Gastroenterology Book

//fpnotebook.com/

MELD Score

Aka: MELD Score, Model for End-Stage Liver Disease
  1. Indications
    1. Cirrhosis Prognosis
    2. Liver Transplantation Evaluation
  2. Contraindications
    1. Age <12 years old
  3. 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)
  4. 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
  5. 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
  6. 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]
  7. 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

Model for end-stage liver disease score:Finding:Point in time:^Patient:Quantitative (C1715987)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree