Model for End-Stage Liver Disease

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The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially described by Kamath et al in 2001 and modified by Wiesner et al, also in 2001.

It uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. This score is also used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants.

It is calculated according to the following formula:

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

Caveats with the score include:^{[citation needed]}

• The maximum score given for MELD is 40. All values higher than 40 are given a score of 40
• 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).

Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is. This staging system is known as the TNM. T stands for the extent of the tumor, N stands for the presence or absence of lymph nodes, and M stands for the presence or absence of metastasis (tumor spread to another organ such as the lung in the case of liver cancer).

Contents 1 Interpretation 2 References 3 See also 4 External links

[edit] Interpretation

In interpeting the MELD Score in hospitalized patients, the 3 month mortality is:

• 40 or more - 100% mortality
• 30-39 - 83% mortality
• 20-29 - 76% mortality
• 10-19 - 27% mortality
• <10 - 4% mortality

[edit] References

• 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. 
• Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, Krom RA, Kim WR (2001). "MELD and PELD: application of survival models to liver allocation". Liver Transpl 7 (7): 567–80. doi:10.1053/jlts.2001.25879. PMID 11460223. 
• Melissa Palmer, MD ," Dr. Melissa Palmer's Guide of Hepatitis and Liver Disease". (Published 2004. Penguin Putnam).
• More information about the MELD/PELD calculation, UNOS [1]

[edit] See also

• Pediatric End-Stage Liver Disease

[edit] External links

Online calculator for MELD score/UNOS modification: [2]