Today, the MELD score is primarily being used to allocate organs for liver transplantation, but recent studies have indicated that the MELD score might be used as a general prognostic tool in patients, independent of the presence of liver disease. Interestingly, the etiology of liver disease was not found to be a relevant predictor of mortality. Subsequently, the MELD score was thoroughly validated in patients with a broad spectrum of liver diseases showing an excellent discriminatory power for prediction of short-term mortality. It has been developed and validated to predict mortality in patients with portal hypertension undergoing placement of transjugular intrahepatic portosystemic shunts. The well-established MELD score depends on 3 readily available laboratory variables, that is, serum creatinine, serum bilirubin, and the international normalized ratio (INR). The laboratory-based model for end-stage liver disease (MELD) score reflects the function of the kidney, liver, and extrinsic coagulation pathway and might be used as a general prognostic tool for the assessment of patients. We suggest to prospectively validate the MELD score in inpatients as part of clinical decision support systems.Ĭlinical decision support systems have been shown to improve the quality of patient care and to reduce health care costs however, little is known about their overall impact on patient outcomes. In our study population consisting of adult inpatients, the MELD score on hospital admission was significantly associated with mortality, LOS, and the number of comorbidities. Increased MELD scores of 15 to 19, 20 to 29, and ≥30 points were positively associated with LOS and the number of comorbidities in uni- and multivariable analysis. The primary outcome measure was in-hospital all-cause mortality secondary outcome measures were LOS and the number of comorbidities.Ī total of 39,323 inpatients were included in the final analysis. The MELD score on hospital admission was calculated retrospectively. From January 2012 through December 2013, all consecutive inpatients aged 18 years were eligible for the study patients with missing MELD parameters on hospital admission and/or treatments influencing the international normalized ratio, that is, novel oral anticoagulants and vitamin K antagonists, were excluded. We performed a retrospective observational study at a tertiary referral center. We therefore aimed to investigate a potential association of the MELD score with mortality, length of hospital stay (LOS), and disease burden in a general patient population. Using the MELD score, patients are assigned a score from 6 to 40, which equates to an estimated 3-month survival rate from 90% to 7%, respectively.The laboratory-based model for end-stage liver disease (MELD) score reflects the function of the kidney, liver, and extrinsic coagulation pathway and might be used as a general prognostic tool for the assessment of patients. The reason for this conversion is that the natural logarithm of 1 is 0, and any value below 1 would yield a negative result. if bilirubin is 0.9, a value of 1.0 is used). Any value less than one should be converted to 1.0 (e.g.If the patient has been dialyzed twice within the last 7 days, then serum creatinine should be assigned a value of 4.0.UNOS has made the following modifications to the original MELD score: It is calculated according to the following formula: MELD uses three laboratory values to predict survival serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR). The United Network for Organ Sharing (UNOS) and Eurotransplant now use MELD score for prioritizing allocation of liver transplants. MELD score has been shown useful both in predicting short-term survival in groups of patients on the waiting list for liver transplantation as well as the risk of postoperative mortality.
Subsequent studies demonstrated its usefulness in determining the prognosis of groups of patients with chronic liver disease. MELD was initially developed to predict death within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The Model for End-Stage Liver Disease (MELD) is a scoring system for assessing the severity of chronic liver disease.
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