caa a22 4500 445796103 CHVBK 20180317145125.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s10620-010-1390-3 doi (NATIONALLICENCE)springer-10.1007/s10620-010-1390-3 Accuracy of MELD Scores in Predicting Mortality in Decompensated Cirrhosis from Variceal Bleeding, Hepatorenal Syndrome, Alcoholic Hepatitis, or Acute Liver Failure As Well As Mortality After Non-transplant Surgery or TIPS [Elektronische Daten] [Mohamad Al Sibae, Mitchell Cappell] Background: To systematically review literature on use of model for end-stage liver disease (MELD) score to determine severity and prognosis of liver disease in various clinical situations and to evaluate its use in decisions regarding therapeutic interventions. Methods: Computerized literature searches using key medical terms; review of authors' extensive files on this subject; and personal clinical experience. Results: The MELD score, a prospectively developed and validated scale for severity of end-stage liver disease, utilizes serum bilirubin, serum creatinine, and international normalized ratio to predict mortality in cirrhotic patients. It has proven clinically useful in increasingly varied clinical situations. The United Network for Organ Sharing uses MELD scores, with bonus points assigned for hepatocellular cancer, to prioritize allocation of deceased donor livers for liver transplantation. This work reviews recent data demonstrating that MELD scores relatively accurately predict mortality in patients with variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, and acute liver failure, as well as assess risks of non-liver transplantation surgery or transjugular intrahepatic portosystemic shunts in cirrhotic patients. MELD scores fail to predict mortality in about 15% of patients with end-stage liver disease. Incorporation of additional parameters, including serum sodium level, serum albumin level, glucose intolerance, or APACHE II score, may potentially improve prognostic accuracy. Conclusions: MELD scores relatively accurately assess severity of liver disease and prognosis in patients with advanced liver disease in general, and in patients with individual complications of liver disease. It is useful in making decisions on potential therapies. Incorporating additional parameters may further improve its prognostic accuracy. Springer Science+Business Media, LLC, 2010 MELD score nationallicence Liver transplantation nationallicence Non-liver transplant surgery nationallicence Liver failure nationallicence Cirrhosis nationallicence Variceal bleeding nationallicence Hepatorenal syndrome nationallicence Alcoholic hepatitis nationallicence TIPS nationallicence Al Sibae Mohamad Division of Transplantation, Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA aut Cappell Mitchell Division of Gastroenterology, Department of Medicine, MOB 233, William Beaumont Hospital, 3535 West Thirteen Mile Road, 48073, Royal Oak, MI, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/4(2011-04-01), 977-987 0163-2116 56:4<977 2011 56 10620 https://doi.org/10.1007/s10620-010-1390-3 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-010-1390-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Al Sibae Mohamad Division of Transplantation, Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA aut NATIONALLICENCE 700 1- Cappell Mitchell Division of Gastroenterology, Department of Medicine, MOB 233, William Beaumont Hospital, 3535 West Thirteen Mile Road, 48073, Royal Oak, MI, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/4(2011-04-01), 977-987 0163-2116 56:4<977 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer