Model for End-Stage Liver Disease

The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict death within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure,^[1] and was subsequently found to be useful in determining prognosis and prioritizing for receipt of a liver transplant.^[2][3] 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.^[3][4]

Determination

MELD uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. It is calculated according to the following formula:^[3]

MELD = 3.78[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.57[Ln serum creatinine (mg/dL)] + 6.43

UNOS has made the following modifications to the score:^[5]

• If the patient has been dialyzed twice within the last 7 days, then the value for serum creatinine used should be 4.0
• Any value less than one is given a value of 1 (i.e. if bilirubin is 0.8, a value of 1.0 is used) to prevent the occurrence of scores below 0 (the natural logarithm of 1 is 0, and any value below 1 would yield a negative result)

Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is.^{[citation needed]}

Interpretation

In interpreting the MELD Score in hospitalized patients, the 3 month mortality is: ^[6]

• 40 or more — 71.3% mortality
• 30–39 — 52.6% mortality
• 20–29 — 19.6% mortality
• 10–19 — 6.0% mortality
• <9 — 1.9% mortality

History

MELD was originally developed at the Mayo Clinic, and at that point was called the "Mayo End-stage Liver Disease" score. It was derived in a series of patients undergoing TIPS procedures. The original version also included a variable based on the underlying etiology (cause) of the liver disease.^[1] The score turned out to be predictive of prognosis in chronic liver disease in general, and–with some modifications–came to be applied as an objective tool in assigning need for a liver transplant. The etiology turned out to be relatively unimportant, and was also regarded as relatively subjective; it was therefore removed from the score.^[3]

See also

• Pediatric End-Stage Liver Disease
• Milan criteria

References

1. ^ ^{a b} Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (April 2000). "A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts". Hepatology 31 (4): 864–71. doi:10.1053/he.2000.5852. PMID 10733541. 
2. ^ Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR (2001). "A model to predict survival in patients with end-stage liver disease". Hepatology 33 (2): 464–70. doi:10.1053/jhep.2001.22172. PMID 11172350. 
3. ^ ^{a b c d} Kamath PS, Kim WR (March 2007). "The model for end-stage liver disease (MELD)". Hepatology 45 (3): 797–805. doi:10.1002/hep.21563. PMID 17326206. 
4. ^ Jung GE, Encke J, Schmidt J, Rahmel A (February 2008). "Model for end-stage liver disease. New basis of allocation for liver transplantations" (in German). Chirurg 79 (2): 157–63. doi:10.1007/s00104-008-1463-4. PMID 18214398. 
5. ^ UNOS (2009-01-28). "MELD/PELD calculator documentation" (PDF). http://www.unos.org/SharedContentDocuments/MELD_PELD_Calculator_Documentation.pdf. Retrieved 2010-02-21. 
6. ^ Wiesner et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology (2003) vol. 124 (1) pp. 91-6. PMID 12512033

External links

• Online calculator for MELD score/UNOS modification