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

MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2413

  • DrJames
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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/
YMMV
Last Edit: 3 years 1 week ago by DrJames.
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2414

  • Joy
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Well that's a bit scary!!

MELD is 33

= 52.6% estimated 3 month mortality - what does that mean exactly?
NSW Australia. Genotype 1b 30+ years, F0-F1, VL 91,000 Feb 2015 (740,000 in 2010), Tx naive.
Ordered Sof/Dac from Buyers Club 21 Sept, received 14 Oct.
Virus UNDETECTED at 3 weeks AND 12 weeks (EOT) AND SVR4 AND SVR12 AND SVR24. :-)
A thousand thankyous to Dr James and the amazing FixHepC team.
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2415

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Is Prothrombin Time the same as INR?
NSW Australia. Genotype 1b 30+ years, F0-F1, VL 91,000 Feb 2015 (740,000 in 2010), Tx naive.
Ordered Sof/Dac from Buyers Club 21 Sept, received 14 Oct.
Virus UNDETECTED at 3 weeks AND 12 weeks (EOT) AND SVR4 AND SVR12 AND SVR24. :-)
A thousand thankyous to Dr James and the amazing FixHepC team.
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2418

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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
YMMV
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2422

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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?
NSW Australia. Genotype 1b 30+ years, F0-F1, VL 91,000 Feb 2015 (740,000 in 2010), Tx naive.
Ordered Sof/Dac from Buyers Club 21 Sept, received 14 Oct.
Virus UNDETECTED at 3 weeks AND 12 weeks (EOT) AND SVR4 AND SVR12 AND SVR24. :-)
A thousand thankyous to Dr James and the amazing FixHepC team.
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2424

  • LondonGirl
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How do you find INR?
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2426

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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
YMMV
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MELD Score - Do You Need To Treat Now? 3 years 1 week ago #2429

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Thank you again.

I'm now leaving this to the experts and going to count my lucky stars.
NSW Australia. Genotype 1b 30+ years, F0-F1, VL 91,000 Feb 2015 (740,000 in 2010), Tx naive.
Ordered Sof/Dac from Buyers Club 21 Sept, received 14 Oct.
Virus UNDETECTED at 3 weeks AND 12 weeks (EOT) AND SVR4 AND SVR12 AND SVR24. :-)
A thousand thankyous to Dr James and the amazing FixHepC team.
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