MELD Score Calculator
Calculate Model for End-Stage Liver Disease (MELD) and MELD-Na scores to assess liver transplant priority and predict mortality in patients with liver disease.
Calculate MELD Score
3-Month Mortality by MELD Score
| MELD Score Range | Risk Category | 3-Month Mortality |
|---|---|---|
| < 10 | Low | 1.9% |
| 10-19 | Moderate | 6.0% |
| 20-29 | High | 19.6% |
| 30-39 | Very High | 52.6% |
| > 40 | Critical | 71.3% |
Understanding MELD Score
The Model for End-Stage Liver Disease (MELD) score is a widely used scoring system for assessing the severity of chronic liver disease. It was initially developed to predict mortality following transjugular intrahepatic portosystemic shunt (TIPS) procedures but is now used primarily for liver transplant allocation.
MELD Formula
MELD = 10 × (0.957 × ln(Cr) + 0.378 × ln(Bili) + 1.12 × ln(INR) + 0.643)MELD-Na Formula
MELD-Na = MELD + 1.32 × (137 - Na) - 0.033 × MELD × (137 - Na)Key Considerations
- Minimum values: Bilirubin, Creatinine, and INR are set to 1.0 if lower
- Maximum creatinine: Capped at 4.0 mg/dL
- Dialysis: If patient had dialysis 2+ times in past week or CRRT for 24+ hours, creatinine is automatically set to 4.0
- Sodium range: For MELD-Na, sodium is capped between 125-137 mEq/L
- Score range: Final MELD/MELD-Na scores are between 6 and 40
Clinical Applications
- Transplant Allocation: Used by UNOS to prioritize patients for liver transplantation
- Mortality Prediction: Predicts 3-month mortality in patients with end-stage liver disease
- Treatment Decisions: Helps guide timing of interventions and procedures
- Exception Points: Certain conditions (HCC, hepatopulmonary syndrome) may qualify for additional points
MELD-Na vs MELD
MELD-Na incorporates serum sodium and has been shown to be superior to MELD alone in predicting mortality. Since January 2016, UNOS has used MELD-Na for liver transplant allocation in the United States. Lower sodium levels indicate worse prognosis and result in higher MELD-Na scores.
Frequently Asked Questions
What is a MELD score?
The MELD (Model for End-Stage Liver Disease) score is a numerical scale ranging from 6 to 40 that assesses the severity of chronic liver disease. It uses laboratory values (bilirubin, creatinine, INR) to predict 3-month mortality and determine priority for liver transplantation.
What MELD score qualifies for liver transplant?
Patients typically need a MELD score of 15 or higher to be actively listed for liver transplantation in most regions. However, the minimum score varies by location and organ availability. Scores above 25-30 indicate urgent need for transplantation.
How often is MELD score updated?
For patients on the transplant waiting list, MELD scores are recalculated regularly based on updated lab values. Frequency depends on the score: weekly for scores ≥25, every 30 days for scores 19-24, and every 90 days for scores <19.
Can MELD score improve?
Yes, MELD scores can improve with treatment of underlying liver disease, management of complications, or improvement in kidney function. However, in most patients with end-stage liver disease, scores tend to increase over time without transplantation.
What is the difference between MELD and MELD-Na?
MELD-Na includes serum sodium in addition to the standard MELD components. Low sodium (hyponatremia) is associated with worse outcomes in liver disease. MELD-Na better predicts mortality and has been the standard for transplant allocation since 2016.
What are MELD exception points?
Certain conditions may qualify patients for additional MELD points (exception points) beyond their calculated score. These include hepatocellular carcinoma (HCC) within Milan criteria, hepatopulmonary syndrome, portopulmonary hypertension, and other specified conditions.
Is MELD score used for acute liver failure?
MELD was developed for chronic liver disease. For acute liver failure, other scoring systems like King's College Criteria are more appropriate. However, patients with acute liver failure are typically Status 1A and receive highest priority regardless of MELD score.
What is a normal MELD score?
The minimum MELD score is 6, which represents normal liver function. Scores below 10 indicate minimal liver dysfunction with low short-term mortality risk. Most healthy individuals would have values that calculate to a score of 6.
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