From the Guidelines
The MELD score is used to prioritize patients for liver transplantation by predicting their short-term mortality risk from liver disease, with a score above 15 generally warranting evaluation and scores above 30 indicating critical illness with high short-term mortality risk without transplantation. The MELD score is calculated using three laboratory values: serum bilirubin, serum creatinine, and INR (International Normalized Ratio for prothrombin time) 1. This scoring system has been shown to be effective in prioritizing patients for liver transplantation, as it relies on objective laboratory data rather than subjective clinical assessments, making it more equitable 1.
Key Points to Consider
- The MELD score ranges from 6 to 40, with higher scores indicating more severe disease and greater urgency for transplantation 1.
- MELD scores are regularly recalculated for patients on the transplant waiting list to ensure those with the highest risk of death receive priority 1.
- A MELD score above 14 is typically the minimal listing threshold for transplantation, and a score above 15 is considered a reasonable clinical trial endpoint for clinical trials intended to support drug approval 1.
- Patients with MELD scores above 30 are considered to be at high risk of mortality and morbidity after transplantation, and require careful consideration and management 1.
Clinical Implications
- Clinicians should use the MELD score to determine the appropriate timing for transplant referral, with scores above 15 generally warranting evaluation 1.
- The MELD score should be used in conjunction with other clinical factors to determine the priority of patients for liver transplantation, as it has several limitations and does not provide a prediction of mortality following transplantation except for those patients with very high MELD scores over 35 1.
From the Research
Overview 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. It is calculated based on three laboratory values:
- Serum bilirubin
- Serum creatinine
- International normalized ratio (INR)
Uses of MELD Score
The MELD score is used for several purposes, including:
- Predicting mortality in patients with cirrhosis 2, 3, 4
- Prioritizing allocation of deceased donor livers for liver transplantation 2, 3
- Assessing the risk of mortality after non-transplant surgery or transjugular intrahepatic portosystemic shunts (TIPS) 2, 3
- Evaluating the prognosis of patients with liver disease, including those with variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, and acute liver failure 2, 5
Limitations of MELD Score
The MELD score has some limitations, including:
- Failure to predict mortality in about 15% of patients with end-stage liver disease 2
- Limited accuracy in situations where the INR or creatinine may be elevated due to reasons other than liver disease 3
- Need for additional parameters, such as serum sodium level, serum albumin level, glucose intolerance, or APACHE II score, to improve prognostic accuracy 2, 6
Clinical Applications
The MELD score has been shown to be a useful tool in clinical practice, including: