MELD and MELD-Na
Model for End-Stage Liver Disease
MELD-Na Score
Answer all questions to see the result
Dialysis
At least 2 dialysis treatments or at least 24 hours of continuous veno-venous hemodialysis within the prior 7 days
Serum creatinine
Total bilirubin
INR
Sodium
További információk
Figyelmeztetés
Ez az eszköz kizárólag oktatási célra szolgál, és nem jelent vagy helyettesít szakmai tanácsot. Az eszköz nem használható orvosi diagnózis felállítására és/vagy orvosi kezelés nyújtására.
General description
Estimating the severity of liver disease is important for predicting survival and assessing benefits and risks of specific therapies, including organ allocation for liver transplantation. Model for End-stage Liver Disease (MELD) was validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity.
MELD uses routinely measured laboratory variables (bilirubin, INR, creatinine) to determine the final score and estimate 3-month survival rate. However, it was subsequently recognized that sodium levels also significantly impact survival of patients with end-stage liver disease. Therefore, an improved version, which accounts for sodium level, named MELD-Na, was developed and subsequently validated in the Eurotransplant region.
The MELD score is endorsed by EASL Clinical Practice Guidelines on Liver Transplantation, but it does not accurately predict survival in all patients with cirrhosis; conditions such as hepatocellular carcinoma, hepatopulmonary syndrome, and portopulmonary hypertension, are associated with higher mortality rates.
Estimating the severity of liver disease is important for predicting survival and assessing benefits and risks of specific therapies, including organ allocation for liver transplantation. Model for End-stage Liver Disease (MELD) was validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity.
MELD uses routinely measured laboratory variables (bilirubin, INR, creatinine) to determine the final score and estimate 3-month survival rate. However, it was subsequently recognized that sodium levels also significantly impact survival of patients with end-stage liver disease. Therefore, an improved version, which accounts for sodium level, named MELD-Na, was developed and subsequently validated in the Eurotransplant region.
The MELD score is endorsed by EASL Clinical Practice Guidelines on Liver Transplantation, but it does not accurately predict survival in all patients with cirrhosis; conditions such as hepatocellular carcinoma, hepatopulmonary syndrome, and portopulmonary hypertension, are associated with higher mortality rates.
Result ranges for MELD
Estimated 3 month mortality: 1.9 %
≤ 9Estimated 3 month mortality: 6.0 %
10–19Estimated 3 month mortality: 19.6 %
20–29Estimated 3 month mortality: 52.6 %
30–39Estimated 3 month mortality: 71.3 %
≥ 40Result ranges for MELD-Na
Estimated 3 month mortality: 1 %
≤ 14Estimated 3 month mortality: 2 %
15–16Estimated 3 month mortality: 3 %
17–18Estimated 3 month mortality: 4 %
19–20Estimated 3 month mortality: 7 %
21–22Estimated 3 month mortality: 13 %
23–26Estimated 3 month mortality: 27–28 %
27–31Estimated 3 month mortality: 76–81 %
32–40Formula for MELD
MELD Score = 3.78 × ln(serum bilirubin [mg/dL]) + 11.2 × ln(INR) + 9.57 × ln(serum creatinine [mg/dL]) + 6.43
If the patient has been dialyzed at least twice within the last 7 days, the serum creatinine value used for calculation is 4.0 mg/dL.
For bilirubin [mg/dL], INR and creatinine [mg/dL] values of less than 1, the value of 1 is used for calculation to prevent occurrence of scores below 0 - as per the original algorithm.
Formula for MELD-Na
MELD-Na Score = MELD - Sodium - [0.025 x MELD x (140 - Sodium)] + 140
For sodium values below 125 mmol/L the number used in calculation is 125.
For sodium values above 140 mmol/L the number used in calculation is 140.
For sodium values above 140 mmol/L the number used in calculation is 140.
References
Kamath, P S et al. “A model to predict survival in patients with end-stage liver disease.” Hepatology (Baltimore, Md.) vol. 33,2 (2001): 464-70. doi:10.1053/jhep.2001.22172
Wiesner, Russell et al. “Model for end-stage liver disease (MELD) and allocation of donor livers.” Gastroenterology vol. 124,1 (2003): 91-6. doi:10.1053/gast.2003.50016
Kim, W Ray et al. “Hyponatremia and mortality among patients on the liver-transplant waiting list.” The New England journal of medicine vol. 359,10 (2008): 1018-26. doi:10.1056/NEJMoa0801209
Goudsmit, Ben F J et al. “Validation of the Model for End-stage Liver Disease sodium (MELD-Na) score in the Eurotransplant region.” American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons vol. 21,1 (2021): 229-240. doi:10.1111/ajt.16142
European Association for the Study of the Liver. “EASL Clinical Practice Guidelines: Liver transplantation.” Journal of hepatology vol. 64,2 (2016): 433-485. doi:10.1016/j.jhep.2015.10.006
Verzió
6
Az eszközről
Estimating the severity of liver disease is important for predicting survival and assessing benefits and risks of specific therapies, including organ allocation for liver transplantation. Model for End-stage Liver Disease (MELD) was validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity.
MELD uses routinely measured laboratory variables (bilirubin, INR, creatinine) to determine the final score and estimate 3-month survival rate. However, it was subsequently recognized that sodium levels also significantly impact survival of patients with end-stage liver disease. Therefore, an improved version, which accounts for sodium level, named MELD-Na, was developed and subsequently validated in the Eurotransplant region.
The MELD score is endorsed by EASL Clinical Practice Guidelines on Liver Transplantation, but it does not accurately predict survival in all patients with cirrhosis; conditions such as hepatocellular carcinoma, hepatopulmonary syndrome, and portopulmonary hypertension, are associated with higher mortality rates.
MELD uses routinely measured laboratory variables (bilirubin, INR, creatinine) to determine the final score and estimate 3-month survival rate. However, it was subsequently recognized that sodium levels also significantly impact survival of patients with end-stage liver disease. Therefore, an improved version, which accounts for sodium level, named MELD-Na, was developed and subsequently validated in the Eurotransplant region.
The MELD score is endorsed by EASL Clinical Practice Guidelines on Liver Transplantation, but it does not accurately predict survival in all patients with cirrhosis; conditions such as hepatocellular carcinoma, hepatopulmonary syndrome, and portopulmonary hypertension, are associated with higher mortality rates.
