MELD is the short form for the Model for End-Stage Liver Disease, a scoring system that is used for gauging prognosis and determining priority for receipt of a liver transplant.
The score was developed at Mayo’s clinic to predict mortality within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt or TIPS procedure.
The score was originally developed at the Mayo Clinic and as called the Mayo End-stage Liver Disease score.
The score is now preferred over Child-Pugh Score which was earlier used for prioritizing the allocation of a liver transplant.
The score is used in patients more than 12 years old. In patients below 12 years, PELD score is used [see below]
After its success in the United States of America, MELD has been adopted globally for use in liver transplant.
MELD is also found useful in a wide range of chronic liver diseases.
How to Calculate MELD Score
MELD uses the patient’s values of
- Serum bilirubin
- Serum creatinine
- International normalized ratio or prothrombin time
It is calculated according to the following formula:
MELD = 3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43
The scores are reported as whole numbers, so the result of the equation above is rounded.
Following modifications have been added by United Network for Organ Sharing
- For patients who underwent dialysis twice in the last 7 days, serum creatinine is taken 4.0
- For any value of any parameter less than 1, the rounding off is done to 1.0.
The calculated score is arranged in a subset of 10. A higher score means worse prognosis.
For each, 3-month observed mortality is assigned to each subset
- 40 or more — 71.3% observed mortality
- 30–39 — 52.6% observed mortality
- 20–29 — 19.6% observed mortality
- 10–19 — 6.0% observed mortality
- <9 — 1.9% observed mortality
Depending on what the MELD score is, a recalculation is scheduled for monitoring purpose
- Less than 10: once a year.
- 11-18: every 3 months.
- 19-24: once a month.
- 25 or higher: every week.
It is a new score to assess the severity of chronic liver disease.
The score includes nine variables which are used to predict 3-month mortality after discharge from a cirrhosis-related admission. The variables include
- Total cholesterol
- White blood cell count
- Length of stay
- Total bilirubin
Later on, 7 factors were taken into consideration because of the lack of uniformity in-hospital stay length and total cholesterol measurements.
Uses of MELD Score
- For calculating prognosis and priority of end-stage liver patients
- For predicting long‐term survival in patients with cirrhosis
- Calculating prognosis of
- Variceal bleeding
- Infections in patients with cirrhosis
- Fulminant hepatic failure.
- Alcoholic hepatitis.
- Other chronic liver diseases.
MELD is not used in patients under 12 years of age. Instead, PELD score is used which stands for pediatric end-stage liver disease.
The calculation is similar to the MELD Score Calculation. Following factors are taken into account-
- Patient’s albumin
- International normalized ratio
- Patient’s age [whether the patient is less than one year old]
- Degree of growth failure
- PELD uses the patient’s values of serum bilirubin, serum albumin, the international normalized ratio or prothrombin time (INR), whether the patient is less than 1 year old, and whether the patient has growth failure (<-2 standard deviation) to predict survival. It is calculated according to the following formula
PELD = 4.80[Ln serum bilirubin (mg/dL)] + 18.57[Ln INR] – 6.87[Ln albumin (g/dL)] + 4.36(in less than1 year old) + 6.67(when growth failure is there)
A higher score means a more serious condition.
Online Calculators for MELD and PELD
There are many other sites offering this calculation which can be found via using your favorite search engine.
- Wiesner, RH, Kamath, PS, Malinchoc, M, Kremers, WK, Krom, RAF, Kim, WR. MELD and PELD: Application of survival models to liver allocation. Liver Transpl 2001; 7: 567– 580.
- Said, A, Williams, J, Holden, J, Remington, P, Gangnon, R, Musat, A, et al. Model for end‐stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 2004; 40:897– 903.