MELD Score Calculator

Calculate MELD Score (Model for End-Stage Liver Disease) to assess liver disease severity and transplant prioritization. Scientifically validated tool.

Calculate MELD

Note: MELD is a prognostic tool. Transplant decisions consider multiple clinical factors, including complications not captured by MELD (encephalopathy, refractory ascites, hepatopulmonary syndrome). Always consult a hepatologist or transplant surgeon.

What is the MELD Score?

MELD (Model for End-Stage Liver Disease) is a prognostic score developed to assess chronic liver disease severity. It uses three objective laboratory tests (creatinine, bilirubin, and INR) to estimate 90-day mortality without transplant. Initially created to predict mortality after TIPS (transjugular intrahepatic portosystemic shunt), MELD was validated as a survival predictor in cirrhosis and is now the primary criterion for liver allocation in most countries. The mathematical formula assigns greater weight to creatinine and INR, reflecting that renal dysfunction and coagulopathy are independent mortality predictors.

MELD = 3.78×ln(bilirubin) + 11.2×ln(INR) + 9.57×ln(creatinine) + 6.43

How to Calculate MELD?

To calculate MELD: 1) Obtain most recent laboratory values: Serum creatinine (mg/dL), Total bilirubin (mg/dL), INR. 2) Check if patient underwent dialysis in the last 72 hours (in this case, creatinine is considered 4.0 mg/dL). 3) Apply minimum values: Creatinine <1.0 = 1.0, Bilirubin <1.0 = 1.0, INR <1.0 = 1.0. 4) Apply maximum values: Creatinine >4.0 = 4.0. 5) Enter values in calculator. Result ranges from 6 (lowest severity) to 40 (highest severity). IMPORTANT: Use values in mg/dL. If your labs provide μmol/L, convert: Creatinine (μmol/L) ÷ 88.4 = mg/dL; Bilirubin (μmol/L) ÷ 17.1 = mg/dL.

MELD Score Interpretation

MELD 6-9: Compensated Liver Disease

90-day mortality: <2%. Compensated cirrhosis without clinical decompensation. Generally not transplant candidates. Focus on etiologic treatment (alcohol abstinence, antivirals for hepatitis, etc.) and regular outpatient follow-up.

MELD 10-19: Early Decompensated Liver Disease

90-day mortality: 6-20%. Cirrhosis with some degree of decompensation. MELD 10-14: Consider transplant listing if complications (ascites, encephalopathy). MELD 15-19: Transplant candidates, but waiting time may be long depending on region.

MELD 20-29: Severe Liver Disease

90-day mortality: 20-50%. Severe decompensated cirrhosis. Priority transplant candidates. MELD ≥15 is considered cutoff for transplant indication in most centers. Requires hospitalization or intensive follow-up.

MELD ≥30: End-Stage Liver Disease

90-day mortality: >50%. Severe liver failure. High transplant priority. MELD ≥35: Mortality >80% at 90 days. Often requires ICU care. Consider living donor listing or regional/national prioritization.

Frequently Asked Questions

What's the difference between MELD and Child-Pugh?

Child-Pugh (A, B, C) was the first cirrhosis severity classification, using 5 parameters: bilirubin, albumin, INR, ascites, and encephalopathy. It's subjective (ascites and encephalopathy are clinical) and has a ceiling (Child C may include patients of very variable severity). MELD is totally objective (labs only), continuous (6-40), and better mortality predictor. Therefore, it replaced Child-Pugh for transplant allocation. Child-Pugh is still used for prognosis in compensated cirrhosis and classification in clinical trials.

When to recalculate MELD?

In listed transplant patients: Every 7 days if MELD ≥25 (high priority), every 30 days if MELD 19-24, every 90 days if MELD <19. In non-listed patients: Recalculate in acute decompensations (infection, bleeding, renal failure), before surgical procedures, and every 3-6 months in outpatient cirrhosis follow-up.

My patient has MELD 15 but refractory ascites. Does he need transplant?

Yes. MELD doesn't capture all complications. Refractory ascites (not responding to diuretics), hepatopulmonary syndrome, recurrent encephalopathy, and recurrent spontaneous bacterial peritonitis are transplant indications even with 'low' MELD. In these cases, MELD exception can be requested from transplant program with detailed clinical justification.

Can MELD be used in acute fulminant hepatitis?

