Model for End-Stage Liver Disease (MELD) score is a prognostic scoring system, based on laboratory parameters, used to predict 3-month mortality due to liver disease
MELD scores range from 6 to 40; the higher the score,
the higher the 3-month mortality related to liver disease
The MELD score does not accurately predict survival in
all patients with cirrhosis; conditions such as liver cancer, hepatopulmonary
syndrome, and porto-pulmonary hypertension, are associated with a higher
mortality rate than MELD score would reflect. Therefore, patients with these
conditions may receive additional MELD points when listed for liver transplantation
Recommendations
- Calculate a MELD score every 3-6 months in all patients with cirrhosis to repeatedly assess their score
- Consider referral for liver transplantation in patients with MELD score of 10 or higher
- Consider using MELD score to assess mortality in patients with acute liver failure or acute variceal bleeding
- Calculate MELD scores for patients who have:
- cirrhosis and are undergoing surgery (abdominal, orthopedic, cardiac, etc.)
- cirrhosis and are being considered for TIPS
- alcoholic hepatitis and are being considered for steroids
- acute liver failure or acute variceal bleeding
Appropriate Use of the MELD
- The original MELD calculator was used to predict mortality in those undergoing placement of a transjugular intrahepatic portosystemic shunt (TIPS)
- The MELD score has been validated to predict short-term survival in patients with cirrhosis waiting for liver transplantation, but it also was found to be useful in predicting liver-related mortality in patients with alcoholic hepatitis, acute liver failure, acute variceal hemorrhage, or postsurgical procedures
- MELD is useful in determining when a patient should be evaluated for transplant; the benefit of liver transplantation outweighs the risk once MELD score is 15 or higher
- In patients with alcoholic hepatitis, MELD score of >20 identifies severe disease, when steroid treatment should be considered
- Patients listed for liver transplantation will have their MELD scores updated at regular intervals (from every 7 days if 25 or greater, to every 1-3 months
Understanding the MELD Score Calculation
- When inputting values, laboratory values of less than 1 are rounded to 1
- A score of 40 is set as the upper limit regardless of how high the inputted laboratory values may be.
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