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Viral Hepatitis and Liver Disease

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MELD Score

for Health Care Providers

What Is the MELD Score and When Do We Use It? - Cirrhosis

Estimating the severity of liver disease is important for predicting survival, assessing risk/benefit of specific treatments, including organ allocation for liver transplantation, and guiding goals-of-care discussions.

Key concepts

  • 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 original MELD calculatorLink will take you outside the VA website. VA is not responsible for the content of the linked site. uses creatinine, bilirubin, and INR measurements; later, hyponatremia (Na concentration of 125-140 mEq/L) was found to be an independent predictor of mortality in patients with cirrhosis and Na levels were added to the MELD score calculation
  • A modified MELD calculatorLink will take you outside the VA website. VA is not responsible for the content of the linked site. became the standard for organ allocation for liver transplantation in January 2016; the modified MELD calculator, called MELD-Na, takes into account Na values of 125-137
  • The MELD score does not accurately predict survival in all patients with cirrhosis; conditions such as liver cancer, hepatopulmonary syndrome, and portopulmonary 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

Key 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
  • Calculate MELD score when considering TIPSLink will take you outside the VA website. VA is not responsible for the content of the linked site. for refractory ascites or variceal bleeding; patients with MELD scores of 18 or higher have significant post-TIPS mortality rates
  • Include MELD score in the preoperative evaluationLink will take you outside the VA website. VA is not responsible for the content of the linked site. of patients with cirrhosis undergoing abdominal, orthopedic, or cardiac surgery
  • 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
  • Original MELD CalculatorLink will take you outside the VA website. VA is not responsible for the content of the linked site.
  • MELD-Na CalculatorLink will take you outside the VA website. VA is not responsible for the content of the linked site.