A Potential Further Refinement of the MELD Scoring System

Key variables in the original model for end-stage liver disease (MELD) score for predicting mortality in patients awaiting liver transplantation are total bilirubin, international normalized ratio (INR), and serum creatinine (sCr). The subsequent addition of serum sodium (Na) to the score (MELD-Na) improved performance. However, there is concern that Na and sCr do not accurately assess renal dysfunction, a key driver of mortality in this population.

In the current study, researchers assessed whether replacement of sCr with the estimated glomerular filtration rate (eGFR) — as estimated by the GFR assessment in liver disease (GRAIL) model — improves accuracy in prediction of mortality. They used data from over 17,000 patients on the U.S. liver…