MELD Score Calculator
End-Stage Liver Disease Severity Scoring
Patient Data
MELD 3.0 Score
Current Standard
MELD-Na
Previous Standard
Original MELD
Unadjusted
Clinical Utility & Evidence
The Model for End-Stage Liver Disease (MELD) is a validated severity index for patients with chronic liver disease. It is the primary tool used by the United Network for Organ Sharing (UNOS) for prioritizing allocation of liver transplants.
Evolution to MELD 3.0: In July 2023, the OPTN adopted MELD 3.0 to address disparities in the previous models. Specifically, the original equations underestimated renal dysfunction in women (who typically have lower muscle mass and thus lower creatinine) and failed to account for hypoalbuminemia, which is a strong independent predictor of mortality.
Key Changes from MELD-Na
- Sex Adjustment: Adds 1.33 points for female patients.
- Albumin: Now included (lower albumin increases score).
- Creatinine Cap: Lowered from 4.0 to 3.0 mg/dL.
- Interactions: Accounts for interaction between Sodium/Bilirubin and Albumin/Creatinine.
Calculation Rules
| Variable | Original Constraints | MELD 3.0 Constraints |
|---|---|---|
| Creatinine | Cap 4.0 mg/dL | Cap 3.0 mg/dL |
| Sodium | 125 - 137 mEq/L | 125 - 137 mEq/L |
| Albumin | Not Used | 1.5 - 3.5 g/dL |
| Dialysis | Set Cr = 4.0 | Set Cr = 3.0 |
3-Month Mortality Risk Table
Estimated mortality rates based on MELD score ranges (OPTN Data).
| MELD Score | Mortality |
|---|---|
| ≤ 9 | 1.9% |
| 10 – 19 | 6.0% |
| 20 – 29 | 19.6% |
| 30 – 39 | 52.6% |
| ≥ 40 | 71.3% |
Mathematical Models
NEW MELD 3.0 Formula
+ 1.33 (if female)
+ 4.56 × ln(Bilirubin)
+ 0.82 × (137 – Sodium)
– 0.24 × (137 – Sodium) × ln(Bilirubin)
+ 9.09 × ln(INR)
+ 11.14 × ln(Creatinine)
+ 1.85 × (3.5 – Albumin)
– 1.83 × (3.5 – Albumin) × ln(Creatinine) + 6
MELD-Na
MELD + 1.32 × (137 – Na)
– [0.033 × MELD × (137 – Na)]
Original MELD
[3.78 × ln(Bili)] + [11.2 × ln(INR)]
+ [9.57 × ln(Cr)] + 6.43
References
- Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The Model for End-stage Liver Disease Updated for the Modern Era. Gastroenterology. 2021;161(6):1887-1895.
- Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
- Biggins SW, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130(6):1652-1660.
- OPTN/UNOS Policy 9.1 (Liver Allocation). Organ Procurement and Transplantation Network.