Model for End-Stage Liver Disease

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The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially described by Kamath et al in 2001 and modified by Wiesner et al, also in 2001.It uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. This score is also used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants.It is calculated according to the following formula::MELD = 3.78serum bilirubin (mg/dL) + 11.2INR + 9.57serum creatinine (mg/dL) + 6.43Caveats with the score include:
  • The maximum score given for MELD is 40. All values higher than 40 are given a score of 40
  • If the patient has been dialyzed twice within the last 7 days, then the value for serum creatinine used should be 4.0
  • Any value less than one is given a value of 1 (i.e. if bilirubin is 0.8, a value of 1.0 is used).
    • PATIENTS WITH LIVER CANCER Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is. This staging system is known as the TNM. T stands for the extent of the tumor, N stands for the presence or absence of lymph nodes, and M stands for the presence or absence of metastasis (tumor spread to another organ such as the lung in the case of liver cancer).

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