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MELD Score Calculator

The MELD score calculator (Model for End-Stage Liver Disease) is a tool for evaluating the severity of advanced liver disease and predicting short-term mortality. It relies on key laboratory values—particularly bilirubin, creatinine, and INR—to quantify how urgently a patient might require transplantation. By assigning a numeric value, the MELD calculator helps guide clinical decisions and prioritize those in greatest need of further intervention.

Over time, this score has evolved into several versions, including MELD (2016), MELD Na, and MELD 3.0. These updates incorporate additional factors such as sodium, albumin, and sex, enhancing accuracy and ensuring that transplant allocation aligns with true disease severity. MELD scores range from 6 to 40, with higher values indicating a more severe condition and an increased risk of death. Although the MELD score is a valuable tool, other considerations—like co-existing medical issues and overall patient health—remain essential in clinical decision-making.

MELD 3.0 is the most updated MELD score calculation.

Sex

Current Age (years)

Age at time of liver transplant registration (years).

Dialysis at least twice in the past week

Or CVVHD for ≥24 hours in the past week

Creatinine (mg/dL)

Cr > 4.0 mg/dL is automatically assigned a value of 4.0

Bilirubin (mg/dL)

INR

Sodium mEq/L)

Albumin (g/dL)

MaleFemale

<12≥12

<18≥18

NoYes

Calculate

Meld Score 2016

Estimated 3-month Mortality

Value

Meld Na (Prior UNOS/OPTN Version)

Estimated 3-month Mortality

Value

Meld 3.0

Estimated 90-day Survival

Value

2016 MELD Score Calculator

The 2016 version of the MELD score calculator is the original formula. Bilirubin, creatinine, and INR are the core inputs, and capping rules help avoid overestimates. By providing a numeric score, MELD (2016) indicates the likelihood of three-month mortality. Higher scores correlate with greater risk, guiding clinicians on when to consider advanced interventions such as liver transplantation.

2016 Meld Score Inputs
• Dialysis at least twice in the past week: Creatine is equal to 3.
• Serum Creatinine (mg/dL): Equal to 1 if less than 1. Equal to 3 if greater than 3.
• Serum Bilirubin (mg/dL): Equal to 1 if less than 1.
• INR: Equal to 1 if less than 1.

2016 Meld Score Formula
• 2016 Meld Score = ((0.957 * log(creatinine)) + (0.378 * log(bilirubin)) + (1.12 * log(inr)) + 0.643)*10

2016 Meld Score Estimated 3-month Mortality
• ≤9: 1.9% mortality rate
• 10-19: 6.0% mortality rate
• 20-29: 19.6% mortality rate
• 30-39: 52.6% mortality rate
• ≥40: 71.3% mortality rate

MELD Na Score Calculator

MELD Na was introduced to capture the impact of serum sodium on outcomes for individuals with cirrhosis. Low sodium often signifies fluid imbalance and more advanced disease. By including sodium alongside bilirubin, creatinine, and INR, MELD Na more accurately identifies patients whose short-term mortality risk is higher than indicated by the 2016 MELD score. This refinement aimed to improve fairness in organ allocation and provide a clearer clinical picture of disease progression.

MELD Na Score Inputs
• Age over 12: If under 12, use the PELD calculator.
• Dialysis at least twice in the past week: Creatine is equal to 3.
• Serum Creatinine (mg/dL): Equal to 1 if less than 1. Equal to 3 if greater than 3.
• Serum Bilirubin (mg/dL): Equal to 1 if less than 1.
• INR: Equal to 1 if less than 1.
• Serum Sodium (mEq/L): Equal to 125 if under 125. Equal to 137 if over 137.

MELD Na Score Formula
• MELD(i) = ((0.957 * log(creatinine)) + (0.378 * log(bilirubin)) + (1.12 * log(inr)) + 0.643)
• Rounded to 1 decimal place and multiplied by 10.

