Model For End-Stage Liver Disease (MELD) for ages 12 and older
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Did the patient have dialysis at least twice in the past week,
The Model for End Stage Liver Disease (MELD) predicts survival for patients with advanced liver disease.
The United Network for Organ Sharing (UNOS) made a policy change regarding a revision in the MELD scoring system on January 11, 2016 that is related to transplant listing. The new MELD scores are calculated first by determining the traditional MELD score as an initial score (MELD(i)); if the initial MELD(i) scores is 12 or greater, the score is adjusted by incorporating the serum sodium value.
MELD
3.78 loge
Serum Bilirubin (mg/dL):
+
11.20 loge
INR (International Normalized Ratio):
+
9.57 loge
Serum Creatinine (mg/dL):
+
Did the patient have dialysis at least twice in the past week,
or receive 24 hours of CVVHD within the prior week?
Constant for Liver Disease Ediology
=
Serum Sodium (mmol/L):
MELD(i) scores less than 12 do not require Serum Sodium correction.
MELD(i) scores of 12 or higher corrected for Serum Sodium level.
MELD(i) score:
MELD Score:
Interpretation:
3-Month Mortality Based on MELD Scores
The estimated 3-month mortality is based on the MELD score highlighted in yellow above.
| MELD Score | Mortality Probability |
|---|---|
| 40 | 71.3% mortality |
| 30-39 | 52.6% mortality |
| 20-29 | 19.6% mortality |
| 10-19 | 6.0% mortality |
| 9 or less | 1.9% mortality |
Formulas and Notes
MELD(i) = round1[ 0.378 * loge(bilirubin)) + (1.120*loge(INR)) + (0.957*loge(creatinine)) + 0.643 ] * 10
1 rounded to the tenth decimal place.
MELD = MELD(i) + 1.32 * (137-Na) - [0.033*MELD(i)*(137-Na)]
Notes
- This version of the MELD calculator includes United Network for Organ Sharing (UNOS) modifications of the original model.
- The MELD utilizes log scale calculations and thus any value less than 1 is automatically given a lower limit value of 1 to prevent generating a negative score.
- The lower limit of Serum Sodium (Na) is capped at 125, and the upper limit is capped at 137.
- The upper limit of serum creatinine is capped at 4; in addition, if the patient had dialysis at least twice in the past week, the value for serum creatinine will be automatically adjusted to 4.0.
- The maximum MELD score is 40.
Sources
- Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology. 2007 Mar;45:797-805.[PubMed Abstract] -
- Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003 Jan;124:91-6.[PubMed Abstract] -
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