From the Guidelines
The MELD score is a crucial tool for assessing the severity of chronic liver disease and prioritizing patients for liver transplantation, with a score of 15 or higher indicating a significant increase in three-month mortality risk without transplantation, as supported by the most recent and highest quality study 1.
Overview of MELD Score
The MELD score is a numerical scale that ranges from 6 (less ill) to 40 (gravely ill) and is calculated using three laboratory values: serum bilirubin, serum creatinine, and INR (International Normalized Ratio for prothrombin time). The formula is: MELD = 3.78 × ln(serum bilirubin) + 11.2 × ln(INR) + 9.57 × ln(serum creatinine) + 6.43.
Importance of MELD Score in Transplantation
Higher MELD scores indicate more severe disease and correlate with increased three-month mortality risk without transplantation. For example, a MELD score of 10-19 indicates approximately 6% three-month mortality, while scores above 40 suggest over 70% mortality risk.
Limitations and Considerations
The MELD score has several limitations, including not providing a prediction of mortality following liver transplantation except for those patients with very high MELD scores over 35 1. Additionally, the MELD score does not account for other important factors such as portal hypertension and hepatic encephalopathy.
Clinical Application
Healthcare providers use MELD scores not only for transplant allocation but also to guide treatment decisions and discuss prognosis with patients who have chronic liver disease. The MELD-Na score, an updated version that includes serum sodium, provides slightly better mortality prediction by accounting for hyponatremia, which is common in advanced cirrhosis and indicates poor prognosis 1.
Key Considerations for Patient Care
- A MELD score of 15 or higher is typically considered the minimal listing threshold for transplantation 1.
- Patients with MELD scores above 30 are at high risk of mortality and morbidity after transplantation and require careful consideration and management 1.
- The MELD score should be used in conjunction with other clinical assessments and laboratory tests to provide a comprehensive evaluation of a patient's condition.
From the Research
MELD Score Overview
- The Model for End-Stage Liver Disease (MELD) score is a marker of disease severity and mortality in persons with chronic alcoholic liver disease 2.
- The MELD score incorporates serum bilirubin, creatinine, and the international normalized ratio (INR) into a formula that provides a continuous variable that is a very accurate predictor of 90-day mortality in patients with cirrhosis 3.
- The MELD score is currently utilized in the United States to prioritize deceased donor organ allocation for patients listed for liver transplantation 3.
Predictive Ability of MELD Score
- The MELD score performs as well as the Discriminant Function (DF) in predicting mortality at 30 days in patients with alcoholic hepatitis 2.
- A MELD score of greater than 11, or the presence of both ascites and an elevated bilirubin greater than 8 mg/dL should prompt consideration of specific therapeutic interventions to reduce mortality 2.
- The MELD score does not predict outcomes of hepatitis B-induced acute-on-chronic liver failure in transplant recipients 4.
- On-treatment improvement of MELD score correlates with reduced risk of mortality and hepatic events in cirrhotic CHB patients 5.
- The MELD score is an independent prognostic factor of mortality in injured cirrhotic patients 6.
Clinical Applications of MELD Score
- The MELD score has proved to be an effective predictor of outcome in other situations, such as patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis 3.
- Several variations of the original MELD score, involving the addition of serum sodium or looking at the change in MELD over time, have been examined, and these may slightly improve its accuracy 3.
- The application of the MELD score in prioritizing patients for liver transplantation has been successful, but further studies and legislation are required to ensure a fair and equitable system 3.