No. MELD was developed for CHRONIC liver disease. In acute liver failure (fulminant hepatitis), use King's College Criteria (more appropriate). These consider encephalopathy, INR, creatinine, pH, and etiology. MELD may underestimate severity in fulminant hepatitis, as bilirubin may not be very elevated in early stages.

Is there a pediatric MELD?

Yes, PELD (Pediatric End-Stage Liver Disease) is used in children <12 years. The formula is different, including: bilirubin, INR, albumin, age (<1 year gains extra points), and presence of growth failure. PELD reflects that children with cirrhosis have different pathophysiology and prognosis than adults.

Related Topics

  • Child-Pugh classification for cirrhosis
  • MELD-Na (MELD with serum sodium)
  • King's College Criteria for fulminant hepatitis
  • Liver transplant indications
  • Hepatorenal Syndrome
  • Hepatocellular Carcinoma and Milan criteria

Scientific References

  1. 1. 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.
  2. 2. 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.
  3. 3. 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.
  4. 4. Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130(6):1652-1660.

What is the MELD Score?

MELD (Model for End-Stage Liver Disease) is a prognostic score developed to assess chronic liver disease severity. It uses three objective laboratory tests (creatinine, bilirubin, and INR) to estimate 90-day mortality without transplant. Initially created to predict mortality after TIPS (transjugular intrahepatic portosystemic shunt), MELD was validated as a survival predictor in cirrhosis and is now the primary criterion for liver allocation in most countries. The mathematical formula assigns greater weight to creatinine and INR, reflecting that renal dysfunction and coagulopathy are independent mortality predictors.

MELD = 3.78×ln(bilirubin) + 11.2×ln(INR) + 9.57×ln(creatinine) + 6.43

How to Calculate MELD?

To calculate MELD: 1) Obtain most recent laboratory values: Serum creatinine (mg/dL), Total bilirubin (mg/dL), INR. 2) Check if patient underwent dialysis in the last 72 hours (in this case, creatinine is considered 4.0 mg/dL). 3) Apply minimum values: Creatinine <1.0 = 1.0, Bilirubin <1.0 = 1.0, INR <1.0 = 1.0. 4) Apply maximum values: Creatinine >4.0 = 4.0. 5) Enter values in calculator. Result ranges from 6 (lowest severity) to 40 (highest severity). IMPORTANT: Use values in mg/dL. If your labs provide μmol/L, convert: Creatinine (μmol/L) ÷ 88.4 = mg/dL; Bilirubin (μmol/L) ÷ 17.1 = mg/dL.

Frequently Asked Questions

What's the difference between MELD and Child-Pugh?
Child-Pugh (A, B, C) was the first cirrhosis severity classification, using 5 parameters: bilirubin, albumin, INR, ascites, and encephalopathy. It's subjective (ascites and encephalopathy are clinical) and has a ceiling (Child C may include patients of very variable severity). MELD is totally objective (labs only), continuous (6-40), and better mortality predictor. Therefore, it replaced Child-Pugh for transplant allocation. Child-Pugh is still used for prognosis in compensated cirrhosis and classification in clinical trials.
When to recalculate MELD?
In listed transplant patients: Every 7 days if MELD ≥25 (high priority), every 30 days if MELD 19-24, every 90 days if MELD <19. In non-listed patients: Recalculate in acute decompensations (infection, bleeding, renal failure), before surgical procedures, and every 3-6 months in outpatient cirrhosis follow-up.
My patient has MELD 15 but refractory ascites. Does he need transplant?
Yes. MELD doesn't capture all complications. Refractory ascites (not responding to diuretics), hepatopulmonary syndrome, recurrent encephalopathy, and recurrent spontaneous bacterial peritonitis are transplant indications even with 'low' MELD. In these cases, MELD exception can be requested from transplant program with detailed clinical justification.
Can MELD be used in acute fulminant hepatitis?
No. MELD was developed for CHRONIC liver disease. In acute liver failure (fulminant hepatitis), use King's College Criteria (more appropriate). These consider encephalopathy, INR, creatinine, pH, and etiology. MELD may underestimate severity in fulminant hepatitis, as bilirubin may not be very elevated in early stages.
Is there a pediatric MELD?
Yes, PELD (Pediatric End-Stage Liver Disease) is used in children <12 years. The formula is different, including: bilirubin, INR, albumin, age (<1 year gains extra points), and presence of growth failure. PELD reflects that children with cirrhosis have different pathophysiology and prognosis than adults.

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