The MELD (Model for End-Stage Liver Disease) score estimates 3-month mortality in patients with advanced chronic liver disease and is the basis of liver-transplant allocation. It uses three objective laboratory values: bilirubin, INR and creatinine.
High-yield: MELD ranges 6–40. All three inputs are floored at 1.0 (a value below 1
is set to 1, since the logarithm of lower values would be negative), and creatinine is capped at
4.0 mg/dL — including a fixed 4.0 for patients on dialysis (≥2 sessions in the prior week).
How to use it
Enter bilirubin, INR and creatinine in either unit system (mg/dL or µmol/L — conversion is done for you). Tick the dialysis box if the patient had at least two dialysis sessions in the last week.
Don't miss: MELD was derived in patients undergoing TIPS (Malinchoc 2000) and
validated for transplant prioritization (Kamath 2001) — it is not validated for acute
liver failure, and the original formula applies to adults. MELD-Na (2016 UNOS adoption) adds sodium
and is now used for allocation in many systems.
Interpretation
| MELD | Approximate 3-month mortality |
|---|---|
| < 10 | ~4% |
| 10–19 | ~6% |
| 20–29 | ~20% |
| 30–39 | ~53% |
| ≥ 40 | ~71% |
References
- Malinchoc M, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31:864–871.
- Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–470.
- Wiesner R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124:91–96.
Draft content — verify against the cited sources before relying on it.