How it's calculated
MELD = 3.78×ln(bilirubin) + 11.2×ln(INR) + 9.57×ln(creatinine) + 6.43, with all input values below 1.0 rounded up to 1.0, and creatinine capped at 4.0 mg/dL (or set to 4.0 if the patient has had dialysis twice in the past week). MELD-Na then adjusts this further for serum sodium, bounded between 125 and 137 mEq/L.
Approximate 90-day mortality by MELD-Na score
| MELD-Na | Approximate 90-day mortality |
|---|---|
| <10 | ~1.9% |
| 10–19 | ~6–20% |
| 20–29 | ~19.6–52.6% |
| ≥30 | ~71–100% |
Clinical use
- MELD-Na is the score currently used in the United States to prioritise patients on the liver transplant waiting list — higher scores indicate more severe disease and higher priority.
- It's also widely used more generally to estimate short-term mortality risk in patients with cirrhosis and to guide decisions around the timing of interventions like TIPS.
- All bounds and caps (minimum value of 1 for bilirubin/INR/creatinine, creatinine capped at 4, sodium bounded 125-137) are part of the standard formula and matter for reproducible, comparable scoring.
- This calculator implements MELD-Na (the current standard) alongside the underlying MELD score without the sodium adjustment, for reference.
Frequently asked questions
What is the MELD-Na score used for?
It estimates the severity of liver disease and short-term mortality risk, and is the score currently used in the US to prioritise patients for liver transplantation — higher scores mean more severe disease and higher transplant priority.
Why is creatinine capped at 4 mg/dL in the MELD formula?
The cap (and setting creatinine to 4 in patients on frequent dialysis) prevents extremely high creatinine values from disproportionately skewing the score, since dialysis itself controls creatinine rather than reflecting ongoing native kidney function.
What is the difference between MELD and MELD-Na?
MELD-Na adds an adjustment for serum sodium to the original MELD formula, since low sodium (hyponatraemia) has been shown to independently predict worse outcomes in cirrhosis beyond what bilirubin, INR, and creatinine alone capture.
What does a MELD-Na score of 25 mean?
It falls in the higher-severity range (20-29), associated with substantially increased 90-day mortality risk (roughly 20-53% depending on where in that range) and correspondingly higher priority for transplant evaluation.
References
- Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464-470.
- Kim WR, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018-1026.
- Organ Procurement and Transplantation Network (OPTN). MELD/PELD Calculator Documentation.