Calculates the MELD, MELD-Na and MELD 3.0 scores for adults with chronic liver disease.
Result
Enter bilirubin, INR and creatinine; add sodium and albumin for MELD-Na and MELD 3.0.
Sources
4 studies
4
studies
5,104
citations
11,386
PubMed papers
Evidence
Known limitations
Across four groups of patients with cirrhosis, MELD predicted death within 3 months with a c-statistic of 0.78 to 0.87; adding complications of portal hypertension improved it very little.
Hepatology: Journal Metrics Score 6.5, Q1 · cited 5,104 times
Among waiting-list patients with chronic liver disease, 12% died within 3 months, rising from 1.9% at the lowest MELD scores to 71.3% at 40 or more; MELD predicted this better than the Child-Turcotte-Pugh score (c-statistic 0.83 against 0.76).
Gastroenterology: Journal Metrics Score 0.6, Q4 · cited 2,560 times
In 6,769 waiting-list registrants in 2005, mortality rose 21% for each MELD point and 5% for each 1 mmol/L fall in sodium between 125 and 140, with a larger effect of sodium at low MELD scores. This led to MELD-Na; OPTN adopted a refitted version (sodium 125–137) in 2016.
N Engl J Med: Journal Metrics Score 29.8, Q1 · cited 1,531 times
PubMed · Free full text · DOI
Adding female sex and albumin, with interaction terms and a creatinine cap of 3.0, discriminated waiting-list death slightly better than MELD-Na (c-statistic 0.869 against 0.862) and reclassified a net 8.8% of patients who died to a higher tier, particularly women.
Gastroenterology: Journal Metrics Score 0.6, Q4 · cited 719 times
PubMed · Free full text · DOI
The original paper has been cited 5,104 times, and 11,386 PubMed articles mention the MELD score in their title or abstract. Citation counts from OpenAlex and article counts from PubMed, retrieved November 13, 2026. Journal Metrics Scores and quartiles are from this site’s current release; follow the journal name for details.
After the result
MELD 15 or more · Before surgery or procedures · Any score
Discuss transplant referral. MELD helps estimate risk. Report which version.
Next steps
Avoid common errors
5 common errors to avoid
and 3 more
When the score misleads
1INR on warfarin
Vitamin K antagonists raise the INR without any change in liver function; the score then overstates the risk. Direct oral anticoagulants can also affect the INR.
2Creatinine in women and frail patients
Low muscle mass gives a low creatinine and understates kidney dysfunction. MELD 3.0 partly corrects for sex.
3Hemolysis and Gilbert syndrome
Raised unconjugated bilirubin from hemolysis or Gilbert syndrome increases the score without worse liver disease.
4Sodium after fluids
Sodium can change quickly with diuretics or intravenous fluids, which moves MELD-Na and MELD 3.0.
5Problems MELD does not capture
Refractory ascites, encephalopathy, hepatopulmonary syndrome and liver cancer can carry high risk with a modest MELD.
Formula
MELD from bilirubin, INR and creatinine; MELD-Na adds sodium; MELD 3.0 adds albumin and sex; capped at 40.
bilirubin · INR · creatinine
MELD from bilirubin, INR and creatinine; MELD-Na adds sodium; MELD 3.0 adds albumin and sex; capped at 40.
Formulas and mortality
| Score | Formula |
|---|---|
| MELD | 10 × (0.957 ln Cr + 0.378 ln bilirubin + 1.120 ln INR + 0.643) |
| MELD-Na | if MELD(i) is 12 or more: MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na); Na bounded 125–137 |
| MELD 3.0 | 1.33 (female) + 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 |
| Bounds | values below 1 count as 1; Cr capped at 4.0 (3.0 for MELD 3.0) and set to the cap on dialysis; albumin 1.5–3.5; scores rounded, maximum 40 |
| MELD | 3-month mortality |
|---|---|
| 9 or less | 1.9% |
| 10–19 | 6.0% |
| 20–29 | 19.6% |
| 30–39 | 52.6% |
| 40 | 71.3% |
Malinchoc 2000
Kamath 2001
Rounding
Units
Test cases
3 published cases, each also a test case
3 published cases; the calculator reproduces every score.
