MELD Score Calculator
Calculate the MELD (Model for End-Stage Liver Disease) score to assess liver disease severity and predict mortality risk for transplant prioritization.
What is the MELD score and what is it used for?
MELD (Model for End-Stage Liver Disease) is a scoring system that predicts 3-month mortality in patients with end-stage liver disease. Developed in 2001, it uses three lab values (bilirubin, INR, creatinine) to score 6-40 points. Primary use: prioritizing patients for liver transplantation in the US and many countries. Higher scores = sicker patients = higher transplant priority. Also predicts surgical risk, guides treatment decisions, and assesses cirrhosis severity. Updated in 2016 to include sodium (MELD-Na) for better accuracy.
How is the MELD score calculated?
MELD formula: 3.78*ln(bilirubin mg/dL) + 11.2*ln(INR) + 9.57*ln(creatinine mg/dL) + 6.43. Rules: If dialyzed twice in past week, creatinine = 4.0 (maximum). Minimum value for any variable = 1.0. Result rounded to nearest whole number, range 6-40 (scores <6 rounded to 6). Natural logarithm (ln) used because relationship between lab values and mortality is exponential. Original MELD could go higher, but UNOS caps at 40 for transplant allocation.
What does my MELD score mean for survival?
MELD score mortality estimates (3-month): 6-9 = 1.9% mortality (compensated cirrhosis), 10-19 = 6% (mild decompensation), 20-29 = 19.6% (moderate-severe), 30-39 = 52.6% (severe), 40 = 71.3% (critical). Transplant priority: <15 = may not need transplant, 15-24 = moderate priority, 25-29 = high priority, 30-39 = very high, >=40 = highest. Exception points given for hepatocellular carcinoma, hepatopulmonary syndrome. MELD recalculated regularly as condition changes; score can improve with treatment or worsen with progression.
What is MELD-Na and how does it differ from MELD?
MELD-Na (MELD-Sodium) adds serum sodium to standard MELD, implemented by UNOS in 2016. Formula: MELD-Na = MELD + 1.32*(137-Na) - [0.033*MELD*(137-Na)]. Sodium capped at 120-137 mEq/L. Why: Hyponatremia (low sodium) indicates worse prognosis independent of bilirubin/INR/creatinine. MELD-Na better predicts waitlist mortality, especially in patients with ascites/fluid retention. Most transplant centers now use MELD-Na for allocation. Standard MELD still used for some clinical decisions and research.
Can my MELD score improve?
Yes, MELD can improve with treatment: 1) Treat underlying cause (antivirals for hepatitis, stop alcohol). 2) Manage complications (diuretics for ascites improves creatinine/sodium, lactulose/rifaximin for hepatic encephalopathy). 3) Nutrition optimization. 4) Avoid nephrotoxic drugs. 5) Treat infections promptly. Example: Patient with alcoholic cirrhosis, MELD 25, stops drinking, receives treatment → MELD drops to 15 over months, may avoid transplant. Conversely, continued liver injury or complications (bleeding, infection, kidney failure) worsen MELD. Monitor regularly.