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TheModel for End-Stage Liver Disease (MELD) scoring system has been established asa reliable measure of short-term mortality risk in patients with end-stagechronic liver disease. The aim of this study was to evaluate the prognosticvalue of the MELD scoring as a predictor of fulminant hepatic failure (FHF) anddeath in patients with acetaminophen poisoning. Prospectively, serialmeasurements of the 3 MELD components--INR, bilirubin, and creatinine--wereperformed in 460 patients with acetaminophen-induced liver injury. Starting onthe first day after the day of overdose, MELD score was significantly higher inpatients who eventually developed hepatic encephalopathy (HE) than in those whodid not. HE developed in 63 of 142 patients with a MELD score above 18 at 48-72hours after the overdose (positive predictive value 44%) compared with 2 of 182patients with a MELD score of 18 or below (negative predictive value 99%).Among 124 patients with FHF, a threshold MELD score of 33 on the day after theonset of HE had sensitivity of 60%, specificity of 69%, positive predictivevalue of 65%, and negative predictive value of 63%. However, the discriminativepower of MELD score was not superior to that of INR alone or of the King's College Hospital criteria.CONCLUSION: MELD score may be useful as a predictor of FHF in patients admittedwith acetaminophen toxicity. However, as a predictor of death from FHF, MELDscore did not provide more information than the King's College Hospital criteriaor INR alone. Leggil'articolo