Hepatology and GI

Model for End-Stage Liver Disease Score

4 inputsHepatology and GI

Estimate 90-day mortality in chronic liver disease.

Calculate

MELD-Na Score calculator

Result

6points

Low priority — 90-day mortality ~2%

How to use it

1
Labs within 24h of listing. UNOS caps creatinine at 4.0 mg/dL and counts 2+ dialysis sessions per week as 4.0.
2
Na 125–137 range matters. Sodium < 125: use 125. > 137: use 137 (no effect).
3
MELD-Na formula. MELD-Na = MELD + 1.32(137−Na) − 0.033×MELD×(137−Na).

When to use it

Use in adults with known or suspected chronic liver disease or cirrhosis to estimate prognosis and prioritise liver transplantation. Also guides intensity of monitoring and ICU admission decisions. Not the tool for acute liver failure: transplant listing there follows the King’s College or Clichy criteria and high-urgency status.

Liver transplant allocation: UNOS uses MELD-Na ≥15 for cadaveric organ offers (priority above living-donor).
Cirrhosis prognosis: MELD-Na < 10: medical management. 10–14: watchful waiting. ≥15: listing discussion.
Pre-TIPS evaluation: MELD > 18 after TIPS: poor survival. Consider hospice vs. transplant.

About the score

The Model for End-Stage Liver Disease (MELD) score is a validated prognostic scoring system for patients with chronic liver disease and liver cirrhosis. Originally developed to predict 90-day mortality following elective TIPS (transjugular intrahepatic portosystemic shunt) procedures, it became the primary tool for organ allocation in liver transplantation in the United States (UNOS/OPTN) from 2002 and is now used by European transplant networks. MELD uses three objective laboratory values — INR, serum bilirubin, and serum creatinine — to generate a score predicting short-term mortality risk. MELD-Na (incorporating serum sodium) has improved predictive accuracy and is now preferred by many centres.

Scoring criteria

INR (International Normalised Ratio)Measure of liver synthetic function: Continuous
Serum bilirubin (µmol/L or mg/dL)Measure of hepatic excretory function: Continuous
Serum creatinine (µmol/L or mg/dL)Measure of renal function; reflects hepatorenal syndrome risk: Continuous
(MELD-Na) Serum sodium (mmol/L)Added in MELD-Na — hyponatraemia independently predicts mortality in cirrhosis: Continuous

Score interpretation

< 10Low severity90-day mortality <5%; outpatient monitoring
10–19Moderate severity90-day mortality ~6–20%; regular hepatology follow-up
20–29High severity90-day mortality ~20–30%; transplant evaluation
≥ 30Very high severity90-day mortality >50%; urgent transplant listing consideration

Guideline recommendation

EASL Clinical Practice Guidelines on Cirrhosis (2018): MELD is the recommended prognostic tool for liver transplant prioritisation and for determining intensity of care in decompensated cirrhosis. MELD-Na is preferred over MELD alone in patients being considered for transplantation.

Clinical pearls

MELD is calculated as: 3.78×ln[bilirubin mg/dL] + 11.2×ln[INR] + 9.57×ln[creatinine mg/dL] + 6.43. Values are capped at specific limits.
MELD-Na adds: MELD + 1.32×(137-Na) − [0.033×MELD×(137-Na)]; sodium <125 or >137 mmol/L is capped.
Creatinine is capped at 4.0 mg/dL; patients on dialysis are assigned a creatinine of 4.0 mg/dL.
A rising MELD score over time is more informative than a single value — monitor trajectory, especially around acute decompensation events.
MELD does not capture hepatocellular carcinoma (HCC) risk — MELD exception points can be added for HCC candidates on transplant waiting lists.

Limitations

Does not include clinical events such as variceal haemorrhage, encephalopathy, or ascites that independently affect prognosis.
Less accurate in patients with cholestatic liver disease where bilirubin is disproportionately elevated.
Creatinine is influenced by muscle mass — MELD may underestimate severity in frail, sarcopenic patients.

A reference for clinicians and students, not medical advice. A score supports a decision; it does not make one. Check every result against the patient in front of you and your local protocol.

At a glance

Specialty: Hepatology and GI
Inputs: 4
Type: Formula
Guidelines from: EASL, AASLD

Frequently asked questions

What is a high MELD score?

A MELD score ≥20 indicates substantial liver disease severity with 90-day mortality risk of 20–30%. Scores ≥30 carry >50% 90-day mortality and typically require urgent liver transplant evaluation. Scores ≥40 are associated with >70% short-term mortality without transplantation.

What is the difference between MELD and Child-Pugh score?

MELD uses three objective laboratory values (INR, bilirubin, creatinine) and is the current standard for transplant prioritisation. Child-Pugh includes two subjective components (ascites severity and encephalopathy grade), making it less reproducible. MELD has replaced Child-Pugh for transplant allocation but Child-Pugh remains useful for assessing surgical risk and cirrhosis staging.