MELD-Na Score (Model For End-Stage Liver Disease)

Background

MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin mg/dL) + 1.120 x Ln(INR) + 0.643 )

For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows:
MELD_Na = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]

Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.
Any value less than one is given a value of 1 to prevent a negative value.

MELD score calculation

Serum Total Bilirubin:
[Normal: < 1.2 mg/dL (0.1 -1.2 mg/dL)]

INR:

Serum creatinine:

Serum sodium: meq/L (mmol/L)

Has the patient had dialysis at least twice in the prior 7 days (or) received 24 hours of continuous veno-venous hemodialysis (CVVHD) within the prior 7 days?

Background Info

The Model for End-Stage Liver Disease (MELD) is a useful tool in predicting the probability of death from liver disease and how urgently an individual needs a liver transplant in the next three months. The MELD score is based on a patient’s serum creatinine, INR and bilirubin, as these were found to most accurately correlate with mortality within a three month period. The score ranges in value from 6 (lowest priority) to 40 (highest priority). Lab values must be updated according to the UNOS Recertification Schedule, otherwise patients will automatically revert to the previous MELD score.

MELD-Na Score (age 12 and older)

Important policy changes including 'Clerical Changes for Implementation of Adding Serum Sodium to the MELD Score'

https://optn.transplant.hrsa.gov/media/1575/policynotice_20151101.pdf

United Network for Organ Sharing proposed that MELD-Na score (an extension of MELD) may better rank candidates based on their risk of pre-transplant mortality and is projected to save 50-60 lives total per year.

References

Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70. [Pubmed]
Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007 Mar;45(3):797-805. [Pubmed]
Wiesner, Russell; Edwards, Erick; Freeman, Richard; Harper, Ann; Kim, Ray; Kamath, Patrick; Kremers, Walter; Lake, John; Howard, Todd; Merion, Robert M; Wolfe, Robert A; Krom, Ruud; United Network for Organ Sharing Liver Disease Severity Score Committee (2003). "Model for end-stage liver disease (MELD) and allocation of donor livers". Gastroenterology. 124 (1): 91-6.

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