Home › Forums › Main Forum › Experts Corner › MELD Score – Do You Need To Treat Now?
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7 November 2015 at 2:23 pm #3478
The MELD Score is the Model for End-Stage Liver Disease developed by the Mayo Clinic.
https://en.wikipedia.org/wiki/Model_for_End-Stage_Liver_Disease
It has largely replace the Child-Pugh classification for assessing severity of liver disease.
https://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.
http://www.mdcalc.com/meld-score-model-for-end-stage-liver-disease-12-and-older/
YMMV
7 November 2015 at 3:08 pm #3479Well that’s a bit scary!!
MELD is 33
= 52.6% estimated 3 month mortality – what does that mean exactly?
7 November 2015 at 3:25 pm #34807 November 2015 at 5:05 pm #3483Is Prothrombin Time the same as INR?
Yes, but no. Prothrombin Time is a measure of how long it takes blood to coagulate.
https://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
8 November 2015 at 1:55 am #3487Thank 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?
8 November 2015 at 2:29 am #3489How 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 HepC8 November 2015 at 2:40 am #3491I 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 http://bestpractice.bmj.com/best-practice/monograph/935/diagnosis.html
YMMV
8 November 2015 at 6:49 am #3494 -
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