Cirrhosis Support Group

Cirrhosis is a consequence of chronic liver disease, most commonly caused by alcoholism and hepatitis C. Ascites is the most common complication of cirrhosis and is associated with a poor quality of life, increased risk of infections, and a poor long term outcome. Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications.

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MELD scores (again) expert required!

Does anyone out there understand what the MELD scores really mean?

I understand the scoring system in that a score of 6 (less ill) apparently though than what I'm not sure.

A score of 40 (gravely ill).

The scores are used to determine how urgently a patient needs a transplant in the next three months.

I understand the chemicals/tests they do:

Bilirubin which measures how effectively the liver excretes bile.
INR which measures blood clotting facors.
Creatinine which measures kidney functions.

So, running these numbers through a complex formula results in a MELD score. But what does it actually mean?

Back in December 2008 my MELD was 19 and then by February 2009 it had decreased to 11. Does that mean I'm getting better or less worse?
If my MELD continues at 11, is the disease halted or is it still progressing?
If my MELD comes down to 6 am I getting better or just getting worse more slowly?
Can my MELD get below 6? I assume a score of 0 means a perfect liver but could be wrong.

Depending on which state you live in, you could be on the Tx list at a MELD of 12, the average seems to be about 20, unless you live in CA where it is allowed to go much higher.

So, assuming I would need a score of 20 from my current 11, which of the three test (above) is really the determinate one? And if there is one (the graph is logarithmic) what is the best defense against a rising MELD score?

I admit that I have absolutely no understanding of MELD scores, but it is possible that there are other folks out there who are as confused by them as well, so, can anyone explain what they really mean??

Replies

deleted_user
deleted_user

If your MELD score is going down - that's technically a good thing. I guess the best way to think of it is: the higher it goes (closer to 40) the more gravely illl you are. So, even though I know all the trouble you're going through right now, this can be a little bit of a sigh of relief while you are trying to work out those other issues we've spoken about.

There is a potential negative feeling about dropping MELD score, according to some people I've talked to. If you are "on the list" you've technically just gone down to a lower priority of who's in more dire need of a transplant. So, that could translate into a longer time before getting a new liver. Try not to look at it that way. Be thankful that it's not getting worse, quickly - especially because you're still trying to get other things in order and you need as much energy and ability as you can right now.

To answer one of you questions, I have a partial answer. When your MELD score is used to place your priority on the list - the most recent score is used. Meaning, if you had three tests on Jan 1st, Feb 1st and March 1st and your scores were 20, 25 and then 10 - 10 would be the score that they are considering as far as urgency is concerned.

Having said that, what I learned at the Lahey Clinic, and what you've already mentioned, different regions have different numbers of people waiting for transplantation and therefore a person with a 20 in your region could be midway down the list but if he were listed in another region he might be near the top. I personally don't know how you would find out where you are "on the list" in terms of order. But, they transplant co-ordinators at Lahey did tell me of some patients who were able to be listed on multiple regions simultaneously.

http://www.unos.org/resources/meldpeldcalculator.asp

That is a MELD score calculator if you have current blood test results to input data.
deleted_user
deleted_user

Here's a link read away
http://www.mayoclinic.org/meld/mayomodel7.html
deleted_user
deleted_user

I am certain a lower MELD score means your liver function is better, but (like alb said) it can be a double edge sword for some.

I do not believe there are any folks with a true zero walking around. Even the healthiest folks have about a 5.

In my case, at my worst I was a 17 and was on my way to the transplant process. In Oregon (and the Northwest), it's an unwritten '15' before it becomes the issue of whether the surgery itself is more dangerous than the need for the transplant.

My best scenario is that I improve to about an 8 and I should be good to go for the long haul. So far so good!

Nicole