Meld Score Calculator
Calculate the Model for End-Stage Liver Disease score for transplant prioritization. Enter values for instant results with step-by-step formulas.
Reviewed by Rahul Singh, Health & Wellness Specialist
Formula
MELD = 10 x (0.957 x ln(Creatinine) + 0.378 x ln(Bilirubin) + 1.120 x ln(INR) + 0.643)
Where Bilirubin is in mg/dL, Creatinine is in mg/dL (capped at 4.0, set to 4.0 for dialysis patients), and INR is unitless. Values below 1.0 are set to 1.0. The result is rounded to the nearest integer and bounded between 6 and 40. MELD-Na further adjusts for serum sodium (bounded 125-137 mEq/L).
Worked Examples
Example 1: Moderate Liver Disease Assessment
Problem:A patient has bilirubin 3.5 mg/dL, creatinine 1.8 mg/dL, and INR 1.6. Calculate the MELD score.
Solution:MELD = 10 x (0.957 x ln(1.8) + 0.378 x ln(3.5) + 1.120 x ln(1.6) + 0.643)\n= 10 x (0.957 x 0.5878 + 0.378 x 1.2528 + 1.120 x 0.4700 + 0.643)\n= 10 x (0.5625 + 0.4736 + 0.5264 + 0.643)\n= 10 x 2.2055 = 22.06\nMELD Score = 22
Result:MELD Score: 22 (Moderate-to-severe liver disease, 3-month mortality ~19.6%)
Example 2: Patient on Dialysis with Hyponatremia
Problem:A dialysis patient has bilirubin 5.0 mg/dL, INR 2.1, sodium 128 mEq/L. Calculate MELD and MELD-Na.
Solution:Creatinine set to 4.0 for dialysis.\nMELD = 10 x (0.957 x ln(4.0) + 0.378 x ln(5.0) + 1.120 x ln(2.1) + 0.643)\n= 10 x (1.327 + 0.608 + 0.832 + 0.643) = 10 x 3.41 = 34.1\nMELD = 34\nMELD-Na = 34 + 1.32 x (137-128) - 0.033 x 34 x (137-128)\n= 34 + 11.88 - 10.10 = 35.78 = 36
Result:MELD: 34 | MELD-Na: 36 (Severe, high priority for transplant)
Frequently Asked Questions
What is the MELD score and what is it used for?
The Model for End-Stage Liver Disease (MELD) score is a numerical scale ranging from 6 to 40 that is used to assess the severity of chronic liver disease and predict short-term mortality. It was originally developed to predict survival in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures but was adopted by the United Network for Organ Sharing (UNOS) in 2002 to prioritize liver transplant allocation. A higher MELD score indicates more severe liver disease and greater urgency for transplantation. The score is recalculated periodically, and patients with higher scores are given priority on the transplant waiting list.
What laboratory values are needed to calculate the MELD score?
The MELD score requires three laboratory values drawn from a blood test: serum bilirubin (which measures the liver ability to excrete bile), serum creatinine (which reflects kidney function, often impaired in advanced liver disease), and the International Normalized Ratio or INR (which measures the blood clotting ability and reflects the liver synthetic function). These values must be obtained within 48 hours of each other for accurate scoring. If any value is less than 1.0, it is rounded up to 1.0 for the calculation. For patients on dialysis at least twice in the prior week, creatinine is automatically set to 4.0 mg/dL to reflect the severe kidney involvement.
What is MELD-Na and how does it differ from the original MELD?
MELD-Na (also called MELD-Sodium) is an updated version of the MELD score that incorporates serum sodium levels into the calculation. Research showed that low sodium (hyponatremia) is an independent predictor of mortality in patients with cirrhosis and ascites, and the original MELD score did not account for this. The MELD-Na score was officially adopted by UNOS in January 2016 for liver transplant allocation. Sodium values below 125 mEq/L are set to 125, and values above 137 are set to 137 in the formula. The MELD-Na score provides a more accurate prediction of waitlist mortality compared to the original MELD score, particularly for patients with moderate liver disease.
How does the MELD score affect liver transplant eligibility?
In the United States, the MELD score is the primary tool used by UNOS to allocate deceased donor livers. Patients are ranked on the waiting list by their MELD score, with higher scores receiving priority. Generally, patients need a MELD score of 15 or higher to be listed for transplant, though this varies by transplant center and region. Certain conditions such as hepatocellular carcinoma receive standardized MELD exception points because their mortality risk is not fully captured by laboratory values alone. The score is updated regularly: every 7 days for scores of 25 or above, every 30 days for scores between 19 and 24, and every 90 days for lower scores.
References
Reviewed by Rahul Singh, Health & Wellness Specialist · Editorial policy