Hepatology

MELD Score Calculator for Liver Disease Severity

Model for End-Stage Liver Disease score for cirrhosis severity and transplant priority

Primary source: Kamath PS et al. Hepatology 2001; 33(2): 464-470 (MELD). UNOS модификации округления

Aleksandr A. Aulov, MD, internal medicine Last clinical review: April 28, 2026

Online calculation

Serum creatinine

µmol/L

Total bilirubin

µmol/L

INR

About this score

MELD (Model for End-Stage Liver Disease; Kamath PS et al., Hepatology 2001) is a formula-based score for predicting 3-month mortality in patients with severe liver disease. It uses 3 objective parameters: total bilirubin, INR, and creatinine (since 2016, sodium has also been incorporated as MELD-Na).

Formula: MELD = 3.78×ln(bilirubin, mg/dL) + 11.2×ln(INR) + 9.57×ln(creatinine, mg/dL) + 6.43. The result is rounded to the nearest integer. Minimum 6, maximum 40 (capped in practice).

MELD is used primarily to prioritize patients on the liver transplant waiting list: the higher the MELD score, the higher the priority. It is also used to predict outcomes after TIPS, to assess perioperative risk in patients with cirrhosis undergoing surgery, and in acute liver injury. Since 2016, MELD-Na has been the standard for liver transplant allocation under UNOS/OPTN policy in the United States. Its advantage over Child-Pugh is full objectivity and inclusion of renal function.

When to use

Cirrhosis — assessing severity and transplant waiting list priority.
Before TIPS — MELD >18 significantly increases periprocedural risk.
Assessing surgical risk before elective procedures in patients with cirrhosis.
Acute liver failure — outcome prediction (though King's College criteria are more specific).

Clinical example

Case

58-year-old woman with HCV cirrhosis. Bilirubin 102 µmol/L (6.0 mg/dL), INR 2.1, creatinine 130 µmol/L (1.5 mg/dL), sodium 132 mmol/L.

Calculation

MELD-Na ≈ 3.78×ln(6.0) + 11.2×ln(2.1) + 9.57×ln(1.5) + 6.43 + sodium correction ≈ 24.

Interpretation and management

MELD-Na 24 indicates a high risk of 3-month mortality (~20%). Management: urgent referral to a transplant center, optimization of therapy (ascites control, SBP prophylaxis, lactulose), and HCC screening. At MELD ≥15, transplantation reduces mortality compared with medical management alone (the MELD-15 cutoff rule).

Limitations and cautions

Not applicable in patients on hemodialysis — creatinine does not reflect renal function; modified versions are used.
Lower accuracy in acute hepatitis without cirrhosis — King's College criteria or the Maddrey score are preferred there.
Does not account for ascites or encephalopathy — some patients with a low MELD score have pronounced clinical symptoms.
In patients on warfarin, the INR is distorted, making the score difficult to interpret.

Frequently asked questions

How is MELD-Na better than the classic MELD?

Incorporating sodium improves prognostic accuracy by 5-15% by better identifying patients with hyponatremia, a marker of severe portal hypertension. Since 2016, MELD-Na has been the standard for organ allocation in the United States.

At what MELD score should transplantation be considered?

MELD ≥15 is the threshold at which transplantation provides a survival benefit. Below 15, the risk of surgery outweighs its benefit.

Can it be used in a patient undergoing TIPS?

Yes, MELD is validated for predicting post-TIPS outcomes. MELD >18 is a relative contraindication to TIPS.

How often should the score be reassessed?

In transplant candidates, recertification frequency depends on MELD score: MELD 10 — every 12 months, 11–18 — every 3 months, 19–24 — monthly, ≥25 — weekly.

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Aleksandr A. Aulov Physician, internal medicine, Sechenov School — independent medical education platform. Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.

This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.