MELD Score

Aka: MELD Score, Model for End-Stage Liver Disease

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II. Indications

  1. Cirrhosis Prognosis
  2. Liver Transplantation Evaluation

III. Contraindications

  1. Age <12 years old

IV. Criteria

  1. Original
    1. Serum Bilirubin
    2. INR
    3. Serum Creatinine
    4. Cirrhosis Etiology
      1. Alcohol or Cholestasis: 0
      2. Other etiologies: 1
  2. Revisions
    1. Serum Sodium (sNa, added in 2015, to adjust MELD Scores >11)

V. Protocol: Revised MELD with Sodium

  1. Initial MELD (MELDi) = 0.957 × (Ln sCr) + 0.378 × (Ln sBili) + 1.120 × (Ln INR) + 0.643 x (etiology)
    1. Multiply Initial MELD by 10, and round to nearest whole number
  2. Adjusted MELD = MELDi + 1.32 x deltaNa - (0.033 x MELDi x deltaNa)
    1. Indicated if MELDi >11 (perform adjusted calculation with Serum Sodium)
  3. Where
    1. Ln is natural logorithm
    2. sCr = Serum Creatinine (in mg/dl)
      1. Use sCr = 4 mg/dl if >4 mg/dl, or dialyzed at least twice or continuous 24 hour Dialysis in last 7 days
    3. sBili = Total Serum Bilirubin (in mg/dl)
    4. etiology = 1 if non-Alcohol, non-cholestasis cause of Cirrhosis (otherwise 0)
    5. sNa = Serum Sodium
      1. Round Sodium value to range 125 to 137 mmol/L
    6. deltaNa = Delta Sodium = 137 - sNa

VI. Protocol: Modifiers

  1. Increment each automatic MELD Score below by 10% for every 3 months from time of diagnosis
  2. Conditions that are automatically assigned a MELD Score 22
    1. Hepatocellular Carcinoma without vascular invasion or extrahepatic disease
      1. One lesion 2 to 5 cm
      2. Two to three lesions <3 cm
    2. Hepatopulmonary Syndrome
      1. PaO2 <60 mmHg on room air
    3. Portopulmonary Hypertension
      1. Mean Pulmonary Artery Pressure >25 mmHg at rest (<35 mmHg with treatment)
    4. Hepatic Artery Thrombosis following Liver Transplant (within first 7-14 days)
    5. Familial Amyloid Polyneuropathy
      1. Transthyretin gene mutation and biopsy with amyloid deposition
    6. Cystic Fibrosis
      1. FEV1 <40%
    7. Hilar Cholangiocarcinoma
  3. Conditions that are automatically assigned a MELD Score of 28
    1. Primary Hyperoxaluria
      1. Alanine glyoxylate Aminotransferase deficiency

VII. Interpretation: Postoperative Mortality for patients with Cirrhosis (based on original MELD Score without Sodium)

  1. Score 0-5
    1. Mortality at 7 days: 0.6%
    2. Mortality at 30 days: 3.2%
    3. Mortality at 90 days: 7.1%
  2. Score 6-10
    1. Mortality at 7 days: 2.8%
    2. Mortality at 30 days: 8.6%
    3. Mortality at 90 days: 13.9%
  3. Score 11-15
    1. Mortality at 7 days: 7.2%
    2. Mortality at 30 days: 21.9%
    3. Mortality at 90 days: 30.6%
  4. Score 16-20
    1. Mortality at 7 days: 14.6%
    2. Mortality at 30 days: 44.0%
    3. Mortality at 90 days: 55.8%
  5. Score 21-25
    1. Mortality at 7 days: 22.2%
    2. Mortality at 30 days: 55.6%
    3. Mortality at 90 days: 66.7%
  6. Score >26
    1. Mortality at 7 days: 25.0%
    2. Mortality at 30 days: 87.5%
    3. Mortality at 90 days: 87.5%
  7. References
    1. Teh (2007) Gastroenterology [PubMed]

VIII. Resources

  1. MELD Score (MDCalc)
    1. https://www.mdcalc.com/meld-score-model-end-stage-liver-disease-12-older
  2. United Network of Organ Sharing (UNOS)
    1. https://optn.transplant.hrsa.gov/media/1575/policynotice_20151101.pdf

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