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MELD, MELD-Na and MELD 3.0

Model for End-Stage Liver Disease: original, sodium (2016 UNOS) and MELD 3.0 (2023 OPTN) versions.

For healthcare professionalsLiverv3.0.1

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

Sex
mmol/L
Dialysis twice, or 24 h of CVVHD, in the past week

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

MELD (Kamath 2001), MELD-Na (Kim 2008; UNOS 2016), MELD 3.0 (Kim 2021; OPTN 2023)

MELD = 10 × (0.957 ln Cr + 0.378 ln Bili + 1.120 ln INR + 0.643); MELD-Na = MELD + 1.32(137 − Na) − 0.033·MELD·(137 − Na) if MELD > 11; MELD 3.0 = 1.33[F] + 4.56 ln Bili + 0.82(137 − Na) − 0.24(137 − Na) ln Bili + 9.09 ln INR + 11.14 ln Cr + 1.85(3.5 − Alb) − 1.83(3.5 − Alb) ln Cr + 6

Lower bounds of 1.0 apply to bilirubin, INR and creatinine. Creatinine is capped at 4.0 (MELD, MELD-Na) or 3.0 (MELD 3.0), sodium is bounded 125–137 and albumin 1.5–3.5. Scores are capped at 40.

Who it is for
People aged 12 and over with chronic liver disease (MELD is used from age 12 in US allocation).
Version
3.0.1

How this calculator works

Where the formula comes from

  • MELD was first developed to predict survival after TIPS (Malinchoc 2000) and then validated by Kamath and colleagues (2001) as a predictor of short-term survival in end-stage liver disease.[1][2]

The inputs

  • Original MELD uses natural logarithms of serum creatinine, bilirubin (both mg/dL) and INR: 10 × (0.957 ln Cr + 0.378 ln bilirubin + 1.120 ln INR + 0.643).[2]
  • In MELD 3.0, bilirubin, INR and creatinine below 1.0 are set to 1.0, sodium is bounded 125–137 mmol/L and albumin 1.5–3.5 g/dL.[3]

Versions and alternatives

  • MELD-Na (Kim 2008) added serum sodium because hyponatraemia predicted death on the liver-transplant waiting list independently of MELD.[4]
  • MELD 3.0 (Kim 2021) was developed from all US waiting-list registrations in 2016–2018 to predict 90-day survival; it adds female sex and albumin, includes bilirubin–sodium and albumin–creatinine interactions and caps creatinine at 3.0 mg/dL.[3]
  • MELD 3.0 discriminated better than MELD-Na in that study (C-statistic 0.869 vs 0.862).[3]

Where accuracy falls (published evidence)

  • Because serum creatinine depends on muscle mass and other factors, creatinine-based scores can underestimate kidney dysfunction in some women; MELD 3.0 includes a female-sex term to address sex-related differences in waiting-list mortality prediction.[3]
  • MELD 3.0 was developed to predict waiting-list mortality; its performance for other purposes needs separate evaluation.[3]

Sources

  1. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–871. doi:10.1053/he.2000.5852
  2. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. doi:10.1053/jhep.2001.22172
  3. Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology. 2021;161(6):1887–1895.e4. doi:10.1053/j.gastro.2021.08.050
  4. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–1026. doi:10.1056/NEJMoa0801209

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate MELD

Inputs

Sex
Male
Total bilirubin
2 mg/dL
INR
1.5
Serum creatinine
1.2 mg/dL
Serum sodium
130 mmol/L
Serum albumin
3 g/dL

Result

MELD 3.0
20
MELD-Na (UNOS 2016)
21
MELD (original)
15

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Allocation policy differs between countries; check which version your transplant programme uses.

References

  1. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. doi:10.1053/jhep.2001.22172
  2. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–1026. doi:10.1056/NEJMoa0801209
  3. Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology. 2021;161(6):1887–1895.e4. doi:10.1053/j.gastro.2021.08.050

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