The Model for End-Stage Liver Disease (MELD) can be used to evaluate short term survival in an adult with end-stage liver disease. This can help stratify candidates for liver transplantation. The original authors are from the Mayo Clinic, Beth Israel Deaconess Medical Center, University of Minnesota and Rotterdam University Hospital.
Parameters:
(1) serum creatinine in mg/dL
(2) serum total bilirubin in mg/dL
(3) international normalized ratio (INR) for the prothrombin time
(4) cause of the cirrhosis (see table below)
|
Cause of Cirrhosis
|
Points
|
|
cholestatic (PBC, etc.)
|
0
|
|
alcoholic
|
0
|
|
other
|
1
|
The parameters are measured at the time of "initial presentation".
original MELD score =
= (0.957 * LN (serum creatinine)) + (0.378 * LN(serum bilirubin)) + (1.12 * LN(INR)) + (0.643 * (points for cause))
probability for survival over a time interval t =
= S0(t) ^ (EXP((MELD) – 1.127))
where:
• 1.127 was the MELD score for the average patient (from page 867, Malinchoc et al)
|
time interval in days
|
S0(t)
|
|
1
|
0.990
|
|
7
|
0.966
|
|
30
|
0.860
|
|
90
|
0.707
|
|
183 (6 months)
|
0.621
|
|
365
|
0.551
|
|
730 (2 years)
|
0.428
|
from Table 5, page 868, Malinchoc et al (2000)
Kamath et al (2001) modified the original score by multiplying the original factors by 10.
modified MELD score =
= 10 * (original MELD score)
|
|
3 Month Mortality Rate
|
|
Modified MELD
|
Hospitalized
|
Ambulatory Noncholestatic
|
Ambulatory PBC
|
|
<= 9
|
4%
|
2%
|
1%
|
|
10 – 19
|
27%
|
5.6%
|
13%
|
|
20 – 29
|
76%
|
50%
|
0%
|
|
30 – 39
|
83%
|
NA
|
NA
|
|
>= 40
|
100%
|
NA
|
NA
|
from Table 3, page 467, Kamath et al (2001)
According to Heuman et al, UNOS made the additional modifications to MELD on 02/27/2002 (in addition to the changes proposed by Kamath et al):
(1) minimum values for bilirubin, creatinine and INR were set to 0
(2) maximum serum creatinine is 4 = MIN(4,creatinine)
(3) serum creatinine is set to 4 if the patient was hemodialyzed 3 or more times in the preceding week
(4) points for cause of cirrhosis was set to 1 for all patients
(5) scores are rounded to the nearest whole number
