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MELD score calculator

Model for End-stage Liver Disease: MELD, MELD-Na and MELD 3.0.

How severe is this liver disease, and how risky would an operation be?

Written and clinically reviewed by , consultant minimally invasive and bariatric surgeon, Al-Makassed Hospital, Jerusalem, and Assistant Professor of Surgery, Al-Quds University. Last updated .

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The formulas

ScoreUsesNotes
MELD (2002)Bilirubin, INR, creatinine10 × (0.957 ln Cr + 0.378 ln bilirubin + 1.120 ln INR + 0.643). Values below 1 set to 1; creatinine capped at 4 mg/dL.
MELD-Na (2016)Adds sodiumIf MELD > 11: MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na), sodium limited to 125–137.
MELD 3.0 (2023)Adds sex and albuminUsed for liver transplant allocation in the United States since 2023; creatinine capped at 3 mg/dL.

Bilirubin in µmol/L is divided by 17.1, and creatinine in µmol/L by 88.4, to give mg/dL.

What the score means

MELD90-day mortality (Wiesner 2003)Elective surgery
Below 10About 2%Usually reasonable
10–19About 6%Caution above 10; avoid above 15
20–29About 20%Avoid; transplant assessment
30–39About 53%Avoid
40 or moreAbout 71%Avoid

A worked example

A man with alcohol-related cirrhosis and symptomatic gallstones. Bilirubin 45 µmol/L (2.6 mg/dL), creatinine 110 µmol/L (1.24 mg/dL), INR 1.6, sodium 132. MELD = 10 × (0.957 × 0.22 + 0.378 × 0.97 + 1.120 × 0.47 + 0.643) = 17; MELD-Na = 21. Elective cholecystectomy is high risk: manage conservatively if possible and involve hepatology first.

MELD or Child-Pugh?

MELD uses only laboratory values, so it is objective and continuous; Child-Pugh includes ascites and encephalopathy, which MELD misses. Both predict surgical risk, and many units use them together. The Mayo Clinic post-operative mortality model (Teh 2007) combines MELD with age and ASA grade.

References

  1. Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–70.
  2. Wiesner R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124:91–6.
  3. Kim WR, et al. MELD 3.0: the model for end-stage liver disease updated for the modern era. Gastroenterology 2021;161:1887–95.
  4. Teh SH, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 2007;132:1261–9.

Educational use

This calculator is a teaching aid. It does not replace clinical judgement, senior advice or your local guidelines.

Related pages

CalculatorChild-Pugh scoreClass A, B or C.InterpretationReading liver function testsBilirubin, albumin and the INR.MCQsHepatobiliary questionsTest yourself.All toolsClinical calculatorsEvery calculator on the site.
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