Model for End-Stage Liver Disease (MELD) score

Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease

• initially developed to predict mortality within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure, and was subsequently found to be useful in determining prognosis and prioritizing for receipt of a liver transplant
  
  
• the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis
  • MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver transplantation
  • despite the many advantages of the MELD score, there are approximately 15%-20% of patients whose survival cannot be accurately predicted by the MELD score (1)
    
    
• 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

Calculation:

• 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:
  • MELD = 3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43
    
    
  • MELD scores are reported as whole numbers - the equation result is rounded
    
    
• UNOS has made the following modifications to the score:
  • if the patient has been dialyzed twice within the last 7 days, then the factor for serum creatinine used should be 4.0
  • any value less than one is given a value of 1 to prevent the occurrence of scores below 0 (because any positive value below 1 the natural logarithm would yield a negative result)

Interpretation:

• interpreting the MELD Score in hospitalized patients, the 3 month mortality was (2):
  • 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

Reference:

• Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007;45 (3): 797-805.
• Wiesner et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2002; 124 (1):91-6.