What is the Melsec (Medical Score or Assessment Tool)?

From the Guidelines

The MELD score, not Melsec, is a widely used scoring system to assess the severity of liver disease. It ranges from 6 to 40, with higher scores indicating more severe disease. The score is calculated based on three laboratory values: bilirubin, creatinine, and international normalized ratio (INR) 1. A MELD score of 15 or higher indicates a high risk of mortality within 90 days and prioritizes liver transplant listing 1.

Key Points

• The MELD score is a numerical scale used to evaluate hepatic reserve 1
• It is derived using 3 laboratory values: serum bilirubin, creatinine, and international normalized ratio 1
• The score ranges from 6 (less ill) to 40 (gravely ill) for individuals 12 years or older 1
• A MELD score of 15 or higher indicates a high risk of mortality within 90 days and prioritizes liver transplant listing 1
• The MELD score has been adopted by the United Network for Organ Sharing (UNOS) to stratify patients on the liver transplantation waiting list according to their risk of death within 3 months 1

Calculation and Interpretation

The MELD score is calculated using a logarithmic assessment of three objective and reproducible variables, namely total serum bilirubin and creatinine concentrations, and the international normalized ratio 1. The score may range from as low as 6 to a high capped at 40 1.

Clinical Application

The MELD score is used to estimate an individual’s mortality risk from liver disease and its complications during the next 90 days: the higher the score, the greater the risk of death 1. A MELD score of 15–17 is significant in that this is the point at which the mortality risk associated with liver disease and its complications is equivalent to the 1-year mortality associated with complications arising from liver transplantation 1.

From the Research

Definition and Purpose of MELD Score

• The Model for End-Stage Liver Disease (MELD) score is a numerical scale used to estimate the severity of liver disease in patients [(2,3,4)].
• The MELD score is calculated based on three laboratory parameters: serum creatinine, serum total bilirubin, and international normalized ratio (INR) for prothrombin time [(2,5,4)].
• The primary purpose of the MELD score is to prioritize patients for liver transplantation based on their disease severity, rather than waiting time [(2,4)].

Components and Variability of MELD Score

• The MELD score incorporates three simple laboratory parameters, which can be subject to inter-laboratory variability 5.
• The variability in INR measurements has been found to be a significant contributor to the overall variability in MELD scores 5.
• The MELD score has been shown to be useful in predicting mortality in patients with compensated and decompensated cirrhosis [(2,3)].

Applications and Limitations of MELD Score

• The MELD score has been widely used to prioritize patients for liver transplantation and has been shown to be an effective predictor of short-term mortality [(2,3,4)].
• The MELD score has limitations, including inter-laboratory variability and the inability to predict mortality accurately in specific settings, such as hepatocellular carcinoma 4.
• Attempts have been made to improve the MELD score's predicting power, including the development of MELD-Na, which incorporates sodium levels into the score 6.