MELD Calculator

Determines the MELD from INR, creatinine and bilirubin and stratifies survival in patients with end of stage liver disease.

There is more information on the formula used and the survival stratification in the text below the tool.


The Model of End Stage Liver Disease is used to estimate the relative severity of the chronic liver disease.

It also provides a survival prognostic in the case of patients waiting for liver transplant.

It is included in the criteria used by the United Network for Organ Sharing (UNOS) for prioritizing liver transplant allocation.


The two formulas, the original one and the 2016 intervention via Policy 9.1 by OPTN, are:

Original MELD Score = 10 x [(0.957 x ln(Creatinine)) + (0.378 x ln(Bilirubin)) + (1.12 x ln(INR))] + 6.43

MELD Score (2016) = MELD(i) + 1.32 x (137-Na) – [0.033 x MELD(i) x (137-Na)]

The estimated 3-month mortality percentages are:

Original MELD score Mortality percentage
10 - 19 6.0%
20 - 29 19.6%
30 - 39 52.6%
40 or more 71.3%

INR:*
Bilirubin:*
Creatinine:*
Hemodialysis twice in the past week:*
Based on the 2016 update, MELD now includes Serum Sodium levels. By completing the below field, will be provided with both the original and updated MELD results.
Serum Sodium (optional)*:
* Serum Sodium Corrected For Hyperglycemic Patients.
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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

Model of End Stage Liver Disease

The MELD score assesses the severity of the chronic liver disease and is used in the liver transplant waiting list prioritization by the United Network for Organ Sharing (UNOS).

The variables used by the MELD calculator are:

■ International normalized ratio time (INR);

■ Serum creatinine;

■ Serum bilirubin;

■ Haemodialysis twice in the past week;

■ Serum sodium (2016 formula inclusion).

The formula resulted from the original study referenced below is:

Original MELD Score = 10 x [(0.957 x ln(Creatinine)) + (0.378 x ln(Bilirubin)) + (1.12 x ln(INR))] + 6.43

In January 2016, OPTN changed Policy 9.1 in regard to the calculation of the MELD score to include serum sodium (measured in mEq/L and in case the patient is known hyperglicemic, sodium correction may be needed for glucose levels above 120 mg/dL).

Therefore, the new formula is:

MELD Score (2016) = MELD(i) + 1.32 x (137-Na) – [0.033 x MELD(i) x (137-Na)]

Regardless of the formula used, there are two adjustments to be made:

■ Values less than 1 are automatically adjusted to the lower limit value of 1 to prevent obtaining a negative score.

■ The upper limit for serum creatinine is 4 mg/dL, therefore for those patients that have had 2 rounds of dialysis in the past week, the value is automatically adjusted to 4 mg/dL.

 

MELD interpretation

The result obtained after the formulas are applied is presented with its corresponding 3-month mortality percentage (based on original MELD).

MELD scores are also calculated as part of the prioritization process of UNOS for liver transplant waiting lists.

Original MELD score Mortality percentage
10 - 19 6.0%
20 - 29 19.6%
30 - 39 52.6%
40 or more 71.3%
 

About the original study

MELD was created as a mean to quantitatively assess the severity of liver disease and to be used in determining priorities in allocation liver transplantion.

The original study aimed to produce a similar model to that created for the survival stratification of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS).

MELD validity was tested in 4 independent data sets:

■ Patients hospitalized for hepatic decompensation;

■ Ambulatory patients with noncholestatic cirrhosis;

■ Patients with primary biliary cirrhosis (PBC);

■ Unselected patients with cirrhosis from the historic 1980s set.

The MELD performed well in predicting death within 3 months in all four validation sets. One finding was that the model is not influenced by individual complications, such as portal hypertension.

 

Original source

Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001; 33(2):464-70.

Validation

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R; United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003; 124(1):91-6.

Other references

1. Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007; 45(3):797-805.

2. Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH. MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients. Hepatology. 2004; 39(3):764-9.


App Version: 1.0.1

Coded By: MDApp

Specialty: Hepatology

System: Digestive

Objective: Survival stratification

Type: Calculator

No. Of Variables: 5

Year Of Study: 2001

Abbreviation: MELD

Article By: Denise Nedea

Published On: March 16, 2017 · 01:10 AM

Last Checked: March 16, 2017

Next Review: March 10, 2018