The MELD score (Model for End-stage Liver Disease) is a classification used to grade liver dysfunction in preparation for liver transplantation. The score has prognostic value in terms of three month mortality and certain complications.
The components of the score are:
- serum creatinine (mg/dl)
- if dialysis twice in last week, then creatinine is given a value of 4 mg/dl
- total bilirubin (mg/dl)
These variables are used to calculate the score 2:
MELD = (0.957 x ln [Cr]) + (0.378 x ln [bilirubin]) + (1.120 x ln [INR]) + 0.643
(ln = log to the base of e, loge)
Scores are used to prioritize liver transplantation:
- >15: may benefit from liver transplantation
Certain clinical situations lead to automatic increases in the MELD score in an attempt to increase or decrease waiting times on a liver transplant waiting list:
- hepatocellular carcinoma: +22 points
- hepatopulmonary syndrome
- familial amyloidosis
- primary oxaluria (pediatric patients)
Use of the MELD score to prioritize transplants has lead to a decreased rate of pretransplant death for those on the waiting list, but use of the score causes some controversy because it does not indicate survival benefit of transplantation.
Patients with acute liver failure are given a distinction called "status 1," which supersedes MELD scores in terms of transplantation prioritization.
The PELD score is used for patients younger than 12 years of age.
- 1. Current Surgical Therapy: Expert Consult - Online and Print, 11e (Current Therapy). Saunders. ISBN:1455740071. Read it at Google Books - Find it at Amazon
- 2. Jr CMT, Beauchamp RD, Evers BM et-al. Sabiston Textbook of Surgery. Saunders. ISBN:1437715605. Read it at Google Books - Find it at Amazon
- 3. Thiago Gomes Romano, Ivana Schmidtbauer, Fernanda Maria de Queiroz Silva, Carlos Eduardo Pompilio, Luiz Augusto Carneiro D'Albuquerque, Etienne Macedo. Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation. (2013) PLOS ONE. 8 (5): e64089. doi:10.1371/journal.pone.0064089 - Pubmed