MELD Score: Difference between revisions
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The '''MELD | {{TOC|right}} | ||
The '''MELD Score''' ([[Model for End-Stage Liver Disease Score]]) can help predict mortality in patients with [[cirrhosis]] and end-stage liver disease. | |||
==Calculation== | ==Calculation== | ||
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:<math>\mbox{MELD}= 6.43 + 3.78 \times \mbox{ln} \left({\mbox{bilirubin mg/dL}}\right) + 9.57 \times \mbox{ln} \left({\mbox{creatinine mg/dl}}\right) + 11.2 \times \mbox{ln} \left({\mbox{INR}}\right)</math> | :<math>\mbox{MELD}= 6.43 + 3.78 \times \mbox{ln} \left({\mbox{bilirubin mg/dL}}\right) + 9.57 \times \mbox{ln} \left({\mbox{creatinine mg/dl}}\right) + 11.2 \times \mbox{ln} \left({\mbox{INR}}\right)</math> | ||
An [http:// | An [http://optn.transplant.hrsa.gov/resources/professionalResources.asp?index=8 online calculator] is available. | ||
Adding the serum sodium to the calculation may improve accuracy.<ref name="pmid18768945">{{cite journal |author=Kim WR, Biggins SW, Kremers WK, ''et al'' |title=Hyponatremia and mortality among patients on the liver-transplant waiting list |journal=N. Engl. J. Med. |volume=359 |issue=10 |pages=1018–26 |year=2008 |month=September |pmid=18768945 |doi=10.1056/NEJMoa0801209 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18768945&promo=ONFLNS19 |issn=}}</ref> | Adding the serum sodium to the calculation may improve accuracy.<ref name="pmid18768945">{{cite journal |author=Kim WR, Biggins SW, Kremers WK, ''et al'' |title=Hyponatremia and mortality among patients on the liver-transplant waiting list |journal=N. Engl. J. Med. |volume=359 |issue=10 |pages=1018–26 |year=2008 |month=September |pmid=18768945 |doi=10.1056/NEJMoa0801209 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18768945&promo=ONFLNS19 |issn=}}</ref> | ||
==Interpretation== | ==Interpretation== | ||
In | In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:<ref name="pmid11172350">{{cite journal |author=Kamath PS, Wiesner RH, Malinchoc M, ''et al'' |title=A model to predict survival in patients with end-stage liver disease |journal=Hepatology |volume=33 |issue=2 |pages=464–70 |year=2001 |pmid=11172350 |doi=10.1053/jhep.2001.22172}}</ref> | ||
* 40 or more - 100% mortality | * 40 or more - 100% mortality | ||
* 30-39 - 83% mortality | * 30-39 - 83% mortality | ||
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In [[preoperative care]], the [[MELD Score]] can help predict complications of surgery among patients with [[cirrhosis]].<ref name="pmid17408652">{{cite journal |author=Teh SH, Nagorney DM, Stevens SR, ''et al'' |title=Risk factors for mortality after surgery in patients with cirrhosis |journal=Gastroenterology |volume=132 |issue=4 |pages=1261–9 |year=2007 |month=April |pmid=17408652 |doi=10.1053/j.gastro.2007.01.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016-5085(07)00179-5 |issn=}}</ref> The MELD Score may <ref name="pmid15546574">{{cite journal |author=Farnsworth N, Fagan SP, Berger DH, Awad SS |title=Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients |journal=Am. J. Surg. |volume=188 |issue=5 |pages=580–3 |year=2004 |month=November |pmid=15546574 |doi=10.1016/j.amjsurg.2004.07.034 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9610(04)00367-8 |issn=}}</ref> or may not<ref name="pmid15290666">{{cite journal |author=Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD |title=Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=8 |pages=719–23 |year=2004 |month=August |pmid=15290666 |doi= |url= |issn=}}</ref> perform better than the [[Child-Pugh Score|Child-Turcotte-Pugh classification]]. | In [[preoperative care]], the [[MELD Score]] can help predict complications of surgery among patients with [[cirrhosis]].<ref name="pmid17408652">{{cite journal |author=Teh SH, Nagorney DM, Stevens SR, ''et al'' |title=Risk factors for mortality after surgery in patients with cirrhosis |journal=Gastroenterology |volume=132 |issue=4 |pages=1261–9 |year=2007 |month=April |pmid=17408652 |doi=10.1053/j.gastro.2007.01.040 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016-5085(07)00179-5 |issn=}}</ref> The MELD Score may <ref name="pmid15546574">{{cite journal |author=Farnsworth N, Fagan SP, Berger DH, Awad SS |title=Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients |journal=Am. J. Surg. |volume=188 |issue=5 |pages=580–3 |year=2004 |month=November |pmid=15546574 |doi=10.1016/j.amjsurg.2004.07.034 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9610(04)00367-8 |issn=}}</ref> or may not<ref name="pmid15290666">{{cite journal |author=Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD |title=Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=8 |pages=719–23 |year=2004 |month=August |pmid=15290666 |doi= |url= |issn=}}</ref> perform better than the [[Child-Pugh Score|Child-Turcotte-Pugh classification]]. | ||
==Variations== | |||
iMELD<ref name="pmid17663415">{{cite journal |author=Luca A, Angermayr B, Bertolini G, ''et al.'' |title=An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis |journal=Liver Transpl. |volume=13 |issue=8 |pages=1174–80 |year=2007 |month=August |pmid=17663415 |doi=10.1002/lt.21197 |url=http://dx.doi.org/10.1002/lt.21197 |issn=}}</ref> | |||
:<math>\mbox{iMELD}=\text{MELD} + 0.3 * \mbox{ age in years}\ - 0.7 * \mbox{sodium mEq/L} + 100</math> | |||
MELD-Na<ref name="pmid16697729">{{cite journal |author=Biggins SW, Kim WR, Terrault NA, ''et al.'' |title=Evidence-based incorporation of serum sodium concentration into MELD |journal=Gastroenterology |volume=130 |issue=6 |pages=1652–60 |year=2006 |month=May |pmid=16697729 |doi=10.1053/j.gastro.2006.02.010 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016-5085(06)00272-1 |issn=}}</ref> | |||
:<math>\mbox{MELD-Na}=\text{MELD} + 1.59 \left(135 - \text{sodium mEq/L}\right)</math> | |||
MESO (maximum and minimum values of sodium are 135 and 120 mEq/L)<ref name="pmid17403190">{{cite journal |author=Huo TI, Wang YW, Yang YY, ''et al.'' |title=Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis |journal=Liver Int. |volume=27 |issue=4 |pages=498–506 |year=2007 |month=May |pmid=17403190 |doi=10.1111/j.1478-3231.2007.01445.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1478-3223&date=2007&volume=27&issue=4&spage=498 |issn=}}</ref> | |||
:<math>\mbox{MESO}= \frac{\text{MELD}}{\text{sodium mEq/L}} \times 100</math> | |||
MELD-XI<ref name="pmid17154400">{{cite journal |author=Heuman DM, Mihas AA, Habib A, ''et al.'' |title=MELD-XI: a rational approach to "sickest first" liver transplantation in cirrhotic patients requiring anticoagulant therapy |journal=Liver Transpl. |volume=13 |issue=1 |pages=30–7 |year=2007 |month=January |pmid=17154400 |doi=10.1002/lt.20906 |url=http://dx.doi.org/10.1002/lt.20906 |issn=}}</ref> | |||
:<math>\mbox{MELD-XI}= 5.11 \times \ln \left( \text{bilirubinemia mg/dl}\right) + 11.76 \ln \left( \text{creatinine mg/dl}\right) + 9.44</math> | |||
==References== | ==References== | ||
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==External links== | ==External links== | ||
* [http://www.unos.org/resources/MeldPeldCalculator.asp?index=98 Online calculator] | * [http://www.unos.org/resources/MeldPeldCalculator.asp?index=98 Online calculator][[Category:Suggestion Bot Tag]] | ||
Latest revision as of 11:00, 14 September 2024
The MELD Score (Model for End-Stage Liver Disease Score) can help predict mortality in patients with cirrhosis and end-stage liver disease.
Calculation
The equation is:
An online calculator is available.
Adding the serum sodium to the calculation may improve accuracy.[1]
Interpretation
In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:[2]
- 40 or more - 100% mortality
- 30-39 - 83% mortality
- 20-29 - 76% mortality
- 10-19 - 27% mortality
- <10 - 4% mortality
The MELD has also been studied in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS).[3]
In preoperative care, the MELD Score can help predict complications of surgery among patients with cirrhosis.[4] The MELD Score may [5] or may not[6] perform better than the Child-Turcotte-Pugh classification.
Variations
iMELD[7]
MELD-Na[8]
MESO (maximum and minimum values of sodium are 135 and 120 mEq/L)[9]
MELD-XI[10]
References
- ↑ Kim WR, Biggins SW, Kremers WK, et al (September 2008). "Hyponatremia and mortality among patients on the liver-transplant waiting list". N. Engl. J. Med. 359 (10): 1018–26. DOI:10.1056/NEJMoa0801209. PMID 18768945. Research Blogging.
- ↑ Kamath PS, Wiesner RH, Malinchoc M, et al (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. Research Blogging.
- ↑ Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (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. Research Blogging.
- ↑ Teh SH, Nagorney DM, Stevens SR, et al (April 2007). "Risk factors for mortality after surgery in patients with cirrhosis". Gastroenterology 132 (4): 1261–9. DOI:10.1053/j.gastro.2007.01.040. PMID 17408652. Research Blogging.
- ↑ Farnsworth N, Fagan SP, Berger DH, Awad SS (November 2004). "Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients". Am. J. Surg. 188 (5): 580–3. DOI:10.1016/j.amjsurg.2004.07.034. PMID 15546574. Research Blogging.
- ↑ Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD (August 2004). "Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores". Clin. Gastroenterol. Hepatol. 2 (8): 719–23. PMID 15290666. [e]
- ↑ Luca A, Angermayr B, Bertolini G, et al. (August 2007). "An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis". Liver Transpl. 13 (8): 1174–80. DOI:10.1002/lt.21197. PMID 17663415. Research Blogging.
- ↑ Biggins SW, Kim WR, Terrault NA, et al. (May 2006). "Evidence-based incorporation of serum sodium concentration into MELD". Gastroenterology 130 (6): 1652–60. DOI:10.1053/j.gastro.2006.02.010. PMID 16697729. Research Blogging.
- ↑ Huo TI, Wang YW, Yang YY, et al. (May 2007). "Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis". Liver Int. 27 (4): 498–506. DOI:10.1111/j.1478-3231.2007.01445.x. PMID 17403190. Research Blogging.
- ↑ Heuman DM, Mihas AA, Habib A, et al. (January 2007). "MELD-XI: a rational approach to "sickest first" liver transplantation in cirrhotic patients requiring anticoagulant therapy". Liver Transpl. 13 (1): 30–7. DOI:10.1002/lt.20906. PMID 17154400. Research Blogging.