The MELD score: Predicting survival in end-stage liver disease [Classics Series]

Classics Series, Landmark Trials in Medicine

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1. The Model for End-Stage Liver Disease (MELD) is a reliable tool for predicting short-term survival in patients with advanced liver disease

2. The score is generalizable to diverse etiologies and a wide range of disease severity

Original Date of Publication: February 2001

Study Rundown: The Model for End-Stage Liver Disease (MELD) was originally developed to predict outcomes in patients after a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The study reported here assessed whether the model could reliably predict short-term survival in patients with chronic liver disease. The investigators found that MELD scores were a good predictor of 1-week, 3-month and 1-year survival, which had important implications for the model’s use in the allocation of donor livers. Previously, the Child-Turcotte-Pugh (CTP) system was used to rank patients according to urgency and medical need, however the broad classifications made it difficult to rank patients according to severity of disease. Another issue with CTP scores was the subjectivity involved in some of the criteria (e.g., assessment of ascites and encephalopathy). The MELD criteria are an improvement on these aspects of CTP scores as patients are assigned a numerical score based on objective measures.

Please click to read study in Hepatology

In-Depth [cohort study]: This study, originally published in Hepatology in 2001, evaluated the validity of the MELD score for predicting survival in patients with end-stage liver disease. The model uses measures of serum creatinine, total serum bilirubin, International Normalized Ratio (INR) for prothrombin time and etiology of cirrhosis to assess disease severity. The model was assessed in four independent samples, which included patients hospitalized with advanced end-stage liver disease, ambulatory patients with noncholestatic cirrhosis, ambulatory patients with primary biliary cirrhosis (PBC) and a historical group of cirrhotic patients from a period when liver transplantation was not widely available. The primary outcome measure was 3-month survival and validity was also assessed for predicting 1-week and 1-year survival. The c-statistics for 3-month mortality in the hospitalized, ambulatory noncholestatic, ambulatory PBC and historical groups respectively were 0.87, 0.80, 0.87 and 0.78. These values changed minimally when etiology of disease was excluded from the model. The MELD score was found to be a reliable tool to predict survival in patients with chronic liver disease.

By Adrienne Cheung, Andrew Cheung, M.D.

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