Comprehensive Liver Care of New Jersey
The Model of Enstage Liver Disease or MELD score.
The Model for End-Stage Liver Disease (MELD) score has been in use since February 2002. It is used to measure a patient's risk of dying from chronic liver failure over a 90 day period from the day it was measured. It is used to determine the order and urgency of patients waiting for a liver transplant. The "MELD score" is a number scale. The range is from 6 (less ill) to 40 (gravely ill). The number is calculated using the following laboratory tests:
If the MELD score is greater than 10 patients are evaluated for a liver transplant. However, even if placed on the liver transplant list, patients are not actively called in for a liver transplant until their MELD score is 15 or greater. Bear in mind, a patient's chances of being alive at one year after receiving a liver transplant is between 85%-90%. A MELD score of 15 means a patient's chance of being alive in a year is about 85%. So a MELD of 15 is the break point favoring a liver transplant is when a patient has a higher chance of being a live with a liver transplant versus to dying from liver failure. As the MELD score increases, patients are progressively sicker and more debilitated.
Although patients are activated for liver transplant at a MELD of 15, patient debility usually significantly worsens at a MELD of 19 or greater. Unfortunately, MELD does not take into account patient debility (or performance status), fluid accumulation (ascites), or confusion (encephalopathy). However, a low serum sodium, lower than 131-134, has been shown to increase the risk dying while waiting for a liver transplant. There is a good chance a measure of sodium will be added to MELD to determine the urgency of need for a liver transplant. Beyond a MELD of 25, patients have a higher risk of dying even should they receive a liver transplant. However receiving a liver transplant still offers the best chance of long term survival.
The Model for End-Stage Liver Disease (MELD) score has been in use since February 2002. It is used to measure a patient's risk of dying from chronic liver failure over a 90 day period from the day it was measured. It is used to determine the order and urgency of patients waiting for a liver transplant. The "MELD score" is a number scale. The range is from 6 (less ill) to 40 (gravely ill). The number is calculated using the following laboratory tests:
- Total Bilirubin: a measure of how well the liver clears certain body wastes.
- INR (International Normalized Ratio or previously known as the prothrombin time): a measures the liver’s ability to make blood clotting factors.
- Creatinine: a measure of kidney function. Severe liver failure often results in kidney failure.
If the MELD score is greater than 10 patients are evaluated for a liver transplant. However, even if placed on the liver transplant list, patients are not actively called in for a liver transplant until their MELD score is 15 or greater. Bear in mind, a patient's chances of being alive at one year after receiving a liver transplant is between 85%-90%. A MELD score of 15 means a patient's chance of being alive in a year is about 85%. So a MELD of 15 is the break point favoring a liver transplant is when a patient has a higher chance of being a live with a liver transplant versus to dying from liver failure. As the MELD score increases, patients are progressively sicker and more debilitated.
MELD and Risk of Death
For the average patient the MELD score can be confusing to understand. Simply put, MELD is the risk of dying over a 90 day period from the time it was measured. The largest increase in risk of death occurs between a MELD of 20 to 30, where the 90 day risk of dying goes from 25% to 62%. The MELD score also relates to a patients risk of dying immediately following a liver transplant. This is called peri-operative death risk. When a patient's MELD score is greater than 30, the peri-operative death risk goes from 10% (1 out of 10 patients) to about 20% (2 out of 10 patients).
Impact of Serum Sodium(Na) on MELD Score
The chart below shows how a low serum sodium (Na) increases one's MELD score. At some point in the near future UNOS will incorporate serum Na as part of the MELD score. If a patient has a MELD score of 15, a serum Na of 134 increases the MELD score to 17, a serum Na of 130 increases the MELD score to 23, and a serum Na increases the MELD score to 29.
Although patients are activated for liver transplant at a MELD of 15, patient debility usually significantly worsens at a MELD of 19 or greater. Unfortunately, MELD does not take into account patient debility (or performance status), fluid accumulation (ascites), or confusion (encephalopathy). However, a low serum sodium, lower than 131-134, has been shown to increase the risk dying while waiting for a liver transplant. There is a good chance a measure of sodium will be added to MELD to determine the urgency of need for a liver transplant. Beyond a MELD of 25, patients have a higher risk of dying even should they receive a liver transplant. However receiving a liver transplant still offers the best chance of long term survival.