MELD Calculator
Calculate MELD score from bilirubin, creatinine, INR, and sodium to estimate 90-day mortality for liver transplant prioritization.
What Is the MELD Score?
The Model for End-Stage Liver Disease (MELD) score predicts short-term mortality in patients with chronic liver disease and prioritizes candidates for liver transplantation. MELD-Na incorporates serum sodium alongside bilirubin, creatinine, and INR. Higher scores indicate greater disease severity and higher 90-day mortality risk. Compare severity with the Child-Pugh Calculator and prognosis after corticosteroid therapy with the Lille Score Calculator.
MELD-Na Formula
Base MELD = 10 × (0.957 × ln[creatinine] + 0.378 × ln[bilirubin] + 1.12 × ln[INR]) + 6.43. Values are floored at 1 for creatinine, bilirubin, and INR. Creatinine is capped at 4 mg/dL for patients on dialysis. MELD-Na = MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na), with sodium clamped between 125 and 137 mEq/L. The final score is rounded to the nearest integer and bounded between 1 and 40.
MELD Score and Mortality Risk
MELD scores guide transplant listing urgency. Score ≤ 9 carries roughly 1.9% 90-day mortality (low urgency). Scores 10 to 19 have about 6.0% mortality (moderate). Scores 20 to 29 reach approximately 19.6% (high). Scores 30 to 39 carry about 52.6% mortality (very high). A score of 40 corresponds to roughly 71.3% 90-day mortality (critical). MELD is recalculated periodically for waitlisted patients and should be interpreted alongside clinical status, complications, and transplant center policies.
Frequently Asked Questions
What is a normal MELD score?
MELD scores below 10 indicate low short-term mortality risk in the validated model. Scores rise with worsening liver function. Transplant listing thresholds vary by region but often begin around MELD 15 or higher depending on indication.
How does MELD-Na differ from the original MELD?
MELD-Na adds serum sodium to the calculation because hyponatremia independently predicts mortality in cirrhosis. It has replaced the original MELD for transplant allocation in the United States since 2016.
Why is creatinine capped at 4 in MELD?
Creatinine values above 4 mg/dL are capped to prevent extreme renal values from dominating the score. Patients on dialysis receive a creatinine floor of 4 mg/dL regardless of measured level.
What MELD score is needed for liver transplant?
Transplant listing does not require a fixed MELD threshold for all patients. Standard criteria often list at MELD ≥ 15, while exceptions exist for hepatocellular carcinoma and acute liver failure. Allocation priority increases as MELD rises.
How often is MELD recalculated?
For transplant waitlist patients, MELD is typically updated every 7 to 30 days depending on score range. Higher scores require more frequent laboratory updates to reflect current illness severity.
Can MELD score improve with treatment?
Yes. Treating complications such as ascites, variceal bleeding, alcoholic hepatitis, or infection can lower bilirubin, INR, and creatinine, reducing MELD. Abstinence from alcohol and optimized medical management may improve scores over time.
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