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model for end-stage liver disease score (MELD score)
Indications:
1) prognosis for post-TIPS patients
2) used to prioritize allocation of deceased donor livers for liver transplantation (UNOS) - MELD-sodium
Method: MELD =
3.8 x (Ln serum bilirubin in mg/dL) +
9.6 x (Ln serum creatinine in mg/dL) +
11.2 x (Ln INR) +
6.4
where Ln = natural logarithm (log e)
MELD-sodium score adds serum sodium giving score better predictive value [2]
- predicts 3 month mortality
- used for liver transplant allocation [2]
Interpretation:
MELD scores > 13 portend poor prognosis
MELD scores 15-23 are candidates for TIPS
MELD scores >= 15 should be referred to a transplantation center
MELD scores > 24 best treated with liver transplantation
MELD scores > 20 consider prednisolone [2]
Notes:
- since 2002, MELD has been used as basis for deceased donor liver allocation to determine a recipient's immediate need for liver transplantation.
General
numerical rating scale (NRS)
References
- UpToDate 14.1
http://www.utdol.com
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19
American College of Physicians, Philadelphia 2015, 2018, 2021,
- MELD score calculator
Mayo Clinic.
http://www.mayoclinic.org/meld/
- UNOS calculator
http://www.unos.org/resources/MELDPeldCalculator.asp?index=98
- MELD Calculator
US Dept of Health & Human Services
Organ Procurement and Transplantation Network.
https://optn.transplant.hrsa.gov/resources/allocation-calculators/meld-calculator