MELD-Plus

Uri Kartoun princeton nov 2018

MELD-Plus is an advanced scoring system used to prioritize patients for liver transplantation. It is an extension of the Model for End-Stage Liver Disease (MELD) score, which has been widely used since its introduction. The MELD score itself is calculated based on laboratory values that reflect the severity of chronic liver disease. MELD-Plus enhances the original MELD score by incorporating additional variables to improve the prediction of mortality in patients with end-stage liver disease.

Overview

The original MELD score is calculated using three laboratory values: bilirubin, INR (International Normalized Ratio, a measure of blood clotting), and creatinine, which assess liver function and kidney function. The MELD score has been a critical tool in determining the urgency of liver transplantation by predicting the 90-day mortality of patients with end-stage liver disease.

MELD-Plus builds on the foundation of the MELD score by including other factors such as sodium levels, which have been shown to further refine the assessment of a patient's prognosis. The inclusion of sodium addresses the issue of hyponatremia, a common condition in patients with advanced liver disease that is associated with a worse prognosis.

Calculation

The MELD-Plus score is calculated using a formula that incorporates the original MELD score components (bilirubin, INR, and creatinine) and adds the serum sodium level. The exact formula for MELD-Plus may vary slightly depending on the specific version or adaptation used, but the goal remains the same: to provide a more accurate prediction of mortality in patients with end-stage liver disease.

Clinical Application

MELD-Plus is primarily used in the context of liver transplantation. By providing a more nuanced assessment of a patient's condition, MELD-Plus helps transplant teams make more informed decisions regarding organ allocation. This is particularly important given the scarcity of available donor livers and the need to prioritize patients who are most in need and most likely to benefit from a transplant.

Advantages

The primary advantage of MELD-Plus over the original MELD score is its increased accuracy in predicting mortality. This is crucial for optimizing the allocation of liver transplants, ensuring that those who are most in need receive priority. Additionally, by incorporating sodium levels, MELD-Plus offers a more comprehensive assessment of a patient's condition, taking into account the impact of hyponatremia.

Limitations

While MELD-Plus represents an improvement over the original MELD score, it is not without limitations. The score may not fully capture the complexity of certain liver diseases or the impact of comorbid conditions. Furthermore, the reliance on laboratory values means that the score can be influenced by factors such as fluid administration or diuretic use, which may not accurately reflect the patient's baseline liver function.

Conclusion

MELD-Plus is a significant advancement in the field of liver transplantation, offering a more accurate and comprehensive method for assessing the severity of liver disease and prioritizing patients for transplantation. By incorporating additional variables such as sodium levels, MELD-Plus addresses some of the limitations of the original MELD score and provides a more nuanced understanding of a patient's prognosis.