نظرة سريرية عامة
MELD and MELD-Na is a structured clinical decision-support tool. The models estimate short-term mortality in advanced liver disease and support transplant-priority discussions. It standardizes calculation and communication, but its output remains an estimate that must be interpreted with the complete history, examination, laboratory method, imaging, serial trend, and institutional protocol. Enter contemporaneous data and verify units before relying on the result.
The displayed category reflects cohorts and conventional thresholds rather than a diagnosis or mandatory treatment instruction. Document inputs with the result, reassess when the patient changes, and prioritize time-critical stabilization over score completion. Discordance between the calculated estimate and clinical concern should prompt review of measurements, assumptions, competing diagnoses, and specialist advice.
دواعي الاستخدام
- Adults with advanced chronic liver disease when MELD-based prognosis is appropriate
- Clinical communication and transplant-referral context
القيود والسلامة
Allocation formulas have changed over time; this tool explicitly reports original MELD and MELD-Na, not current US MELD 3.0. Performance varies with population, prevalence, disease stage, treatment era, and local laboratory reference intervals. Avoid extrapolation to groups excluded from validation, and do not use a low score to dismiss concerning symptoms or a high score to prove a diagnosis.
Clinical decisions should incorporate contraindications, comorbidities, patient preferences, and current regional guidance. Pregnancy, childhood, older age, critical illness, altered physiology, and organ failure often require population-specific interpretation. Clinipocket stores no entered patient values; record clinically relevant results in the approved medical record.
- Official transplant allocation may use updated jurisdiction-specific MELD versions
- Not a tool for acute liver failure or pediatric candidates younger than 12
المعادلة
MELD = 3.78 ln(bilirubin) + 11.2 ln(INR) + 9.57 ln(creatinine) + 6.43. MELD-Na = MELD + 1.32(137−Na) − 0.033×MELD×(137−Na)
تفسير النتائج
- 6–9 — Lower MELD range: Lower estimated 90-day mortality than higher bands. Manage liver disease and monitor trajectory.
- 10–19 — Intermediate: Increasing decompensation risk. Hepatology review and referral planning as appropriate.
- 20–29 — High: Substantial short-term mortality. Urgent specialist/transplant assessment.
- ≥30 — Very high: Very high short-term mortality. High-acuity hepatology and transplant-network management.
المراجع
- Kamath PS, et al. A model to predict survival in end-stage liver disease.
- Biggins SW, et al. Incorporation of serum sodium into MELD.
- OPTN MELD Calculator
الأسئلة الشائعة
Is this the current US allocation score?
No. US adult allocation uses MELD 3.0. Use the official OPTN calculator for allocation decisions.
Why are values capped?
Validated MELD conventions floor bilirubin, INR, and creatinine at 1, cap creatinine at 4, sodium at 125–137, and total score at 6–40.
Does dialysis change creatinine?
For original MELD/MELD-Na, qualifying recent dialysis sets creatinine to 4 mg/dL.