• Stage 3 :patients have ascites with or without esophageal varices that have never bled (mortality rate while remaining in this stage is 20% per year )
MELD score
≤8 ≥9
1-Year survival (%)
89 46
3-Year survival (%)
63 34
5-Year survival (%)
51 23
The long-term survival for patients with MELD score ≥9 was significantly shorter than that for patients with MELD score ≤8 (<0.01). .
(6-40 ) 若MELD积分相同则：
△ MELD（30d内积分的差值）>0表明疾病在进展；
好转。
0表明疾病处于相对平稳期或在
see:
/int-med/gi/model/mayomodl-5-unos.htm
to calculate MELD score directly
stage Liver Disease，MELD) Combined MELD 2007年 Lille Model
Child-Turcotte-Pugh肝功能分级
指标
评分标准
1
腹水
无
2 少量
3
中等量以上或难治性 腹水
血清胆红素(umol/L)
<34
34~51
> 51
血清白蛋白(g/l)
> 35
凝血酶原时间(较正 常延长秒数)
2002年2月27日：美国器官共享网/全美器 官获取和移植网(Organ Procurement
and Transplantation Network, OPTN)确 定MELD为选择肝移植患者的新标准
Perioperative Mortality and long-term survival after Hepatic Resection for HCC
血清钠 <135mmol/L， 发生腹水的概率要比血钠水平正常的患者高；
血清钠 <130mmol/L， 更容易出现肝性脑病、自发性细菌性腹膜炎、
肝肾综合征。
Hepatology 2006 Dec; Vol. 44 (6), pp. 1535-42.
MELD-Na
• MELD-Na = MELD +1.0x(140- Na) − 0.025 × MELD ×(140 − Na) .
0.687 0.773
0.790 0.758
MELD-AS may improve predictive accuracy, especially at lower MELD scores
HEPATOLOGY. 2004 Oct; 40:802- 810
Association between serum sodium levels and severity of ascites and complications of cirrhosis
W.Ray Kim et al.N Eng J Med 2008;359:1018-26
Prevalence of Ascites, Severity of Liver Failure, Renal Function, and Mortality According to Hyponatremia
• Use of the MEL-DNa score may reduce mortality among patients on the waiting list.
• The difference between the MELD score and the MELD-Na score was often large enough to make a real difference in the probability of receiving a liver transplant and averting death
or(INR)*
1~3 （正常值范围内）
<1.7
肝性脑病
无
*INR, international normalised ratio.
28~35
4~6 （延长< 2秒）
1.7~2.3 1-2级
< 28
>6 （延长 2秒）
> 2.3 3-4级
总积分 <6 7-9 ≥10
估 计 生 存 率 (%)
分组
一年
• Stage 4 :with portal hypertensive GI bleeding with or without ascites (1-year mortality rate of 57% )
De Franchis R. J Hepatol 2005; 43:167–176.
Hale Waihona Puke decompensated cirrhosis
Journal Of Gastrointestinal Surgery 2005 Dec; Vol. 9 (9), pp. 1207-15
Outcome post-transplant dependent on △MELD between listing and transplant
△MELD ≤+1 90 day survival (%) 95.3 180 day survival (%) 94.9 1 year survival (%) 91.9 2 year survival (%) 88.1 3 year survival (%) 88.1
Liver Transpl,2003.9:19-20
Kiran M.Banbha,Curr opi org transp 2008,13:227-233
RELATIONSHIP BETWEEN MELD AND 3-MONTH MORTALITY IN HOSPITALIZED CIRRHOTIC PATIENTS
△MELD > +1
90.4 84.7 77.8 72.1 72.1
P-value
0.0001 0.0001 0.0001 0.0001 0.0001
Change in MELD score whilst on the transplant waiting list has a significant effect on survival post-transplant
Four clinical stages of cirrhosis
• stage 1 :patients without varices or ascites (mortality is about 1% per year)
• Stage 2 : patients with varices but without ascites or bleeding (mortality rate of about 4% per year )
W.Ray Kim et al.N Eng J Med 2008;359:1018-26
the expected number of transplantations : 67 × (58.4% − 18.5%)+ 43 × (70.4% − 58.4%)=32 Thus, 7% of deaths (32 of 477) that occurred within 3 months after registration on the waiting list might have been prevented
A(轻度)
90-100
B(中度)
70~80
C(重度)
40~45
二年 85 60 35
MELD
(Model for End-stage Liver Disease) (终末期肝病模型)
MELD = 9.57 log e(creatine mg/dl) + 3.78 log e
（积分） (bilirubin mg/dl) +11.20 log e (INR) + 6.4 3 (肝硬化病因：胆汁性或酒精性0，其余为1）
MELD score ≤8 ≥9
No. of patients Perioperative mortality, n (%)
37
0 (0)
45
13 (29)
The perioperative mortality for patients with MELD score ≥9 was significantly greater than that for patients with MELD score ≤8 (<0.01).
HEPATOLOGY. 2004 Oct; 40:802- 810
MELD-AS
Predictors of 180-day Cirrhotic Patient Mortality
CTP
MELD MELD-AS
ALL MELD
0.789
0.83
0.874
MELD<21 MELD>21
0.696 0.586
MELD
9 10-19 20-29 30-39 40
MORTALITY (%; NUMBER/TOTAL)
4 (6/148) 27 (28/103) 76 (16/21)
83 (5/6) 100 (4/4)
Adapted from Wiesner RH, McDiarmid SV, Kamath PS, et al : MELD and PELD: application of survival models to liver allocation. Liver Transpl 2001;7:567-580