MELD Score

What This Calculator Measures

Calculates the Model for End-stage Liver Disease (MELD) score to estimate 3-month mortality in adults with chronic liver disease and to guide liver transplant prioritization.

How to Use

1. Use the most recent serum bilirubin, creatinine, and INR from the same clinical assessment.
2. Indicate whether the patient has been on dialysis at least twice in the past week — the calculator sets creatinine to 4 mg/dL in that case, per UNOS convention.
3. Note that bilirubin and INR are floored at 1 and non-dialysis creatinine is capped at 4 mg/dL before scoring.
4. Review the score against the mortality-risk bands and the patient's clinical trajectory.

Interpretation Guide

MELD <10 indicates low 3-month mortality risk; 10–19 moderate; 20–29 high; 30–39 very high; ≥40 extremely high risk. Higher scores warrant expedited transplant evaluation.

Clinical Significance

MELD is a well-validated mortality-risk score that estimates 3-month survival in chronic liver disease and historically underpinned liver transplant prioritization in the United States. Current U.S. liver allocation uses the MELD 3.0 model (adopted July 2023), which incorporates albumin, sex, and updated coefficients rather than the classic MELD formula.

When to Use

• Liver transplant listing and risk stratification
• Prognosis in decompensated cirrhosis
• Serial monitoring of disease severity over time
• Risk stratification before major interventions in cirrhotic patients

When Not to Use

• Acute liver failure, which uses dedicated criteria rather than MELD
• Pediatric patients, where PELD-based scores apply
• As a substitute for a full clinical assessment, including ascites and encephalopathy
• Solely to predict outcomes in non-liver surgical procedures

Limitations

• Does not include ascites or hepatic encephalopathy, which carry independent prognostic information.
• Creatinine depends on muscle mass, so MELD may under-estimate risk in low-muscle-mass patients.
• INR assays vary between laboratories, affecting reproducibility.
• The score is validated for chronic liver disease, not acute liver failure.

Worked Example

A 55-year-old man with decompensated alcoholic cirrhosis is being evaluated for transplant listing. Bilirubin is 2.5 mg/dL, creatinine 1.2 mg/dL, INR 1.5, and he is not on dialysis.

MELD = 3.78×ln(2.5) + 11.2×ln(1.5) + 9.57×ln(1.2) + 6.43 ≈ 16 — moderate 3-month mortality risk (band 10–19).

Evidence

Source

Original MELD Description / UNOS

Reference

Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001.

Reviewed By

MedCalcHub Clinical Team

Version

1.0

Updated

2026-08

1. Kamath PS, et al. Hepatology. 2001.

References

1. Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001. (Original model)