Calculating the model for end-stage liver disease (MELD) final result.

Liver diseases are the eleventh leading explanation for death worldwide (Cheemerla and Balakrishnan, 2021). Chronic liver disease (CLD), which affects roughly 1.5 billion people worldwide, is usually brought on by non-alcoholic fatty liver disease (NAFLD), hepatitis B virus (HBV), hepatitis C virus (HCV), or alcohol-related disease liver disease (ALD). The progression of liver disease to cirrhosis or liver fibrosis is irreversible in advanced stages; the one treatment option at this stage is liver transplantation. In 2021, over 34,000 liver transplants were performed worldwide, of which roughly 9,400 were performed within the USA (Terrault et al., 2023). With demand for transplants high and donor numbers low, doctors must make difficult decisions about how best to allocate life-saving organs.

Model for end-stage liver disease (MELD) scoring.

The Model for End-Stage Liver Disease (MELD) scoring is a tool that was originally developed to predict three-month mortality after transjugular intrahepatic portosystemic shunt (TIPS) placement, a procedure performed to treat advanced liver disease. The result includes laboratory values ​​indicating liver and kidney function.

• Serum bilirubin: how effectively the liver excretes bile.
• International normalized ratio (INR) for prothrombin time: how well the liver can produce clotting aspects.
• Serum creatinine: the flexibility of the kidneys to filter creatinine from the bloodstream.

Initial scoring included etiology of liver disease; nonetheless, this was removed since it was difficult to categorize patients with multiple causes of the disorder. The researchers found that the rating could accurately predict patient survival after TIPS. Subsequently, it was applied to a broader group of patients over the age of 12 years, and in 2002 the tool was adopted by the United Network for Organ Sharing (UNOS) to estimate the severity of CLD, predict short-term survival of patients with cirrhosis, and help prioritize patients waiting for liver transplantation within the USA (Bambha and Kamath, 2022).

How to calculate your MELD rating

The MELD rating will be calculated using the next algorithm.

MELD = 3.8 x log_{to me}(serum bilirubin [mg/dL]) + 11.2 X log_{to me}(INR) + 9.6 X log_{to me}(serum creatinine [mg/dL]) + 6.4

There isn’t any have to memorize this complex formula as there are several online tools available where you just enter your patient details and the result can be calculated for you, including MELD calculator from Mayo Clinic. MELD scores range from 6 to 40, and increasing MELD scores are related to worsening impaired liver function and a better risk of death inside three months. To avoid negative values, all lab results lower than one default to 1. Additionally, the upper limit of the MELD rating is 40 points.

REPORT – After the result

Hyponatremia is common in patients with liver cirrhosis, and sodium (Na) levels are a marker of liver disease (Bambha and Kamath, 2022). The MELD-Na rating was updated in 2016 to incorporate hyponatremia in patients on the liver transplant waiting list.

MELD-Na = MELD + 1.32X (137-Na) – [0.033 X MELD X (137-Na)]

Any transplant candidate with a MELD rating greater than 11 can be recalculated using the MELD-Na equation. Bambha and Kamath (2022) provide the next example. If a patient’s initial MELD rating is 12 but his serum sodium level is 125 mmol/L, his MELD-Na rating can be 23, which is able to increase his position on the transplant waiting list. Go to MDCalc.com to acquire the file MELD-Na calculator.

MELD 3.0

MELD version 3.0 was developed to incorporate additional variables resembling patient gender, serum albumin, updated model coefficients, and adjusted upper limit of creatinine (3 mg/dL). In a big study, the MELD 3.0 test was found to be more accurate than MELD-Na in predicting 90-day waitlist mortality. Additionally, historically, women were less likely than men to receive a donor liver. MELD 3.0 eliminates this gender disparity and should improve overall organ allocation (Bambha and Kamath, 2022). MDcalc.com delivers all three MELD calculations.

PEARLS (Bambha & Kamath, 2022)

• The primary use of the MELD and MELD-Na scales is to prioritize patients on the waiting list for a deceased donor liver transplant. Patients are ranked by MELD rating and stratified by blood type. MELD scores of 25 or higher are updated every seven days.
• MELD also predicts mortality in the next cases:
  • After TIPS treatment
  • Patients with cirrhosis undergoing surgery aside from transplantation
  • Acute alcoholic hepatitis
  • Acute varicose hemorrhage
• When calculating your MELD-Na rating, laboratory values ​​shouldn’t be greater than 48 hours old.
• There isn’t any change within the scores of patients taking anticoagulants.
• Several conditions receive additional MELD points, a rating often known as “standard MELD exceptions,” because they might impair survival. They include:
  • Hepatocellular carcinoma
  • Hepatopulmonary syndrome
  • Portopulmonary hypertension
  • Familial amyloid polyneuropathy
  • Primary hyperoxaluria
  • Cystic fibrosis
  • Hilar bile duct cancer
  • Hepatic artery thrombosis
• Acute, reversible conditions, resembling spontaneous bacterial peritonitis or prerenal Azotemia secondary to dehydration, needs to be treated before applying the MELD equation.
• MELD is just not currently utilized in patients with acute liver failure (UNOS status 1A) awaiting liver transplantation.

Bambha, K., & Kamath, P. S. (2022, August 31). Model for end-stage liver disease (MELD). . https://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld

Cheemerla, S. and Balakrishnan, M. (2021). Global epidemiology of chronic liver disease. , (5), 365–370. https://doi.org/10.1002/cld.1061

Terrault, N. A., Francoz, C., Berenguer, M., Charlton, M., & Heimbach, J. (2023). Liver transplant 2023: status report, current and future challenges. , (8), 2150–2166.