MELD Score Calculator
Disclaimer: This calculator is for informational purposes only. Clinical decisions should be based on a full evaluation and professional judgment.
How to Calculate the MELD Score
1. Initial MELD
For candidates ≥12 years old, the initial MELD(i) is calculated
- Round this to the tenth decimal place.
- Multiply by 10 to get the MELD(i) value.
Important: Use serum creatinine, bilirubin, and INR in US units, and sodium in mEq/L. If bilirubin, creatinine, or INR is <1.0, use 1.0 to avoid negative logarithms.
2. Final MELD Calculation (If MELD(i) > 11)
If MELD(i) is greater than 11, an additional step incorporates serum sodium:
Special Rules
- Creatinine Cap at 4.0:
- If Creatinine is >4.0, set it to 4.0.
- If the patient has ≥2 dialysis treatments in the prior 7 days or ≥24 hours of CVVHD in the prior 7 days, use 4.0 as the creatinine value.
- Sodium Clamping:
- If Na <125, use 125.
- If Na >137, use 137.
- Minimum Lab Values:
- Bilirubin <1.0 ⇒ use 1.0
- Creatinine <1.0 ⇒ use 1.0
- INR <1.0 ⇒ use 1.0
- MELD Score Maximum = 40:
- If the calculated MELD exceeds 40, it is typically capped at 40 for the purpose of listing and transplant allocation.
MELD Score Interpretation
Several studies have linked MELD scores with 3-month mortality. The following table summarizes approximate mortality risk:
| MELD Score | Estimated 3-month Mortality |
|---|---|
| ≤9 | 1.9% |
| 10–19 | 6.0% |
| 20–29 | 19.6% |
| 30–39 | 52.6% |
| ≥40 | 71.3% |
Patients with higher MELD scores are at significantly increased risk of mortality, which highlights the urgency for potential liver transplantation or other interventions.
Clinical Pearls
- Assessment Beyond MELD: While MELD is an excellent predictor of short-term mortality, always consider additional factors such as overall clinical status, comorbidities, and patient support systems.
- Dialysis and Sodium: Creatinine level and sodium level corrections (dialysis, Na clamp) are critical in accurately determining the MELD score, especially as advanced disease often involves renal impairment and electrolyte disturbances.
- Maximum Score of 40: Although the formula might produce a higher number, 40 is the recognized ceiling for listing purposes.
- Pediatric Cases: Patients under 12 years of age use the PELD (Pediatric End-Stage Liver Disease) score, which incorporates different parameters.
