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 developed to predict death within three months of surgery in patients that had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure.^[1]

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 system. T stands for the local extent of the tumor, N stands for the presence or absence of lymph node metastases, and M stands for the presence or absence of distant metastasis (tumor spread to another organ such as the lung in the case of liver cancer).

Contents 1 Interpretation 2 References 3 Notes 4 See also 5 External links

[edit] Interpretation

In interpreting 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] Notes

1. ^ 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. 

[edit] See also

• Pediatric End-Stage Liver Disease
• Saab S, Landaverde C, Ibrahim AB, Durazo F, Han S, Yersiz H, Farmer DG, Ghobrial RM, Goldstein LI, Tong MJ, Busuttil RW. The MELD score in advanced liver disease: association with clinical portal hypertension and mortality. Exp Clin Transplant. 2006 Jun;4(1):395-9. PMID: 16827633 [PubMed - indexed for MEDLINE]

• Saab S, Ibrahim AB, Shpaner A, Younossi ZM, Lee C, Durazo F, Han S, Esrason K, Wu V, Hiatt J, Farmer DG, Ghobrial RM, Holt C, Yersiz H, Goldstein LI, Tong MJ, Busuttil RW. MELD fails to measure quality of life in liver transplant candidates. Liver Transpl. 2005 Feb;11(2):218-23. PMID: 15666392 [PubMed - indexed for MEDLINE]

• Saab S, Wang V, Ibrahim AB, Durazo F, Han S, Farmer DG, Yersiz H, Morrisey M, Goldstein LI, Ghobrial RM, Busuttil RW. MELD score predicts 1-year patient survival post-orthotopic liver transplantation. Liver Transpl. 2003 May;9(5):473-6. PMID: 12740789 [PubMed - indexed for MEDLINE]

[edit] External links

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