1/31/2024 0 Comments Meld score formula![]() ![]() The etiology of liver disease was subsequently removed from the model because it posed difficulties, such as how to categorize patients with multiple causes of liver disease. The original model included serum bilirubin, serum creatinine, INR, and etiology of the liver disease (cholestatic or alcohol-associated versus other etiologies). The model was subsequently validated in an independent cohort of patients from the Netherlands undergoing TIPS placement. (See 'Adoption of MELD for organ allocation' below and "Liver transplantation in adults: Patient selection and pretransplantation evaluation", section on 'Cirrhosis'.)ĭevelopment of the MELD score - MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement. Given its accuracy in predicting short-term survival among patients with cirrhosis, MELD was initially adopted by the United Network for Organ Sharing (UNOS) in 2002 for prioritizing patients awaiting liver transplantation in the United States. In patients with cirrhosis, an increasing MELD score is associated with increasing severity of hepatic dysfunction and increased three-month mortality risk ( figure 1). MELD OVERVIEW - The original MELD score is a prospectively developed and validated chronic liver disease severity scoring system that uses a patient's laboratory values for serum bilirubin, serum creatinine, and the international normalized ratio (INR) for prothrombin time to predict three-month survival ( original MELD score). (See "Liver transplantation in adults: Patient selection and pretransplantation evaluation".) Other issues related to the selection of patients for liver transplantation are discussed separately. This topic will review the use, impact, refinements, and limitations of the MELD score, particularly with regard to its use in allocating organs for liver transplantation. Models that are used commonly in the care of patients with cirrhosis are the Child-Turcotte-Pugh score, the Model for End-stage Liver Disease (MELD) score, and the MELD-Sodium (MELD-Na) score. Some focus on generalized health status such as the Acute Physiology and Chronic Health Evaluation System (APACHE III), while others are disease-specific. Several prognostic models are used in health care settings. Machine learning is increasingly being used to derive these predictive models. These models are developed using statistical methodologies that involve determining the effects of variables of interest (eg, demographics, clinical data, and laboratory values) on specific outcomes, such as death. 4 A study including 140 patients undergoing TIPS showed that the MELD was more accurate than the CTP score for predicting three-month mortality.INTRODUCTION - Prognostic models are useful for estimating disease severity and survival and can serve as helpful medical decision-making tools for guiding patient care. The study showed: (1) the MELD, the CTP score, and the Emory score were similar in accuracy for predicting three-month mortality (2) the MELD was more accurate than the others for predicting 12-month mortality and (3) the MELD and the CTP score were more accurate than the Emory score for predicting 36-month mortality. The accuracy of each score was measured using the concordance-statistic (c-statistic): 1 was a score that perfectly predicted the outcome in question, and 0 was a score that failed to predict any outcome correctly. The mean age of patients was 57 years, about two thirds were men, and most had alcoholic cirrhosis. 4 The study used the version of the MELD that included creatinine, bilirubin, INR, and cause of cirrhosis. A German study compared the MELD, the CTP score, and the Emory score in predicting the prognosis of 162 patients with end-stage liver disease who were undergoing transjugular intrahepatic portosystemic shunting (TIPS).
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