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MELD Score (Model For End-Stage Liver Disease)


MELD Score (age 12 and older)


Equation:
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 )

MELD scores are reported as whole numbers, so the result of the equation above is rounded.



MELD score calculation


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


INR:  



Serum creatinine:


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.

This score is now used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants instead of the older Child-Pugh score. 

Any value less than one is given a value of 1 to prevent a negative value (logarithm of a number below one will be a negative number)

References

  1. 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]

    Abstract


    A recent mandate emphasizes severity of liver disease to determine priorities in allocating organs for liver transplantation and necessitates a disease severity index based on generalizable, verifiable, and easily obtained variables. The aim of the study was to examine the generalizability of a model previously created to estimate survival of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred to as "hospitalized" patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unselected patients from the 1980s with cirrhosis (referred to as "historical" patients). In these patients, the model's ability to classify patients according to their risk of death was examined using the concordance (c)-statistic. The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholestatic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for historical cirrhotic patients. Individual complications of portal hypertension had minimal impact on the model's prediction (range of improvement in c-statistic: <.01 for spontaneous bacterial peritonitis and variceal hemorrhage to ascites: 0.01-0.03). The MELD scale is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities.

  2. 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]

    Abstract


    The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver transplantation. Despite the many advantages of the MELD score, there are approximately 15%-20% of patients whose survival cannot be accurately predicted by the MELD score. It is possible that the addition of variables that are better determinants of liver and renal function may improve the predictive accuracy of the model. Efforts at further refinement and validation of the MELD score will continue.

  3. 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.

    Mortality data


    Three month mortality data was provided based on the Model for End-stage Liver Disease (MELD) score and the  Child-Turcotte-Pugh (CTP) score.

    3-Month Mortality  (MELD Score)
    Score     -    Mortality rate
    <9:    1.9%
    10  to  19:    6%
    20  to  29:  19.6%
    30  to  39:  52.6%
    40 or more: 71.3%




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