For healthcare professionals
MELD score calculator (MELD, MELD-Na and MELD 3.0)
The Model for End-Stage Liver Disease (MELD) score estimates short-term survival in adults with end-stage liver disease, and in the US it has been used to rank candidates on the liver transplant waiting list. This calculator gives the original MELD, MELD-Na and MELD 3.0 side by side from the same lab values. It is written for clinicians and is not a diagnosis.
Lab values
US units. Use values from the same day. Nothing you enter leaves this page.
What you will see
MELD, MELD-Na and MELD 3.0 for the same lab values, with the bounds the formulas apply.
Educational only, not medical advice. Not a diagnosis and not a transplant listing decision.
Source
Kim WR et al., Gastroenterology 2021 (MELD 3.0). The MELD, MELD-Na and MELD 3.0 formulas and their bounds are as printed in the Methods and Results of that paper; the tests check this tool against the 8 example patients in its Table 4.
Validated in
MELD 3.0 was built and checked in adults aged 18 or older newly placed on the US liver transplant waiting list from January 2016 to December 2018 (OPTN registry): 20,587 in the development set and 8,823 in the validation set. People with a previous liver transplant, most multi-organ listings and exception points were left out.
Limits
Adults with end-stage liver disease only; not for children. It predicts survival up to 90 days on the waiting list and does not include ascites, encephalopathy, frailty or the cause of liver disease. Lab error, anticoagulants that raise the INR and recent albumin infusion can move the score. Transplant programs use the score that current national policy specifies; this tool does not decide listing or priority.
Urgent symptoms
General safety advice (not part of the published score): a person with liver disease who vomits blood, passes black or bloody stools, becomes confused or very drowsy, or has a high fever with a swollen belly needs emergency care now. Call 911.
How the three scores are calculated
MELD = 9.57 × ln(creatinine) + 3.78 × ln(bilirubin) + 11.20 × ln(INR) + 6.43, rounded to a whole number. Creatinine, bilirubin and INR below 1.0 are set to 1.0. Creatinine is set to 4.0 mg/dL if it is 4 or higher, or if the patient had 2 or more dialysis treatments in the past week (Kim 2021). MELD was first described as a model to predict survival in end-stage liver disease (Kamath 2001).
MELD-Na = MELD + 1.32 × (137 − Na) − [0.033 × MELD × (137 − Na)], rounded, with sodium bounded between 125 and 137 mmol/L as defined by the OPTN. For US allocation it is applied only when MELD is above 11 (Kim 2021). The 2008 study that first added sodium used a slightly different form with sodium bounded between 125 and 140 mmol/L (Kim 2008); this tool uses the OPTN form printed in the 2021 paper.
MELD 3.0 = 1.33 (if female) + 4.56 × ln(bilirubin) + 0.82 × (137 − Na) − 0.24 × (137 − Na) × ln(bilirubin) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5 − albumin) − 1.83 × (3.5 − albumin) × ln(creatinine) + 6, rounded (Kim 2021). Bilirubin, INR and creatinine below 1.0 are set to 1.0, creatinine has an upper bound of 3.0 mg/dL, sodium is bounded between 125 and 137 mmol/L and albumin between 1.5 and 3.5 g/dL (Kim 2021). The paper does not print a separate dialysis rule for MELD 3.0; for a patient on dialysis this tool uses the 3.0 mg/dL creatinine ceiling. Check current national policy for how dialysis is handled.
ln is the natural logarithm. Bilirubin and creatinine are in mg/dL, sodium in mmol/L and albumin in g/dL.
What changed in MELD 3.0
MELD 3.0 adds female sex and serum albumin, adds interactions between bilirubin and sodium and between albumin and creatinine, and lowers the creatinine ceiling to 3.0 mg/dL (Kim 2021). The authors added sex partly because serum creatinine overestimates kidney function in women, which can understate their risk of death (Kim 2021). In the validation set, MELD 3.0 separated patients who died from those who survived slightly better than MELD-Na (concordance 0.869 versus 0.862), and in a simulation of allocation it was linked with fewer waitlist deaths (7,788 versus 7,850) (Kim 2021). MELD-Na had been used to set US liver allocation priority since 2016 (Kim 2021).
Example patients from the 2021 paper
Table 4 of the paper shows how the scores and predicted waitlist mortality move together (Kim 2021). This calculator reproduces all of its scores.
| Sex | Bilirubin | Na | INR | Creatinine | Albumin | MELD | MELD-Na | MELD 3.0 | 90-day mortality |
|---|---|---|---|---|---|---|---|---|---|
| M | 2.5 | 131 | 1.0 | 1.2 | 3.8 | 12 | 18 | 16 | 2.6% |
| F | 2.5 | 131 | 1.0 | 1.2 | 3.8 | 12 | 18 | 17 | 3.1% |
| M | 6.0 | 131 | 1.5 | 1.5 | 3.5 | 22 | 26 | 25 | 12.1% |
| M | 6.0 | 131 | 1.5 | 1.5 | 2.2 | 22 | 26 | 26 | 14.5% |
| F | 6.0 | 131 | 1.5 | 1.5 | 2.2 | 22 | 26 | 27 | 17.5% |
| M | 12.0 | 128 | 2.2 | 1.8 | 2.0 | 30 | 33 | 34 | 47.1% |
| M | 12.0 | 128 | 2.2 | 2.8 | 2.0 | 35 | 36 | 38 | 72.3% |
| F | 12.0 | 128 | 2.2 | 2.8 | 2.0 | 35 | 36 | 39 | 79.1% |
Mortality is the predicted 90-day waitlist mortality the paper gives for MELD 3.0 in each example (Kim 2021). For a patient with the average score in the development set (MELD 3.0 of 20), predicted mortality was 1.9% at 30 days and 5.4% at 90 days (Kim 2021). These are waitlist figures from US transplant candidates, not a prognosis for an individual patient.
Related tools
MELD is for established end-stage liver disease. To look for liver scarring earlier, the FIB-4 calculator uses age, AST, ALT and platelets, the APRI calculator uses AST and platelets, and the NAFLD fibrosis score adds BMI, blood sugar and albumin. To grade liver function in cirrhosis by class A, B or C, use the Child-Pugh score calculator. For kidney function from creatinine, see the eGFR calculator or, for drug dosing, the creatinine clearance calculator (Cockcroft-Gault). Another clinician score on this site is the CURB-65 calculator for pneumonia severity.
Sources
- Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SW, Wood NL, Gentry SE, Kwong AJ. MELD 3.0: The Model for End-stage Liver Disease Updated for the Modern Era. Gastroenterology. 2021;161(6):1887-1895.e4. doi:10.1053/j.gastro.2021.08.050. PMID 34481845. pmc.ncbi.nlm.nih.gov/articles/PMC8608337/
- Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018-1026. doi:10.1056/NEJMoa0801209. PMID 18768945. pmc.ncbi.nlm.nih.gov/articles/PMC4374557/
- Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470. doi:10.1053/jhep.2001.22172. PMID 11172350. doi.org/10.1053/jhep.2001.22172
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