Calculateur de l’ancienne politique américaine MELD-Na de l’OPTN (2016–2023)

État

clinical-review-pending

Version de la méthode

Retired US OPTN Policy 9.1.D MELD-Na arithmetic, retired-optn-policy-9.1.d-meld-na-2016-01-11-to-2023-07-12, sources checked 2026-08-12: floor total bilirubin mg/dL, INR, and serum creatinine mg/dL below 1 to 1; cap creatinine above 4 or set it to 4 for at least two dialysis treatments or at least 24 hours CVVHD in the previous 7 days; classic coefficient sum = 0.957×ln(creatinine) + 0.378×ln(bilirubin) + 1.120×ln(INR) + 0.643; round that sum arithmetic-half-up to the nearest 0.1, multiply by 10, and limit the initial MELD to 6–40; limit serum sodium mmol/L to 125–137; only when initial MELD is greater than 11 calculate initial MELD + 1.32×(137−sodium) − 0.033×initial MELD×(137−sodium); then round arithmetic-half-up to the nearest whole and limit the retired-policy integer to 6–40. Exact midpoint ties use an explicit arithmetic-half-up implementation convention pending clinical review because the archived policy prose does not define an IEEE-754 tie algorithm

Population

Historical US liver-transplant candidates who were at least 12 years old at the historical score date and for whom the retired US OPTN MELD-Na policy effective 2016-01-11 through 2023-07-12 is independently known to be the intended version. Exact final total serum bilirubin, serum sodium, INR, serum creatinine, fixed policy units, one coherent historical laboratory context, and both dialysis/CVVHD criteria relative to the serum-creatinine test must be independently verified. This arithmetic cannot establish historical certification, recertification, exception points, listing status, record validity, or the score that controlled a match run.

Limites et exclusions

Current MELD 3.0 and its albumin or sex inputs, candidates younger than 12 at the historical score date, PELD, another historical policy interval, or an unknown score date, policy version, or age-at-score context. · Unknown dialysis or CVVHD history treated as no; inferred, imputed, defaulted, carried-forward, mismatched, uncertified, or unverified laboratory identities, values, dates, context, or units. · The different Biggins 2006 or Kim 2008 research sodium equations; comparing retired MELD-Na and current MELD 3.0 as interchangeable scores; silently applying coefficients or bounds from another version; or silently substituting another continuous renal-replacement identity for the policy-named CVVHD criterion. · Calling this output a current or authoritative historical allocation score, allocation priority, candidacy or eligibility decision, Status 1A/1B, exception score, certified record, recertification result, match-run result, mortality probability, risk category, diagnosis, prognosis, or treatment recommendation. · Delaying, withholding, or altering indicated fluids, dialysis, CVVHD, anticoagulation, or other care to influence arithmetic; any listing, allocation, management, disposition, or treatment decision.

• https://www.hrsa.gov/sites/default/files/hrsa/optn/optn_policy_notice_07-24-2014.pdf
• https://unos.org/news/policy-and-system-changes-effective-january-11-2016-adding-serum-sodium-to-meld-calculation/
• https://www.hrsa.gov/sites/default/files/hrsa/optn/policy-guid-change_impr-liv-alloc-meld-peld-sta-1a-sta-1b_liv.pdf
• https://pubmed.ncbi.nlm.nih.gov/11172350/
• https://pubmed.ncbi.nlm.nih.gov/18768945/

Outil importé de la bibliothèque PharmaTek de MDose. Aucune date de révision clinique indépendante n’est documentée dans cette version.

Bibliothèque source

PharmaTek · MDose

Version importée

4b66536936ed

État de publication

Révision clinique en cours