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Model for End-Stage Liver Disease

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Title: Model for End-Stage Liver Disease  
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Subject: United Kingdom Model for End-Stage Liver Disease, Meld, Pyloromyotomy, Hill repair, Artificial extracorporeal liver support
Collection: Digestive System Procedures, Hepatology, Medical Scoring System
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Model for End-Stage Liver Disease

The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of Eurotransplant for prioritizing allocation of liver transplants instead of the older Child-Pugh score.[3][4]

Contents

  • Determination 1
  • Interpretation 2
  • History 3
  • See also 4
  • References 5
  • External links 6

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 positive value below 1 would yield a negative result)

The etiology of liver disease was subsequently removed from the model because it posed difficulties such as how to categorize patients with multiple causes of liver disease. Modification of the MELD score by excluding etiology of liver disease did not significantly affect the model's accuracy in predicting three-month survival.

Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is.

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 by Dr. Patrick Kamath, 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

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.  
  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.  
  3. ^ a b c d Kamath PS, Kim WR (March 2007). "The model for end-stage liver disease (MELD)". Hepatology 45 (3): 797–805.  
  4. ^ Jung GE, Encke J, Schmidt J, Rahmel A (February 2008). "Model for end-stage liver disease. New basis of allocation for liver transplantations". Chirurg (in German) 79 (2): 157–63.  
  5. ^ UNOS (2009-01-28). "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

  • Mobile friendly MELD score by MedWebApp
  • Model for End-Stage Liver Disease Calculator by MDCalc
  • Online calculator for MELD score/UNOS modification
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