In the group with MELD score 20-29, factors including age, etiology, presence of low serum sodium and persistent ascites may influence the MELD scoring system. The MELD scoring system is a reliable method for predicting mortality in patients with AOCH. In multivariate analysis, in patients with MELD scores 20-29, age (P=0.012), etiology (P=0.024), serum sodium (P=0.005) and ascites (P=0.017) were independent predictors of mortality for MELD scores above 30, only MELD score (P=0.015) was independently predictive. Univariate analysis showed that mortality was significantly related to age (P=0.047), etiology (P=0.039), serum sodium (P=0.029) and ascites (P=0.031) for patients with MELD scores 20-29. The MELD score is calculated with three serum levels : bilirubin. The concordance (c) statistic of 3-month mortality was 0.782. The prospective validation study by CLIP confirmed the prognostic capability of the. The 3-month mortality of AOCH patients with a MELD score of 20-29 was 56.0%, with a score of 30-39 it was 76.5%, and with a score over 40 it was 98.2%. The influential factors on MELD were also assessed. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance (c) statistic. The MELD scores of 300 patients with AOCH were calculated according to the original formula. Hyponatremia is in general considered a predictor of early. Serum sodium is often used as a marker for the severity of a disease, especially in cirrhosis where hyponatremia indicates solute-free water retention and the indirect marker of portal hypertension during cirrhosis. The MELD score was found to be a reliable tool to predict survival in patients with chronic liver disease.To predict prognosis in patients with acute-on-chronic hepatitis (AOCH) using the model for end-stage liver disease (MELD) scoring system and to study the effects of age, sex, etiology, low serum sodium, and persistent ascites on MELD. MELD Na MELD Na 0.025 × MELD × (140 Na) + 140. These values changed minimally when etiology of disease was excluded from the model. The c-statistics for 3-month mortality in the hospitalized, ambulatory noncholestatic, ambulatory PBC and historical groups respectively were 0.87, 0.80, 0.87 and 0.78. The primary outcome measure was 3-month survival and validity was also assessed for predicting 1-week and 1-year survival. The model was assessed in four independent samples, which included patients hospitalized with advanced end-stage liver disease, ambulatory patients with noncholestatic cirrhosis, ambulatory patients with primary biliary cirrhosis (PBC) and a historical group of cirrhotic patients from a period when liver transplantation was not widely available. The model uses measures of serum creatinine, total serum bilirubin, International Normalized Ratio (INR) for prothrombin time and etiology of cirrhosis to assess disease severity. In-Depth : This study, originally published in Hepatology in 2001, evaluated the validity of the MELD score for predicting survival in patients with end-stage liver disease. The MELD criteria are an improvement on these aspects of CTP scores as patients are assigned a numerical score based on objective measures.

Another issue with CTP scores was the subjectivity involved in some of the criteria (e.g., assessment of ascites and encephalopathy). It is calculated according to the following formula: 3 MELD 3.78×ln serum bilirubin (mg/dL) + 11.2×ln INR + 9.57×ln serum creatinine (mg/dL) + 6. Previously, the Child-Turcotte-Pugh (CTP) system was used to rank patients according to urgency and medical need, however the broad classifications made it difficult to rank patients according to severity of disease. MELD uses the patients values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. The investigators found that MELD scores were a good predictor of 1-week, 3-month and 1-year survival, which had important implications for the model’s use in the allocation of donor livers. The study reported here assessed whether the model could reliably predict short-term survival in patients with chronic liver disease. Study Rundown:The Model for End-Stage Liver Disease (MELD) was originally developed to predict outcomes in patients after a transjugular intrahepatic portosystemic shunt (TIPS) procedure. Original Date of Publication: February 2001

Meld score 24 prognosis