Many chronic Liver disease end in liver failure.
You should know when to send a patient for specialist treatment a MELD score helps you make that decision
https://www.mdcalc.com/meld-score-model-end-stage-liver-disease-12-older
MELD Score (Model For End-Stage Liver Disease) (12 and older)
This is calculated using the values of
Dialysis at least twice in the past week
No
Yes
Creatinine Norm: 0.7 - 1.3 mg/dL
Cr >4.0 mg/dL is automatically assigned a value of 4.0
Bilirubin Norm: 0.3 - 1.9 mg/dL
INR Norm: 1 - 2
Sodium
ADVICE
- Consider referral to hepatologist or liver transplant center for patients with MELD Score ≥10.
- MELD Score should be periodically re-assessed, as it changes with changing lab values.
- All cirrhosis patients should be periodically screened for hepatocellular carcinoma with serum alpha-fetoprotein (AFP) and by appropriate imaging to see if they can earn “standard MELD exceptions”.
CRITICAL ACTIONS
Standard MELD Exceptions
The following conditions are automatically assigned a MELD Score of 22 (28 in case of hyperoxaluria), with a 10% increase in score every 3 months from diagnosis.
- Hepatocellular carcinoma (HCC) with one lesion between 2 - 5 cm or two to three lesions <3 cm="" criteria="" disease.="" extrahepatic="" ilan="" invasion="" li="" no="" or="" provided="" vascular="">
- Hepatopulmonary syndrome with PaO2 <60 air.="" li="" mmhg="" on="" room="">
- Portopulmonary hypertension, with mean pulmonary artery pressure (mPAP) >25 mmHg at rest but maintained <35 li="" mmhg="" treatment.="" with="">
- Hepatic artery thrombosis 7–14 days post-liver transplantation.
- Familial amyloid polyneuropathy, as diagnosed by identification of the transthyretin (TTR) gene mutation by DNA analysis or mass spectrometry in a biopsy sample and confirmation of amyloid deposition in an involved organ.
- Primary hyperoxaluria with evidence of alanine glyoxylate aminotransferase deficiency (these patients requires combined liver-kidney transplantation).
- Cystic fibrosis with FEV1 (forced expiratory volume in 1 second) <40 li="">
- Hilar cholangiocarcinoma.
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