MELD Score Calculator
Calculate the Model for End-Stage Liver Disease score and its sodium-adjusted version, using the same floor and cap rules transplant systems apply.
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What MELD Measures
MELD estimates three-month mortality in people with end-stage liver disease from three laboratory values: bilirubin, INR and creatinine. It replaced the Child-Pugh score for allocating donor livers in the United States in 2002 and is used in similar systems elsewhere, because it is built from objective measurements rather than clinical judgement and produces a continuous scale.
The Formula and Its Rules
- MELD = 3.78 × ln(bilirubin mg/dL) + 11.2 × ln(INR) + 9.57 × ln(creatinine mg/dL) + 6.43
- Any value below 1.0 is set to 1.0, so no logarithm becomes negative
- Creatinine is capped at 4.0 mg/dL, and is set to 4.0 if the patient has had dialysis at least twice in the past week
- The result is rounded to the nearest integer and reported between 6 and 40
- MELD-Na = MELD + 1.32 × (137 − Na) − [0.033 × MELD × (137 − Na)], with sodium bounded to 125–137 mmol/L
A worked example: bilirubin 2.0, INR 1.5 and creatinine 1.0 give 3.78 × 0.693 + 11.2 × 0.405 + 9.57 × 0 + 6.43 = 13.59, which rounds to MELD 14 — inside the 10–19 band, corresponding to roughly 6 % three-month mortality in the original cohorts.
Reading the Number
- 6–9 — approximately 2 % three-month mortality
- 10–19 — approximately 6 %
- 20–29 — approximately 20 %
- 30–39 — approximately 53 %
- 40 or above — approximately 71 %
Those percentages come from the OPTN/UNOS cohorts that shaped the allocation policy. They describe populations, not individuals, and contemporary survival is generally better with modern management of complications. Sodium matters because hyponatraemia independently predicts death in cirrhosis, which is why MELD-Na became the default allocation score in the United States in 2016.
Limitations
- Warfarin and direct oral anticoagulants inflate INR independently of liver function, distorting the score.
- MELD is validated for chronic liver disease, not acute liver failure, where King’s College criteria apply.
- It ignores albumin, ascites, encephalopathy and variceal bleeding, which are why Child-Pugh is still documented alongside it.
- MELD 3.0 adds albumin, sex and interaction terms and is gradually replacing MELD-Na in some systems; check which version your centre uses.
- Assay variability in creatinine and INR between laboratories shifts the score by a point or two.
Frequently Asked Questions
What MELD score is needed for a transplant?
There is no single threshold. Allocation systems rank candidates by score within a region, so the practical cut-off varies over time and by blood group and geography.
Why does dialysis force creatinine to 4.0?
Because dialysis clears creatinine, the measured value understates how sick the kidneys are. Setting it to the 4.0 cap keeps the score comparable between dialysis-dependent and non-dialysis patients.
Is MELD better than Child-Pugh?
For predicting short-term mortality and ranking transplant candidates, yes — it uses objective variables and performs better in validation. Child-Pugh remains useful at the bedside because it captures clinical decompensation.