MELD score

The MELD score (Model for End-stage Liver Disease) is a classification used to grade chronic liver disease in preparation for liver transplantation in adults. The score has prognostic value in terms of three-month mortality.

The components of the MELD score are:

• serum creatinine (mg/dL)

  • if dialysis twice in the last week, then creatinine is given a value of 4 mg/dL

• total bilirubin (mg/dL)

• INR

These variables are used to calculate the score with the following formula 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, log_e)

Usage

Three-month mortality of patients with chronic liver disease per MELD score is as follows:

• 40 or more: 71.3% mortality

• 30-39: 52.6% mortality

• 20-29: 6% mortality

• 9 or less: 1.95 mortality

Scores are used to prioritize liver transplantation; for example a score of >15 may benefit from liver transplantation ⁴.

Exception categories exist in which certain clinical conditions lead to automatic increases in the MELD score in an attempt to increase or decrease waiting times on a liver transplant waiting list ⁵. Such conditions include ^5,7:

• hepatocellular carcinoma

• hepatopulmonary syndrome

• familial amyloidosis

• primary oxaluria

Practical points

• the MELD score is not used for patients with acute liver failure as they are rather given a "status 1" distinction (due to imminent death), which supersedes MELD scores in terms of transplantation prioritisation ⁹

• 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 ⁴

• the Paediatric End-stage Liver Disease (PELD score) is used for patients younger than 12 years of age ⁹

• while the MELD score may be used to rank cirrhotics according to short term mortality, survival is not accurately predicted in 15-20% of patients ⁸

History and etymology

The MELD score was originally developed to predict three month mortality in patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) ⁶. The acronym originally stood for "Mayo End-stage Liver Disease" ¹⁰.

See also

• Child-Pugh score