What the MELD score is for
The Model for End-Stage Liver Disease (MELD) score was first developed at the Mayo Clinic to predict survival after a TIPS procedure. Since 2002 it has been used to prioritize patients on the US liver transplant waiting list: the sicker the patient, the higher the score and the sooner an organ is offered.
Three versions
- Original MELD: bilirubin, creatinine and INR.
- MELD-Na (2016): adds serum sodium, because low sodium predicts death independently.
- MELD 3.0 (OPTN, July 2023): adds albumin and female sex, and changes the weights.
MELD 3.0 formula
MELD 3.0 = 1.33 × (female) + 4.56 × ln(bilirubin) + 0.82 × (137 − Na) − 0.24 × (137 − Na) × ln(bilirubin) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5 − albumin) − 1.83 × (3.5 − albumin) × ln(creatinine) + 6
Bounds: bilirubin, creatinine and INR below 1.0 are set to 1.0; creatinine is capped at 3.0 mg/dL (4.0 for MELD-Na) and set to that cap with dialysis twice in the past week; sodium is kept between 125 and 137 mmol/L; albumin between 1.5 and 3.5 g/dL. The result is rounded and kept between 6 and 40.
Worked example
A man with bilirubin 2.0 mg/dL, creatinine 1.2 mg/dL, INR 1.5, sodium 132 mmol/L and albumin 3.0 g/dL:
- ln(2.0) = 0.693, ln(1.2) = 0.182, ln(1.5) = 0.405.
- MELD 3.0 = 3.16 + 4.10 − 0.83 + 3.68 + 2.03 + 0.93 − 0.17 + 6 ≈ 19.
- MELD-Na ≈ 19; the original MELD ≈ 15.
Score and 3-month mortality
| MELD | Approximate 90-day mortality |
|---|---|
| Below 10 | 1.9% |
| 10–19 | 6.0% |
| 20–29 | 19.6% |
| 30–39 | 52.6% |
| 40 | 71.3% |
These figures come from hospitalized patients in the original validation (Wiesner, 2003) and serve as a general guide.
In practice
Transplant evaluation is usually considered from a MELD of about 15, when the survival benefit of a transplant outweighs its risks. Exception points exist for conditions that MELD underestimates, such as liver cancer within transplant criteria. The score is recalculated regularly, more often as it rises.
Limits
INR varies between laboratories, creatinine underestimates kidney problems in people with low muscle mass, and the score does not capture complications such as encephalopathy or recurrent ascites well.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.