MELD (Model for End-stage Liver Disease) Calculator
- MELD (Model for End-stage Liver Disease): Explanation and clinical context
The MELD score is an objective, laboratory-based model developed to predict short-term mortality in patients with advanced liver disease and to assist in prioritizing liver transplant allocation. The original formula (Kamath/Wiesner et al.) uses three laboratory inputs — serum total bilirubin (mg/dL), international normalized ratio (INR), and serum creatinine (mg/dL) — in a natural-logarithm linear model: MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43. For practical use and to avoid negative logs, laboratory values less than 1.0 are set to 1.0; creatinine is capped at 4.0 mg/dL and is set to 4.0 if the patient has required dialysis twice in the prior 7 days (or equivalent continuous renal replacement therapy), per transplant allocation conventions. The MELD score is conventionally reported as an integer and correlates with 3-month mortality and organ allocation priority; however, the exact mortality probability associated with each MELD value depends on the derivation cohort and subsequent recalibrations, and local transplant policy may use updated variants (for example MELD-Na or later revisions) to improve prognostic accuracy.
References:
Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology (Kamath/Wiesner paper and derivation). (Original derivation and description).
UNOS / OPTN MELD calculator documentation and conventions (creatinine cap, dialysis handling).
MELD 3.0 and recent work on MELD recalibration and improvements (for context on later updates).
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