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MELD-Plus
MELD-Plus is a risk score to assess severity of chronic liver disease. The score includes nine variables as effective
MELD-Plus
predictors for 90-day mortality after a discharge from a cirrhosis-related admission. The variables include all Model for
End-Stage Liver Disease (MELD)'s components, as well as sodium, albumin, total cholesterol, white blood cell count, Medical diagnostics
age, and length of stay. MELD-Plus was created as a result of a collaboration between Massachusetts General Hospital Purpose Assess severity of
and IBM.[1] chronic liver disease

The development of MELD-Plus was based on using unbiased approach toward discovery of biomarkers. In this approach, a feature selection machine learning
algorithm observes a large collection of health records and identifies a small set of variables that could serve as the most efficient predictors for a given medical
outcome. An example for a notable feature selection method is lasso (least absolute shrinkage and selection operator).[2]

Contents
Press coverage
External validation
Potential of alternative scores to extend life expectancy
Criticism of machine learning in prediction modeling
Source code
References

Press coverage
Johnson HR. Developing a new score: how machine learning improves risk prediction.[3]

Livernois C. Harvard researchers develop predictive model for cirrhosis outcomes.[4]

Goedert J. IBM taps machine learning to predict cirrhosis mortality rates.[5]

Cohen JK. Harvard, IBM researchers develop prediction model for cirrhosis outcomes.[6]

Massachusetts General Hospital (Snapshot of Science).[7]

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External validation
A study published in April 2018 in Surgery, Gastroenterology and Oncology reported on the increased accuracy of using MELD-Plus vs. MELD in predicting early
acute kidney injury after liver transplantation.[8]

Potential of alternative scores to extend life expectancy

United Network for Organ Sharing proposed that MELD-Na score (an extension of MELD) may better rank candidates based on their risk of pre-transplant
mortality and is projected to save 50-60 lives total per year.[9] Furthermore, a study published in the New England Journal of Medicine in 2008, estimated that
using MELD-Na instead of MELD would save 90 lives for the period from 2005 to 2006.[10] In his viewpoint published in June 2018, co-creator of MELD-Plus, Uri
Kartoun, suggested that " ...MELD-Plus, if incorporated into hospital systems, could save hundreds of patients every year in the United States alone."[11]

Criticism of machine learning in prediction modeling

Chen & Asch 2017 wrote: "With machine learning situated at the peak of inflated expectations, we can soften a subsequent crash into a “trough of disillusionment”
by fostering a stronger appreciation of the technology’s capabilities and limitations." However, the authors further added "Although predictive algorithms cannot
eliminate medical uncertainty, they already improve allocation of scarce health care resources, helping to avert hospitalization for patients with low-risk pulmonary
embolisms (PESI) and fairly prioritizing patients for liver transplantation by means of MELD scores."[12]

Source code
A sample code for calculating MELD-Plus is available in GitHub.[13]

References
1. Kartoun, Uri; Corey, Kathleen E; Simon, Tracey G; Zheng, Hui; Aggarwal, Rahul; Ng, Kenney; Shaw, Stanley Y (2017). "The MELD-Plus: A generalizable
prediction risk score in cirrhosis" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656314). PLoS ONE. 12 (10): e0186301. doi:10.1371/journal.pone.0186301
(https://doi.org/10.1371/journal.pone.0186301). PMC 5656314 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656314)  . PMID 29069090 (https://www.ncbi.
nlm.nih.gov/pubmed/29069090).
2. Zou H. The adaptive lasso and its oracle properties. Journal of the American Statistical Association. Volume 101, 2006 - Issue 476. 2006.
3. https://www.mddionline.com/developing-new-score-how-machine-learning-improves-risk-prediction
4. https://www.clinical-innovation.com/topics/clinical-practice/harvard-researchers-develop-predictive-model-cirrhosis-outcomes
5. https://www.healthdatamanagement.com/news/ibm-taps-machine-learning-to-predict-cirrhosis-mortality-rates
6. https://www.beckershospitalreview.com/data-analytics-precision-medicine/harvard-ibm-researchers-develop-prediction-model-for-cirrhosis-outcomes.html
7. https://www.massgeneral.org/research/news/SnapshotScience/Snapshot-2017/snapshot-science-October-2017.aspx

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8. Marian-Irinel, Marian-Tudoroiu; Constantin, Georgiana; Pâslaru, Liliana; Iacob, Speranţa; Gheorghe, Cristian; Popescu, Irinel; Tomescu, Dana; Simona
Gheorghe, Liliana (2018). "The Combination of Serum Cystatin C, Urinary Kidney Injury Molecule-1 and MELD plus Score Predicts Early Acute Kidney Injury
after Liver Transplantation" (https://www.sgo-iasgo.com/article/the-combination-of-serum-cystatin-c,-urinary-kidney-injury-molecule-1-and-meld-plus-score-pre
dicts-early-acute-kidney-injury-after-liver-transplantation). Surgery, Gastroenterology and Oncology. 23 (2): 121–126.
9. "Meeting agenda" (https://optn.transplant.hrsa.gov/media/1834/liver_boardreport_20140702.pdf) (PDF). optn.transplant.hrsa.gov. 2014.
10. Kim, WR; Biggins, SW; Kremers, WK; Wiesner, RH; Kamath, PS; Benson, JT; Edwards, E; Therneau, TM (2008). "Hyponatremia and mortality among patients
on the liver-transplant waiting list". N Engl J Med. 359 (10): 1018–6. PMID 18768945 (https://www.ncbi.nlm.nih.gov/pubmed/18768945).
11. Kartoun, Uri (2018). "Toward an accelerated adoption of data-driven findings in medicine" (https://link.springer.com/article/10.1007%2Fs11019-018-9845-y).
Medicine, Health Care and Philosophy.
12. Chen, Jonathan H; Asch, Steven M (2017). "Machine Learning and Prediction in Medicine — Beyond the Peak of Inflated Expectations". New England Journal
of Medicine. 376 (26): 2507–2509. doi:10.1056/NEJMp1702071 (https://doi.org/10.1056/NEJMp1702071). PMID 28657867 (https://www.ncbi.nlm.nih.gov/pub
med/28657867).
13. "kartoun/meld-plus" (https://github.com/kartoun/meld-plus). GitHub.

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