What is the MELD Score?
Summary
The MELD Score is a calculation used to assess the risk of mortality in patients with end-stage liver disease, not just those on the waitlist for liver transplantation. It primarily uses three results from laboratory studies (bilirubin, creatinine, and INR) for its calculation, with an additional consideration for serum sodium levels introduced in later versions. The score ranges from 6 to 40, indicating the severity of liver disease and the urgency for liver transplantation.
In this article, you can find what is the MELD score and its use by medical practitioners, along with some of the advancements of this clinical tool.
Introduction to MELD Score
The MELD Score is a tool doctors use to estimate the risk of demise while on a waiting list for liver transplantation. (1)
Many liver diseases are devastating to patients, and some can develop into liver failure, a condition in which the organ is no longer able to perform its normal functions.
The MELD Score enables doctors to have an adjunct and objective measure of the patient’s health status and to have an order of priority in the liver transplantation waiting list.
Thanks to advancements in transplantation medicine, patients who have undergone organ transplantation have seen improved outcomes in recent decades.
This article provides an overview of the MELD Score, its use, and its calculation.
What is the MELD Score?
The MELD Score is the result of a complex equation that has a high predictive value for estimating the risk of death in a patient with severe liver disease. (2)
The MELD Score is a complementary method that doctors use in the assessment of patients with liver disease and is included in the care strategies doctors use for addressing patients with liver disease.
Why is the MELD Score Used?
The MELD Score was originally used to estimate mortality for a specific set of patients after a surgical procedure called trans-jugular intrahepatic portosystemic shunt (TIPS). TIPS surgery is a procedure that helps relieve the consequences of a misfunctioning liver, like ascites (liquid in the abdominal cavity) and esophageal varices (engorged veins in the esophagus that can bleed); though it is not a cure for the underlying liver condition. (3)
The score was tested for patients on the waiting list for liver transplantation and resulted in increased accuracy, replacing the former method used called Child-Turcotte-Pugh Score.
A few years after its development by a group of investigators in the Mayo Clinic, the score was slightly modified for improved efficacy, including a new test to the former three-test score. (4)
How is the MELD Score calculated?
The MELD Score is calculated with the results of four blood tests:
- Serum Creatinine;
- Serum Bilirubin;
- Serum sodium;
- International Normalized Ratio (INR).
These studies are commonly used for the assessment of renal function (creatinine, sodium) and liver and coagulation functioning (bilirubin, and INR, respectively).
Doctors take the results of these studies from a blood test and introduce the values into special calculators that yield the corresponding score.
The liver allocation might depend on the specific blood type of the patient and the donor.
In addition, the result of the score is modified if the patient is affected by hepatocellular carcinoma or if the patient is in dialysis due to end-stage chronic kidney disease. (5)
What is the MELD Score Range?
The range of results ranges from 6-40 points. Higher scores mean severe disease and an increased risk of mortality while waiting for a liver transplant. For that reason, patients with higher scores are prioritized in the waiting list.
Lower scores mean better functioning of the aforementioned systems and usually imply that the liver transplant surgery is of greater risk than staying in the wait.
What is the Frequency of Scoring?
The frequency of updates of the score depends on the overall health status of the patient and the previous score results. The higher the score, the more frequently the score has to be updated.
Scoring frequency is determined by hepatologists, which are specialized doctors in Internal Medicine and Liver diseases.
The Score is not the sole method doctors use for determining the frequency of scoring, but as we mentioned, it is an adjunct study, meaning that patients are assessed in every relevant aspect of their individual situation.
Is it Important to Continue Updating the Score?
The short answer to this question is yes; it is important to continue updating the score since, unfortunately, chronic liver diseases often continue their course. Therefore, regular medical checkups directed by healthcare professionals should be followed in order to get the best results from medical therapy and, eventually, organ transplantation surgery when needed.
Prospectives of the MELD Score
The medical community has continued to test the MELD score and its modified version over the last 2 decades.
The interesting finding on the prediction power of this score is that over time, its accuracy has declined, presumably because of the changing causes of liver disease. (6)
Despite that, data on mortality (the number of demises over a period) in the wait list have continued to decrease in relationship with improvements in liver allocation. (7)
Novel approaches and modifications to the MELD score are proposed in research studies to improve the accuracy of the score and applicability to the wide range of patients in need of liver transplantation. (8)
Moreover, more methods to estimate waitlist mortality, along with the MELD score, have been proposed recently, including indices of frailty, sarcopenia (loss of muscle protein due to chronic conditions or age), and functional status. (7)
Final Remarks
The MELD score is the current tool for assessing the severity of liver disease and prioritizing patients for liver transplantation.
Its accuracy and predictive value have been demonstrated in clinical practice, and ongoing research aims to improve its applicability and effectiveness over a wide variety of patients and conditions.
Regular updating of the score is essential for monitoring disease progression and ensuring the best possible outcomes for patients with liver disease.
With advancements in transplantation medicine, improvement in mortality associated with liver conditions has been seen, as well as novel methods currently under study.
See Also
What is Creatinine Level in Blood Tests?
What are the Names of Blood Thinners?
What are the Normal Lab Values?
Grants for Kidney Transplant Patients
Respiratory Alkalosis Lab Values
- Freeman RB, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2002 Sep;8(9):851–8. The new liver allocation system: moving toward evidence-based transplantation policy – PubMed (nih.gov)
- Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003 Jan;124(1):91–6.
- Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatol Baltim Md. 2000 Apr;31(4):864–71. Model for end-stage liver disease (MELD) and allocation of donor livers – PubMed (nih.gov)
- Leise MD, Kim WR, Kremers WK, Larson JJ, Benson JT, Therneau TM. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology. 2011 Jun;140(7):1952–60. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation – PubMed (nih.gov)
- Guerrini GP, Pinelli D, Marini E, Corno V, Guizzetti M, Zambelli M, et al. Value of HCC-MELD Score in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation. Prog Transplant Aliso Viejo Calif. 2018 Mar;28(1):63–9. Value of HCC-MELD Score in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation – Gian Piero Guerrini, Domenico Pinelli, Elena Marini, Vittorio Corno, Michela Guizzetti, Marco Zambelli, Alessandro Aluffi, Lisa Lincini, Stefano Fagiuoli, Alessandro Lucianetti, Michele Colledan, 2018 (sagepub.com)
- Godfrey EL, Malik TH, Lai JC, Mindikoglu AL, Galván NTN, Cotton RT, et al. The decreasing predictive power of MELD in an era of changing etiology of liver disease. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2019 Dec;19(12):3299–307. The decreasing predictive power of MELD in an era of changing etiology of liver disease – PubMed (nih.gov)
- Mahmud N, Goldberg DS. Declining Predictive Performance of the MELD: Cause for Concern or Reflection of Changes in Clinical Practice? Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. 2019 Dec;19(12):3221–2. Declining predictive performance of the MELD: Cause for concern or reflection of changes in clinical practice? – PubMed (nih.gov)
- Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SW, et al. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology. 2021 Dec;161(6):1887-1895.e4. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era – PubMed (nih.gov)
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