MELD Score (Model For End-Stage Liver Disease)
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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.
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MELD score calculation
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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?
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Background Info
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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)
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References
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- 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. |
- 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. |
- 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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