How it's calculated
MELD = 3.78×ln(bilirubin mg/dL) + 11.2×ln(INR) + 9.57×ln(creatinine mg/dL) + 6.43. Values below 1.0 are set to 1.0, and creatinine is capped at 4.0 mg/dL (or set to 4.0 if the patient has had dialysis twice or more in the past week). The result is rounded to the nearest whole number and bounded between 6 and 40.
Interpretation
| MELD score | Risk |
|---|---|
| < 10 | Lower short-term mortality risk |
| 10-19 | Moderate short-term mortality risk |
| 20-29 | High short-term mortality risk |
| ≥ 30 | Very high short-term mortality risk |
Clinical use
- Originally developed to predict survival after a transjugular intrahepatic portosystemic shunt (TIPS) procedure, then adopted for liver transplant organ allocation priority.
- Largely superseded by MELD-Na (which adds serum sodium) for transplant allocation in most systems, since hyponatraemia independently predicts mortality in cirrhosis.
- Still used as a general severity/prognosis marker in cirrhosis and for surgical risk stratification when sodium is unavailable.
Frequently asked questions
What's the difference between MELD and MELD-Na?
MELD-Na adds serum sodium to the original 3-variable MELD (bilirubin, INR, creatinine), improving mortality prediction, particularly in patients with hyponatraemia — MELD-Na has replaced the original MELD for transplant allocation purposes in most regions.
Why is creatinine capped at 4.0 mg/dL in the MELD formula?
To avoid disproportionately weighting very high creatinine values (e.g. from acute kidney injury) and to standardise scoring for patients on dialysis, where creatinine is set to 4.0 regardless of the measured value.
What is MELD score used for besides transplant allocation?
General prognostication in cirrhosis, perioperative risk assessment before non-transplant surgery, and monitoring disease trajectory over time.
References
- Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
- OPTN/UNOS Policy — MELD/PELD calculation.