2.0, as much as the creatinine term.
- Emergency
- ACEF II only, worth 3 - the largest single add-on. The original has NO emergency term.
- Scope
- Group-level preoperative mortality. Does not decide whether to operate; a high score is NOT a reason to decline surgery.
What you enter
- Age.
- Left ventricular ejection fraction.
- Serum creatinine.
- Emergency surgery.
- Hematocrit.
Full field descriptions
- Age. The NUMERATOR of the ratio.
- Left ventricular ejection fraction. THE DENOMINATOR, not a scored item: halving it doubles the score.
- Serum creatinine. Above 2 adds 1 to ACEF and 2 to ACEF II. Exactly 2 is the one value where published renderings disagree.
- Emergency surgery. Adds 3 to ACEF II ONLY - the original has no emergency term and was derived in elective surgery.
- Hematocrit. ACEF II adds 0.2 for EACH point below 36 and nothing above it. Continuous, not a threshold flag.
How this is calculated
Ranucci M, Castelvecchio S, Menicanti L, et al. Circulation. 2009;119(24):3053-3061. ACEF II from Ranucci M, Pistuddi V, Scolletta S, et al. Eur J Cardiothorac Surg. 2018;53(5):1064-1071. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.