The specificity of this score for treatment failure is 68%, and its positive predictive value is 19% (see Table 88-5). In AIH, a MELD score of ≥12 points at presentation identifies 97% of patients who fail to respond to glucocorticoid treatment. 69 Survival predicted by the MELD score relates mainly to the degree of impaired liver function and not the presence of cirrhosis or the cause of liver disease. The MELD score is an established method by which to predict early mortality associated with severe liver disease it is based on the serum creatinine level, total serum bilirubin concentration, and international normalized ratio (INR). Czaja, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease (Ninth Edition), 2010 MODEL FOR END-STAGE LIVER DISEASE SCORE Cirrhotic patients who underwent liver resection for HCC with a MELD score greater than 8 had a higher risk of death, morbidity, and impaired long-term survival ( Cucchetti et al, 2006 Delis et al, 2009).Īlbert J. Regarding liver resection in cirrhotic patients, the MELD score was only retrospectively studied. The most frequent use of the MELD score has been in the allocation of organs for patients awaiting liver transplantation ( Freeman et al, 2005 Wiesner et al, 2001). The MELD score was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease ( Kamath et al, 2001). This system was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts (TIPS) ( Malinchoc et al, 2000). The Model for End-Stage Liver Disease (MELD) score uses only objective variables calculated from the international normalized ration (INR), serum total bilirubin (mg/dL), and serum creatinine (mg/dL). Jacques Belghiti, Safi Dokmak, in Blumgart's Surgery of the Liver, Pancreas and Biliary Tract (Fifth Edition), 2012 Model for End-Stage Liver Disease Score Although this has been demonstrated for PSC, 107 there are no specific data examining this issue with respect to PBC to date. 105,106 With over a decade of experience using the MELD score for LT, there are questions about PBC having a disadvantage in terms of waiting list time as compared to non–cholestatic liver disease. However, the influence of liver disease cause on MELD score was eliminated from the model when UNOS implementation was undertaken. It should be noted that the original MELD study recognized that patients with cholestatic liver disease had improved predicted survival as compared to other types of liver disease. Subsequent analysis demonstrated that the MELD score was equivalent to the Mayo PBC risk score for predicting survival in PBC patients. 104 In this cohort the MELD score was associated with a very high discriminative value of 0.87 (95% confidence interval, 0.71-1.00) for mortality at 3 months that remained at the same (0.87) value when assessing 1-year mortality. The original MELD score was based on a predictive survival model described for patients receiving transjugular intrahepatic portosystemic shunt. 102,103 The MELD score involves three readily available laboratory values: serum total bilirubin, creatinine, and international normalized ratio (INR). The MELD score was adopted in February 2002 by UNOS to guide organ allocation policies. Talwalkar, in Transplantation of the Liver (Third Edition), 2015 MELD Scores in Patients with Primary Biliary Cirrhosis