MELD score (Model for End-Stage Liver Disease) with MELD-Na

The MELD score estimates mortality risk in advanced liver disease from bilirubin, creatinine and INR. Adding serum sodium gives MELD-Na. Higher values indicate more severe disease (range 6–40).

⚠︎ Learning tool for medical education – not for use in patients or for treatment decisions.

Calculator

Unit for bilirubin and creatinine
Dialysis at least 2 dialysis treatments in the prior week → creatinine is set to 4.0 mg/dl
mmol/l
–MELD

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Equation and bounds

MELD = 9.57 × ln(creatinine) + 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 6.43, rounded to the nearest integer (creatinine and bilirubin in mg/dl). Values below 1.0 are set to 1.0; creatinine is set to 4.0 mg/dl if it is 4.0 mg/dl or higher or after at least two dialysis treatments in the prior week. The score ranges from 6 to 40 (Kim 2008, Kim 2021).

MELD-Na = MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na), with sodium bounded to 125–137 mmol/l and the result rounded. Per the OPTN definition, the sodium correction is applied only when MELD is above 11 (Kim 2021). Conversion: bilirubin µmol/l ÷ 17.1, creatinine µmol/l ÷ 88.4.

Origin

Kamath et al. (2001) tested a model originally developed for patients undergoing TIPS in four independent cohorts. It included bilirubin, creatinine, INR and the aetiology of liver disease and predicted death within 3 months with a c-statistic of 0.78–0.87. The UNOS version in common use replaces the aetiology term with a constant.

MELD and mortality

In the waiting-list cohort of Wiesner et al. (2003, 3,437 adults), 3-month mortality rose with MELD: 1.9% with a MELD below 9 and 71.3% with a MELD of 40 or more. The original study does not define severity classes, so the calculator shows the score only.

MELD 3.0

Kim et al. (2021) introduced MELD 3.0, which additionally includes sex and albumin and caps creatinine at 3.0 mg/dl. MELD 3.0 is not implemented in this calculator.

FAQ

Why are values below 1 set to 1?▾

The natural logarithm of values below 1 is negative and would artificially lower the score. Bilirubin, creatinine and INR therefore have a lower bound of 1.0, so MELD starts at 6.

What is the difference between MELD and MELD-Na?▾

MELD-Na additionally includes serum sodium because hyponatraemia is associated with higher mortality independently of MELD (Kim 2008).

How do MELD and Child-Pugh differ?▾

MELD uses laboratory values only. The Child-Pugh score additionally includes ascites and encephalopathy.

References

  1. Kamath PS et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–70. · PubMed
  2. Wiesner R et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124:91–6. · PubMed
  3. Kim WR et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359:1018–26. · PubMed
  4. Kim WR et al. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology 2021;161:1887–95. · PubMed

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Intended purpose: learning tool for medical education only. Not intended for use in patients or for diagnostic or treatment decisions; not a medical device. Calculations follow the cited original publications; no guarantee of completeness or correctness. Last updated: 10/2026 · Dr. Pascal Bafteh