To MELD or not to MELD, that is a question

Huo, Teh Ia; Lin, Han Chieh; Lee, Shou Dong

doi:10.1002/lt.21270

Cited by 3 publications

(2 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, for transplant candidates on the waiting list, the MELD score should be theoretically calculated only after the acute complications are treated or stabilized and one should be cautious before expanding the use of the MELD beyond this original model. Careful evaluation in applying the MELD as a prognostic tool should be carried out when it is used outside the original clinical scenario (68, 69).…”

Section: Future Perspectivesmentioning

confidence: 99%

Selecting an optimal prognostic system for liver cirrhosis: the model for end‐stage liver disease and beyond

Huo

Lee

Lin

2008

Liver International

Self Cite

View full text Add to dashboard Cite

In comparison with the Child–Turcotte–Pugh (CTP) system, recent studies suggested that the model for end‐stage liver disease (MELD) may more accurately predict the survival for patients with cirrhosis. In the US, the liver allocation system was changed in 2002 from a status‐based algorithm utilizing CTP scores to one using continuous MELD severity scores as a reference system in prioritizing adult patients on the waiting list. Direct evidence that demonstrates the benefits of MELD is the fact that the mortality rates of transplant candidates on the waiting list have remarkably decreased after the implementation of the MELD. The MELD score is closely associated with the degree of portal hypertension as reflected by the hepatic venous pressure gradient. Hyponatraemia occurs as a result of advanced cirrhosis, and a serum sodium (Na) level <126 mEq/L at the time of listing for transplantation is a strong independent predictor of mortality. Several MELD‐derived prognostic models that incorporate serum Na into calculation have been proposed in the hopes of further improving the MELD's prognostic accuracy. Additionally, serum parameters such as creatinine and international normalized ratio are subject to interlaboratory variations and may need unifying standardizations. Patients with refractory complications of cirrhosis may need a priority MELD score to prioritize them on the waiting list. Appropriate modifications and the fine‐tuning of the MELD based on well‐designed prospective studies are necessary in solving the current controversial issues.

show abstract

Section: Future Perspectivesmentioning

confidence: 99%

Selecting an optimal prognostic system for liver cirrhosis: the model for end‐stage liver disease and beyond

Huo

Lee

Lin

2008

Liver International

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, a recent study from our unit showed that MELD was equally superior to the King's College and Clichy criteria in patients with viral, indeterminate, or other etiologies of FHF. 6 The second issue raised by Huo et al 1 is timing of prognosis assessment. It is well known that progression of hepatic encephalopathy is largely unpredictable, as are the onset and severity of extrahepatic complications leading to multiorgan failure.…”

mentioning

confidence: 99%

Reply: To MELD or not to MELD: Early assessment of prognosis in fulminant hepatic failure

Yantorno¹,

Villamil

2007

Liver Transpl

View full text Add to dashboard Cite

Model for End-Stage Liver Disease and liver cirrhosis-related complications

et al. 2012

View full text Add to dashboard Cite

The Model for End-Stage Liver Disease (MELD) score has gained wide acceptance for predicting survival in patients undergoing liver transplantation. The strength of this score remains in the mathematical formula derived from a multivariate Cox regression analysis; it is a continuous scale and lacks a ceiling or a floor effect with a wide range of discrimination. It is based on objective, reproducible, and readily available laboratory data and the wide range of samples which have been validated. Liver cirrhosis complications such as ascites, encephalopathy, spontaneous bacterial peritonitis and variceal bleeding were not considered in the MELD score underestimating their direct association with the severity of liver disease. In this regard, several recent studies have shown that clinical manifestations secondary to portal hypertension are good prognostic markers in cirrhotic patients and may add additional useful prognostic information to the current MELD. We review the feasibility of MELD score as a prognostic predictor in patients with liver cirrhosis-related complications.

show abstract

To MELD or not to MELD, that is a question

Cited by 3 publications

References 2 publications

Selecting an optimal prognostic system for liver cirrhosis: the model for end‐stage liver disease and beyond

Selecting an optimal prognostic system for liver cirrhosis: the model for end‐stage liver disease and beyond

Reply: To MELD or not to MELD: Early assessment of prognosis in fulminant hepatic failure

Model for End-Stage Liver Disease and liver cirrhosis-related complications

Contact Info

Product

Resources

About