II. Indications
- Cirrhosis Prognosis
- Liver Transplantation Evaluation
III. Contraindications
- Age <12 years old
IV. Criteria
- Original
- Serum Bilirubin
- INR
- Serum Creatinine
- Cirrhosis Etiology
- Alcohol or Cholestasis: 0
- Other etiologies: 1
- Revisions
- Serum Sodium (sNa, added in 2015, to adjust MELD Scores >11)
V. Protocol: Revised MELD with Sodium
- Initial MELD (MELDi) = 0.957 × (Ln sCr) + 0.378 × (Ln sBili) + 1.120 × (Ln INR) + 0.643 x (etiology)
- Multiply Initial MELD by 10, and round to nearest whole number
- Adjusted MELD = MELDi + 1.32 x deltaNa - (0.033 x MELDi x deltaNa)
- Indicated if MELDi >11 (perform adjusted calculation with Serum Sodium)
- Where
- Ln is natural logorithm
- sCr = Serum Creatinine (in mg/dl)
- Use sCr = 4 mg/dl if >4 mg/dl, or dialyzed at least twice or continuous 24 hour Dialysis in last 7 days
- sBili = Total Serum Bilirubin (in mg/dl)
- etiology = 1 if non-Alcohol, non-cholestasis cause of Cirrhosis (otherwise 0)
- sNa = Serum Sodium
- Round Sodium value to range 125 to 137 mmol/L
- deltaNa = Delta Sodium = 137 - sNa
VI. Protocol: Modifiers
- Increment each automatic MELD Score below by 10% for every 3 months from time of diagnosis
- Conditions that are automatically assigned a MELD Score 22
- Hepatocellular Carcinoma without vascular invasion or extrahepatic disease
- One lesion 2 to 5 cm
- Two to three lesions <3 cm
- Hepatopulmonary Syndrome
- PaO2 <60 mmHg on room air
- Portopulmonary Hypertension
- Mean Pulmonary Artery Pressure >25 mmHg at rest (<35 mmHg with treatment)
- Hepatic Artery Thrombosis following liver transplant (within first 7-14 days)
- Familial Amyloid Polyneuropathy
- Transthyretin gene mutation and biopsy with amyloid deposition
- Cystic Fibrosis
- FEV1 <40%
- Hilar Cholangiocarcinoma
- Hepatocellular Carcinoma without vascular invasion or extrahepatic disease
- Conditions that are automatically assigned a MELD Score of 28
- Primary Hyperoxaluria
- Alanine glyoxylate Aminotransferase deficiency
- Primary Hyperoxaluria
VII. Interpretation: Postoperative Mortality for patients with Cirrhosis (based on original MELD Score without Sodium)
- Score 0-5
- Mortality at 7 days: 0.6%
- Mortality at 30 days: 3.2%
- Mortality at 90 days: 7.1%
- Score 6-10
- Mortality at 7 days: 2.8%
- Mortality at 30 days: 8.6%
- Mortality at 90 days: 13.9%
- Score 11-15
- Mortality at 7 days: 7.2%
- Mortality at 30 days: 21.9%
- Mortality at 90 days: 30.6%
- Score 16-20
- Mortality at 7 days: 14.6%
- Mortality at 30 days: 44.0%
- Mortality at 90 days: 55.8%
- Score 21-25
- Mortality at 7 days: 22.2%
- Mortality at 30 days: 55.6%
- Mortality at 90 days: 66.7%
- Score >26
- Mortality at 7 days: 25.0%
- Mortality at 30 days: 87.5%
- Mortality at 90 days: 87.5%
- References
VIII. Resources
- MELD Score (MDCalc)
- United Network of Organ Sharing (UNOS)
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Clinical Attribute (T201) |
| LNC | 44760-7 |
| English | Model for end-stage liver disease score:Finding:Point in time:^Patient:Quantitative, Model for end-stage liver disease score:Find:Pt:^Patient:Qn, Model for end-stage liver disease score, MELD score Qn |
