MELD score calculator (MELD, MELD-Na, MELD 3.0)

Three scores for the same question

People with cirrhosis are sometimes compared on one number: how sick is the liver right now? MELD was the first widely used answer, built from bilirubin, INR and creatinine. Sodium was added in MELD-Na, which the paper says has set priorities for US liver allocation since 2016. In 2021 a team from Stanford, Mayo Clinic, the Naval Academy and other centers published MELD 3.0, which adds albumin and female sex and caps creatinine at 3.0 mg/dL. All three scores in this calculator come from the equations printed in that paper, and we reproduce the paper’s eight illustrative patients in our own tests.

What is the MELD score?

MELD stands for Model for End-Stage Liver Disease. It turns three lab values (bilirubin, INR and creatinine) into a single number that estimates the risk of dying within about three months for a person with advanced liver disease. It was first built to predict survival after a TIPS procedure and was later used to rank adults waiting for a liver transplant in the United States. MELD-Na adds the sodium level, and MELD 3.0 adds sodium, albumin and sex.

What is the MELD 3.0 formula?

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 to the nearest whole number. Bilirubin and creatinine are in mg/dL, sodium in mmol/L and albumin in g/dL. This is the equation printed by Kim and colleagues in Gastroenterology in 2021.

What bounds are put on the lab values?

The paper sets bilirubin, INR and creatinine below 1.0 to 1.0. Creatinine is capped at 3.0 mg/dL in MELD 3.0 (it was 4.0 in the older MELD and MELD-Na), and the page treats two or more dialysis treatments in the past week the same way as a creatinine at the cap. Sodium is held between 125 and 137 mmol/L. Albumin is held between 1.5 and 3.5 g/dL. The page tells you whenever one of your numbers was bounded.

What are the original MELD and MELD-Na equations?

Original MELD = 9.57 × ln(creatinine) + 3.78 × ln(bilirubin) + 11.20 × ln(INR) + 6.43, rounded. MELD-Na = MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na), calculated from the rounded MELD. According to the 2021 paper, MELD-Na is applied only when the MELD is above 11, so below that the page shows the plain MELD in the MELD-Na slot.

What does the MELD 3.0 number mean for survival?

The paper does not give a single table of risk by score. It reports that a patient with the average risk in the development data (MELD 3.0 of 20) had a predicted death rate of 1.9 percent at 30 days and 5.4 percent at 90 days, and it lists eight illustrative patients. Their predicted 90-day mortality runs from 2.6 percent (MELD 3.0 of 16) to 79.1 percent (MELD 3.0 of 39). The second example below, a MELD 3.0 of 27, has a predicted 90-day mortality of 17.5 percent in that table. These are model predictions for people on the US waiting list, not individual forecasts.

Why does MELD 3.0 include sex and albumin?

The authors fitted the model to the records of adults newly listed for a liver transplant in the US between 2016 and 2018 and found that female sex and albumin both added information to the older variables. Their introduction points to concern that women were disadvantaged under the old system, including because serum creatinine overestimates kidney function in women and so underestimates their risk of death. The 1.33 points for female sex in the equation address that. MELD 3.0 reclassified a net 8.8 percent of people who died to a higher tier than MELD-Na did, in their analysis.

Is MELD used outside transplant lists?

Yes. A 2016 systematic review (Peng and colleagues) describes both MELD and Child-Pugh as widely used to predict outcomes in people with cirrhosis. But the equations were calibrated on people listed for transplant in the United States. The 2021 paper also states that the score does not address problems such as size mismatch and access to size-appropriate organs for shorter men and women; its authors leave those to the national policy process.

Worked example

This is one of the paper’s own illustrative patients. A man has bilirubin 6.0 mg/dL, INR 1.5, creatinine 1.5 mg/dL, sodium 131 mmol/L and albumin 3.5 g/dL. The original MELD is 22, MELD-Na is 26, and MELD 3.0 is 25. A woman with the same labs but an albumin of 2.2 g/dL has the same MELD and MELD-Na but a MELD 3.0 of 27, because of the sex and albumin terms. In a third case, bilirubin 12.0, INR 2.2, creatinine 4.5, sodium 120 and albumin 1.8 in a woman: creatinine is bounded to 3.0 for MELD 3.0, sodium to 125 and albumin to 1.8, and the scores come out at 38 (MELD), 39 (MELD-Na) and 40 (MELD 3.0).

Limits of this method

The score was developed on adults newly registered on the US liver transplant waiting list from January 2016 to December 2018 and predicts survival up to 90 days after registration, not long-term outcomes. A separate 2022 comment in Gastroenterology by Goudsmit and colleagues argues that MELD 3.0 is an update without proven accuracy, so the debate is not closed. Lab methods differ: INR in particular varies between laboratories, a weakness a 2016 meta-analysis (Peng and colleagues, Medicine) lists for both MELD and Child-Pugh. The score also leaves out causes of illness that matter in practice, such as liver cancer, which transplant programs handle with separate rules.

Common mistakes

A frequent slip is entering lab values in SI units: this page needs bilirubin and creatinine in mg/dL (divide µmol/L by 17.1 for bilirubin and by 88.4 for creatinine) and albumin in g/dL (divide g/L by 10). Another is comparing a MELD 3.0 with an old MELD-Na from last year; they are different equations and the numbers are not interchangeable. A third is forgetting that the female term only applies to MELD 3.0.

Sources: 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;161:1887–1895 (equations, bounds and Table 4); Goudsmit BJ, Putter H, van Hoek B, “The Model for End-Stage Liver Disease 3.0: an update without proven accuracy,” Gastroenterology 2022;162:1781. Peng Y, Qi X, Guo X, “Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis,” Medicine (Baltimore) 2016;95:e2877. The Organ Procurement and Transplantation Network (OPTN) policies govern the score actually used for allocation; we could not open the policy text and rely on the paper’s equations. Related: Child-Pugh score, FIB-4 index, eGFR calculator.

For general information only — not medical advice, and not a tool for patient care decisions. Talk with a doctor or the transplant program about any liver score. How we check our calculators.