If MELD(i) > 11
• MELD Na = MELD(i) + (1.32 * (137 - sodium)) - (0.033 * MELD(i) * (137 - sodium))

If MELD(i) ≤ 11
• MELD Na = MELD(i)

MELD Na Score Estimated 3-month Mortality
• ≤9: 1.9% mortality rate
• 10-19: 6.0% mortality rate
• 20-29: 19.6% mortality rate
• 30-39: 52.6% mortality rate
• ≥40: 71.3% mortality rate

MELD 3.0 Score Calculator

MELD 3.0 is the most recent adaptation, incorporating albumin and a factor for female sex to address observed disparities. Albumin levels help account for nutritional status and hepatic synthetic function, while the sex variable corrects for potential underestimation of disease severity in women. By adding these components to bilirubin, creatinine, INR, and sodium, MELD 3.0 further refines predictions of short-term mortality, aiming for more equitable transplant allocation and a broader reflection of each patient’s physiological condition.

MELD 3.0 Score Inputs
• Sex
• Age over 12: If under 12, use the PELD calculator.
• Age under or equal to or greater than 18.
• Dialysis at least twice in the past week or CVVHD for ≥24 hours in the past week: Creatine is equal to 3.
• Serum Creatinine (mg/dL): Equal to 1 if less than 1. Equal to 3 if greater than 3.
• Serum Bilirubin (mg/dL): Equal to 1 if less than 1.
• INR: Equal to 1 if less than 1.
• Serum Sodium (mEq/L): Equal to 125 if under 125. Equal to 137 if over 137.
• Serum Albumin (g/dL): Equal to 1.5 if under 1.5. Equal to 3.5 if over 3.5.

MELD 3.0 Score Formula
If age is over 12, over 18, and female:
• MELD 3.0 = (1.33) + (4.56 * log(bilirubin)) + (0.82 * (137 - sodium)) - (0.24 * (137 - sodium) * log(bilirubin)) + (9.09 * log(inr)) + (11.14 * log(creatinine)) + (1.85 * (3.5 - albumin)) - (1.83 * (3.5 - albumin) * log(creatinine)) + 6

If age is over 12, over 18, and male:
• MELD 3.0 = (4.56 * log(bilirubin)) + (0.82 * (137 - sodium)) - (0.24 * (137 - sodium) * log(bilirubin)) + (9.09 * log(inr)) + (11.14 * log(creatinine)) + (1.85 * (3.5 - albumin)) - (1.83 * (3.5 - albumin) * log(creatinine)) + 6

If age is over 12, but under 18:
• MELD 3.0 = (4.56 * log(bilirubin)) + (0.82 * (137 - sodium)) - (0.24 * (137 - sodium) * log(bilirubin)) + (9.09 * log(inr)) + (11.14 * log(creatinine)) + (1.85 * (3.5 - albumin)) - (1.83 * (3.5 - albumin) * log(creatinine)) + 7.33

Round MELD 3.0 to no decimals.

MELD 3.0 Estimated 90-day Survival
• MELD 3.0 Estimated 90-day Survival = (0.946 ^ exp((0.17698 * MELD 3.0)-3.56)) * 100

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on the MELD Score Calculator and how to build your practice by listening to the BackTable Podcast.

Ep 473 Portal Hypertension Treatment Strategies: IR & Hepatology Perspectives with Dr. Thomas Leventhal and Dr. Siobhan Flanagan

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References

[1] Kamath, P. S., Wiesner, R. H., Malinchoc, M., Kremers, W., Therneau, T. M., Kosberg, C. L., & Kim, W. R. (2001, February). A model to predict survival in patients with end-stage liver disease. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11172350/
[2] Mayo Clinic. (n.d.). MELD Model for End-Stage Liver Disease (12 and older). Retrieved from https://www.mayoclinic.org/medical-professionals/transplant-medicine/calculators/meld-model-for-end-stage-liver-disease-calculator/itt-20434702
[3] United Network for Organ Sharing (UNOS). (n.d.). MELD Calculator. Retrieved from https://optn.transplant.hrsa.gov/resources/allocation-calculators/meld-calculator/

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