MELD Score Calculator (MELD, MELD-Na, MELD 3.0)

Liver disease severity score from bilirubin, INR, creatinine, sodium and albumin.

MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43, with values below 1 set to 1 and creatinine capped at 4. Bilirubin 2.5, INR 1.6, creatinine 1.3 and sodium 132 give MELD 18 and MELD-Na 21.

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How to use it

1. Enter bilirubin, INR, creatinine, sodium and albumin.
2. Choose sex and whether the patient had dialysis twice in the past week.
3. Compare MELD, MELD-Na and MELD 3.0.

What you enter

• Bilirubin (mg/dL)
• INR
• Creatinine (mg/dL)
• Sodium (mmol/L)
• Albumin (g/dL)
• Sex
• Dialysis

What you get

• MELD
• MELD-Na
• MELD 3.0
• Estimated 90-day mortality

Formula

MELD(i) = 0.957 ln(Cr) + 0.378 ln(Bili) + 1.120 ln(INR) + 0.643; MELD = 10 × MELD(i) | MELD-Na = MELD + 1.32(137 − Na) − 0.033 × MELD(137 − Na)

Lab values below 1.0 are set to 1.0; creatinine is capped at 4.0; sodium is bounded to 125–137 mmol/L (125–137 in MELD 3.0 as well). MELD-Na is applied when MELD > 11.

Worked example

Input: Bilirubin 2.5, INR 1.6, creatinine 1.3, Na 132, albumin 3.0, male

Result: MELD 18, MELD-Na 21, MELD 3.0 21

About 20% estimated 90-day mortality; transplant evaluation is appropriate.

Questions

What does a MELD score mean?

It predicts 90-day mortality in chronic liver disease. Scores range from 6 to 40; under 10 is about 2% risk, 20–29 about 20%, and 40 or above over 70%.

What is MELD 3.0?

An updated score that adds albumin and sex and refines sodium and creatinine terms. OPTN adopted it for US liver allocation in July 2023 because it reduces a disadvantage women had under MELD-Na.

What MELD score qualifies for a liver transplant?

Referral is usually considered at MELD 15 or higher, when the benefit of transplant tends to exceed its risk.

Why is creatinine set to 4 with dialysis?

Dialysis lowers measured creatinine, so patients on dialysis twice in the past week get the maximum creatinine value to reflect their kidney failure.

Limitations

• For clinicians; not validated for acute liver failure.
• Mortality bands are approximate and from older cohorts.

References

• Kim WR et al. (2021) Gastroenterology 161(6):1887-1895.
• Kim WR et al. (2008) New England Journal of Medicine 359:1018-1026.

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All free tools · By Dr. Zubair Khalid, DVM, MS, PhD.