Model for End-Stage Liver Disease
The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict death within three months of surgery in patients that had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
It uses the patient’s values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. This score is also used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants. It is calculated according to the following formula:
* The maximum score given for MELD is 40. All values higher than 40 are given a score of 40
* If the patient has been dialyzed twice within the last 7 days, then the value for serum creatinine used should be 4.0
* Any value less than one is given a value of 1 (i.e. if bilirubin is 0.8, a value of 1.0 is used).
Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is. This staging system is known as the TNM system. T stands for the local extent of the tumor, N stands for the presence or absence of lymph node metastases, and M stands for the presence or absence of distant metastasis (tumor spread to another organ such as the lung in the case of liver cancer).