MELD score calculator (MELD-Na and MELD 3.0)
Calculate the MELD and MELD-Na score for adults and children 12 and over with chronic liver disease, using the OPTN rules in force from 2016 to 2023, and see MELD 3.0 and the observed 3-month mortality for the score's tier.
Guides
- What MELD score qualifies for a liver transplant?Why no MELD score qualifies for a liver transplant on its own, the MELD 15 referral rule, the survival benefit at each score, and how the list is ranked.
How this MELD calculator works
This MELD calculator first works out the Model for End-Stage Liver Disease (MELD) score from serum creatinine, total bilirubin and INR, the three lab values in the model Kamath and colleagues validated in 2001, and then adds serum sodium to give MELD-Na, the version Kim and colleagues described in 2008. It applies the rules of the US Organ Procurement and Transplantation Network (OPTN), which ranked liver transplant candidates by MELD-Na from January 2016 until MELD 3.0 replaced it in July 2023. Lab values under 1.0 are set to 1.0. Creatinine over 4.0 mg/dL is set to 4.0, and so is any creatinine when the patient had dialysis at least twice, or 24 hours of continuous veno-venous hemodialysis (CVVHD), in the past week. The first score, MELD(i), is rounded to the tenth decimal place and multiplied by 10. Sodium is added only when MELD(i) is greater than 11, with sodium bounded between 125 and 137 mmol/L. Both scores are capped at 40.
MELD(i) = 10 × [0.957 × ln(creatinine) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643]
MELD-Na (if MELD(i) > 11) = MELD(i) + 1.32 × (137 − Na) − [0.033 × MELD(i) × (137 − Na)]
Creatinine and bilirubin in mg/dL, sodium (Na) in mmol/L. Creatinine 1 mg/dL = 88.4 µmol/L; bilirubin 1 mg/dL = 17.1 µmol/L; albumin 1 g/dL = 10 g/L. Switching units converts the values you typed.
The calculator also shows MELD 3.0, published by Kim and colleagues in Gastroenterology in 2021 from all US wait-list registrations in 2016 to 2018. It adds female sex and serum albumin, updates the coefficients, adds interactions between bilirubin and sodium and between albumin and creatinine, and caps creatinine at 3.0 mg/dL. Bilirubin, INR and creatinine under 1.0 are set to 1.0, sodium is bounded at 125 to 137 mmol/L and albumin at 1.5 to 3.5 g/dL, and the result is rounded to the nearest whole number. The paper set no maximum of 40. This calculator uses a creatinine of 3.0 mg/dL for MELD 3.0 when the dialysis box is ticked.
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
Albumin in g/dL. In the paper's own examples, a woman with bilirubin 6.0 mg/dL, sodium 131, INR 1.5, creatinine 1.5 mg/dL and albumin 2.2 g/dL has MELD 22, MELD-Na 26 and MELD 3.0 of 27, the values this calculator opens with.
MELD score and 3-month mortality
The MELD score tiers below come from Wiesner and colleagues, who applied MELD to 3,437 adults with chronic liver disease added to the US liver transplant waiting list between November 1999 and December 2001. Of these, 412 (12%) died within 3 months, and mortality rose in step with the listing MELD score. MELD predicted 3-month death better than the Child-Turcotte-Pugh score (c-statistic 0.83 vs 0.76). The figures are observed deaths for MELD without sodium in that cohort; the calculator shows the tier for the MELD-Na score, so read them as a guide rather than a personal risk.
| MELD score | Observed 3-month mortality |
|---|---|
| 9 or less | 1.9% |
| 10–19 | 6.0% |
| 20–29 | 19.6% |
| 30–39 | 52.6% |
| 40 or more | 71.3% |
When the MELD score is less accurate
The MELD score depends on lab values that can change for reasons other than liver disease. INR varies between laboratories and rises with anticoagulant treatment, which does not reflect liver function. Creatinine runs lower when muscle mass is low, so MELD can understate kidney dysfunction; Kim and colleagues note that creatinine overestimates kidney function in women, one reason MELD 3.0 adds female sex. Serum sodium can be lowered or raised by fluids and diuretics. MELD does not capture complications such as hepatocellular carcinoma, for which OPTN gives exception points rather than a calculated score. OPTN used MELD for candidates aged 12 and over, and the PELD score for younger children.
Questions
What is the difference between MELD and MELD-Na?
MELD uses creatinine, bilirubin and INR. MELD-Na adds serum sodium, because Kim and colleagues found in 2008 that low sodium predicted 90-day wait-list death on top of MELD, with a larger effect at lower MELD scores. Under OPTN rules, sodium changes the score only when MELD is greater than 11, so MELD-Na equals MELD at 11 or less.
Why does MELD 3.0 differ from MELD-Na?
MELD 3.0 adds female sex and albumin, caps creatinine at 3.0 mg/dL instead of 4.0, and refits the coefficients on 2016 to 2018 data. In its validation set it discriminated slightly better than MELD-Na (c-statistic 0.869 vs 0.862) and moved a net 8.8% of patients who died to a higher MELD tier, especially women. OPTN began using it for liver allocation in July 2023.
Can I enter creatinine and bilirubin in µmol/L?
Yes. Pick µmol/L at the top. The calculator divides creatinine by 88.4 and bilirubin by 17.1 to get mg/dL, and albumin in g/L by 10 to get g/dL, before it runs the formulas.
How is MELD different from the Child-Pugh score?
MELD is calculated only from lab values and was validated to predict 3-month mortality, while the Child-Pugh score adds points for five items, two of them clinical grades (ascites and encephalopathy), and does not include kidney function.
Is my data sent anywhere?
No. The calculation runs in your browser, and the values you type are not sent or stored.
Sources
- Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. doi:10.1053/jhep.2001.22172
- Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91–96. doi:10.1053/gast.2003.50016
- Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–1026. doi:10.1056/NEJMoa0801209
- 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.e4. doi:10.1053/j.gastro.2021.08.050