TOPIC: MELD Score - Do You Need To Treat Now?

The MELD Score is the Model for End-Stage Liver Disease developed by the Mayo Clinic.

en.wikipedia.org/wiki/Model_for_End-Stage_Liver_Disease

It has largely replace the Child-Pugh classification for assessing severity of liver disease.

en.wikipedia.org/wiki/Child-Pugh_score

You can calculate your MELD score here and (somewhat frighteningly) get a prediction of your statistical 3 month mortality.

www.mdcalc.com/meld-score-model-for-end-...isease-12-and-older/

Well that's a bit scary!!

MELD is 33

= 52.6% estimated 3 month mortality - what does that mean exactly?

Is Prothrombin Time the same as INR?

Yes, but no. Prothrombin Time is a measure of how long it takes blood to coagulate.

en.wikipedia.org/wiki/Prothrombin_time

The problem with prothrombin time is that different test methods get slightly different results.

The INR (International Normalised Ratio) essentially just takes the Protrombin Time and divides it by a correction factor.

A normal Prothrombin Time is around 12 seconds.

A normal INR is 1

If the Prothrombin time was 24 seconds, the INR would be ~2

Thank you Dr James, I miscalculated, what a relief.

PT=11, don't know the ISI so will guess INR = 1

Which changes MELD score to 6 (1.9% mortality)

In Feb Creatinine = 37, on day 6 of Tx it was 51 (normal range 45-90).

Does this explain the marked decrease in frequency of urination since starting Tx?

How do you find INR?

I am happy for you Joy. MELD scoring is really only relevant for patients with cirrhosis.

Your creatinine represents a balance between muscle breakdown (usually pretty constant and releases creatinine) and kidney function washing the creatinine out.

Your creatinine is absolutely fine, and nothing to worry about.

When kidneys start to fail creatinine rises. In round numbers a creatinine of:

• 80 represents 100% renal function
• 160 represents 50% renal function
• 320 represents 25% renal function
• 640 represent 12% renal function, and
• 1280 means only 6% renal function

People go pretty well with only 10% renal function, but need dialysis if their renal function falls below this level.

There are many things that can increase muscle breakdown and thus the quantity of creatinine that needs to be excreted by the kidneys.

Eating more meat due to a better appetite or doing more exercise (causing a small increase in muscle breakdown) are quite possibly the reason in you because your creatinine was unusually low to start with, so either you have kick ass kidneys that work much better than the average person, or your meat intake or base level muscle breakdown was lower than usual.

If you want more detail that you could ever possibly need bestpractice.bmj.com/best-practice/monograph/935/diagnosis.html

Thank you again.

I'm now leaving this to the experts and going to count my lucky stars.