Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding

Chalasani, Naga; Kahi, Charles J.; François, Fritz; Pinto, Amar; Marathe, Atul; Bini, Edmund J.; Pandya, Prashant; Sitaraman, S; Shen, Jianzhao

doi:10.1053/jhep.2002.32532

Cited by 118 publications

(86 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[113][114][115] MELD score has been shown to be an accurate predictor of outcome after VH. 83,116,117 MELD >18 was a predictor of rebleeding within first 5 days and overall mortality at 6 weeks. 117 MELD score is also a powerful predictor for mortality at 6 weeks for patients who develop early rebleeding after endoscopic variceal ligation.…”

Section: Variceal Bleedingmentioning

confidence: 91%

“…4 MELD score in predicting mortality after TIPS placement was superior to Emory score in one study and slightly superior or similar to CTP score in another study. 83,84 MELD score <18 is ideal for TIPS placement, and those with MELD scores19-24 are borderline for successful outcome. Patients with MELD >24 are not optimal candidates for TIPS placement; TIPS may be carried out in these patients if they are candidates for liver transplantation.…”

Section: Transjugular Intrahepatic Portosystemic Placementmentioning

confidence: 99%

See 1 more Smart Citation

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

125

View full text Add to dashboard Cite

Section: Variceal Bleedingmentioning

confidence: 91%

Section: Transjugular Intrahepatic Portosystemic Placementmentioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

125

View full text Add to dashboard Cite

“…Retrospective studies have shown that both MELD and CTP are accurate predictors of survival in patients with variceal bleeding. 35 MELD and hepatocellular carcinoma were better predictors of survival than CTP score in a study of 172 patients with cirrhosis and first variceal bleed, with MELD score discriminating between patients at high risk (Ն15) and low risk (Ͻ15) for mortality. 36 Our own unpublished data confirms the superiority of MELD over the CTP score in determining mortality following a variceal bleed.…”

Section: Prediction Of Long-term Survival In Patients With Cirrhosismentioning

confidence: 99%

“…The MELD score has been compared to both the Emory score, 35 as well as the CTP score for prediction of long-term survival in patients undergoing TIPS. The "c" statistic for the MELD score was superior to the Emory score but only slightly superior to or no better than the CTP classification in predicting post procedure mortality.…”

Section: Meld In the Management Of Patients With Esldmentioning

confidence: 99%

The model for end-stage liver disease (MELD)

2007

View full text Add to dashboard Cite

The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver trans- becoming the standard by which priorities in donor liver allocation were determined. Since the score was first derived in a relatively small number of patients undergoing the transjugular intrahepatic portosystemic shunts (TIPS) procedure, it has been validated in many different populations of patients with liver disease. Within a relatively short period of time, MELD became a common metric by which the severity of liver disease could be accurately described.In this paper, we review the initial development and validation of the MELD score, its application in organ allocation and management of patients with a variety of liver conditions, its strengths and limitation, and current and future efforts to refine and improve it further. Creation and Validation of MELDMELD was initially created to predict survival following elective placement of TIPS. 1 The model was subsequently validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity (e.g., hospitalized and ambulatory patients), as well as patients of geographically and temporally diverse origin. 2 The survival model was initially termed the "Mayo End-Stage Liver Disease" or "MELD" model to acknowledge the affiliation of the investigators who created the model. During discussions leading to the establishment of MELD as the basis for prioritization of organs for liver transplantation, 3,4 we changed the name to "Model for End-Stage Liver Disease" which maintained the acronym "MELD", but removed the association with a particular institution, a process that was thought would lead to wider acceptance of the model. MELD incorporates 3 widely available laboratory variables including the international normalized ratio (INR), serum creatinine, and serum bilirubin. The original mathematical formula for MELD is: MELD ϭ 9.57 ϫ log e (creatinine) ϩ 3.78 ϫ Log e (total bilirubin) ϩ 11.2 ϫ Log e (INR) ϩ 6.43.The score can be calculated on handheld computing devices, and is available at www.mayoclinic.org/gi-rst/ mayomodel5.html. When the model was initially created the etiology of cirrhosis was also included. In the TIPS

show abstract

“…Child-Pugh and MELD scores are two of the most important models for predicting the survival of AUGIB in such patients (5,6). Several studies by our team and others have also suggested a similar prognostic performance between them (7,8). However, the role of the ALBI score for the assessment of prognosis of AUGIB in liver cirrhosis remains unclear.…”

Section: Introductionmentioning

confidence: 99%