From the Guidelines
To interpret a MELD score, a score above 14 is typically considered the minimal listing threshold for liver transplantation, as it indicates a higher risk of decompensation and liver-related clinical outcomes 1. When interpreting MELD scores, it's essential to consider the following key points:
- A MELD score above 10 indicates a higher risk of decompensation and liver-related clinical outcomes, with scores above 14 being a critical threshold for transplantation consideration 1.
- The MELD score is a strong predictor of short-term (3-month) mortality risk in patients with decompensated cirrhosis, with higher scores indicating greater mortality risk 1.
- For clinical decision-making, patients with MELD scores above 15 should be considered for transplant evaluation, as this score indicates a significant increase in mortality risk and potential need for transplantation 1.
- The MELD score is calculated using three laboratory values: serum bilirubin, serum creatinine, and INR (International Normalized Ratio), providing an objective quantification of liver dysfunction.
- Regular recalculation of the MELD score (every 3 months for stable patients, more frequently for deteriorating patients) is crucial, as disease progression can change transplant priority status.
- A MELD score of 15 or higher with a minimal 2-point change from baseline can establish a link to "need for transplant" and "mortality" in patients with cirrhosis, making it a potentially reasonable clinical trial endpoint 1.
From the Research
MELD Score Interpretation
The Model for End-Stage Liver Disease (MELD) score is a measure of chronic liver disease severity, used to assess patients awaiting liver transplantation 2. The score incorporates three laboratory parameters: serum creatinine, serum bilirubin, and international normalized ratio (INR) for prothrombin time 3.
Strengths of MELD Score
- The MELD score has been shown to be an effective tool for prioritizing patients for liver transplantation, with a high accuracy in stratifying patients according to their risk of dying in the short-term 3.
- The score has led to a reduction in waitlist mortality, shorter waiting times, and an increase in transplants, without altering overall graft and patient survival rates after transplantation 3.
- The MELD score is simple, objective, and continuous, making it a reliable tool for assessing liver disease severity 4.
Weaknesses of MELD Score
- The score has limitations, including inter-laboratory variability of the parameters included in the score, and the inability to predict mortality accurately in specific settings 3.
- The MELD score does not take into account certain variables associated with poor short-term prognosis in cirrhotic patients, such as persistent ascites and hyponatremia 4.
- The score is currently capped at 40, which can result in the exclusion of sicker patients who could benefit from transplantation 4.
Predictors of Mortality
- Studies have identified several predictors of mortality in patients with high MELD scores, including refractory ascites, alcoholic cirrhosis, and variceal bleeding 2.
- The development of hepatic encephalopathy has also been associated with increased mortality in patients with high MELD scores 2.
- High MELD scores have been shown to confer a risk of graft failure in living donor liver transplantation (LDLT), although outcomes are still acceptable with proper management 5.
Alternative Scoring Systems
- The MELD-eXcluding INR (MELD-XI) scoring system has been proposed as an alternative to the traditional MELD score, particularly for patients on oral anti-coagulation 6.
- The MELD-XI score has been shown to be a viable alternative for assessing liver dysfunction in heart failure patients, with a higher predictive power than the traditional MELD score 6.