Question 1

Does MELD-Na apply to patients on beta-blockers?

Accepted Answer

Yes — beta-blockers do not directly affect MELD-Na components. However, they may mask signs of decompensation. The score itself remains valid regardless of beta-blocker use.

Question 2

Why is sodium included in MELD-Na but not in the original MELD?

Accepted Answer

Hyponatraemia is an independent predictor of mortality in cirrhosis, particularly from complications of ascites and hepatorenal syndrome. Adding sodium to MELD improves the concordance statistic (C-statistic) for 90-day mortality by approximately 0.02–0.03, especially in patients with low MELD scores but significant hyponatraemia.

Question 3

What if the patient has acute kidney injury requiring dialysis?

Accepted Answer

MELD-Na handles this by setting creatinine to 4 mg/dL (the maximum) when the patient has been dialysed ≥ 2 times in the prior week. Dialysis does not affect the sodium adjustment. This prevents a falsely low score in patients whose creatinine is lowered by dialysis.

Question 4

Is MELD-Na used for all causes of liver disease?

Accepted Answer

MELD-Na was validated in patients with end-stage liver disease from all aetiologies. However, it may not perform as well in patients with cholestatic liver disease (PBC, PSC) because bilirubin is disproportionately elevated relative to liver failure severity. Alternative scores such as the UKELD are preferred in some jurisdictions for specific populations.