Worked examples
A 77-year-old man with compensated hepatitis C cirrhosis (Child-Pugh A) had a recanalized paraumbilical vein that looked like an umbilical hernia. His bilirubin was 1.8 mg/dL, INR 1.35, creatinine 0.7 mg/dL, albumin 4.1 g/dL and sodium 140 mmol/L. The report gives a MELD 3.0 of 11; surgery on the "hernia" was avoided.
“Model for End-Stage Liver Disease 3.0 (MELD 3.0) score of 11”
MELD 3.0 is 11, as reported; the original MELD is 12. The abstract gives a MELD of 10, which neither version reproduces from the stated labs. Creatinine 0.7 counts as 1, sodium 140 as 137 and albumin 4.1 as 3.5.
Entered as: Total bilirubin: 1.8 mg/dL; INR: 1.35 INR; Creatinine: 0.7 mg/dL; Dialysis twice or more in the past week, or 24 hours of CVVHD: no; Sodium: 140 mmol/L; Albumin: 4.1 g/dL; Sex: Male.
Source: Cavalcanti GA et al., Cureus 2026 (PubMed · Free full text · DOI)
A 55-year-old man with alcohol-related cirrhosis was admitted with refractory ascites, encephalopathy and kidney impairment. Bilirubin was 2.9 mg/dL, PT-INR 1.29, creatinine 2.94 mg/dL and sodium 115 mEq/L; the report gives a MELD of 24 and a MELD-Na of 30. He later developed pneumocystis pneumonia.
“a MELD score of 24 and a MELD-Na score of 30”
Sodium 115 counts as 125, the lower bound. The report also gives albumin 3.0 g/dL; it is left blank here so the headline shows MELD-Na as reported. With it, MELD 3.0 would be 32.
Entered as: Total bilirubin: 2.9 mg/dL; INR: 1.29 INR; Creatinine: 2.94 mg/dL; Dialysis twice or more in the past week, or 24 hours of CVVHD: no; Sodium: 115 mmol/L; Sex: Male.
Source: Miyamoto K et al., Clin J Gastroenterol 2025 (PubMed · Free full text · DOI)
A 46-year-old woman with newly diagnosed alcohol-related decompensated cirrhosis presented with sepsis and was found to have bilateral tubo-ovarian abscesses with enterococcal peritonitis. Bilirubin was 9.4 mg/dL, INR 2.1, creatinine 1.8 mg/dL and sodium 136 mmol/L; the report gives a MELD-Na of 29.
“Her serum sodium concentration was 136 mmol/L, and the calculated MELD-Na score was 29”
MELD and MELD-Na are both 29 here, since the sodium is close to 137. The report also gives albumin 2.1 g/dL, left blank to match the reported MELD-Na; with it, MELD 3.0 would be 32.
Entered as: Total bilirubin: 9.4 mg/dL; INR: 2.1 INR; Creatinine: 1.8 mg/dL; Dialysis twice or more in the past week, or 24 hours of CVVHD: no; Sodium: 136 mmol/L; Sex: Female.
Source: Albusta N et al., Reports (MDPI) 2026 (PubMed · Free full text · DOI)
FAQ
6 questions and answers
and 4 more answers
Questions
MELD = 10 × (0.957 × ln creatinine + 0.378 × ln bilirubin + 1.120 × ln INR + 0.643), with creatinine and bilirubin in mg/dL. Values below 1 count as 1, creatinine is capped at 4 mg/dL (and set to 4 on dialysis), and the score is rounded and capped at 40.
MELD uses bilirubin, INR and creatinine. MELD-Na adds sodium, because a low sodium raised waiting-list mortality, especially at lower MELD scores; it was used for US liver allocation from 2016. MELD 3.0 adds albumin and female sex, adds interactions between the terms and caps creatinine at 3.0; it replaced MELD-Na in US allocation in 2023. The calculator shows every version the entered values allow.
In patients added to the US waiting list from late 1999 to 2001, 3-month mortality was 1.9% with a MELD of 9 or less, 6.0% at 10 to 19, 19.6% at 20 to 29, 52.6% at 30 to 39 and 71.3% at 40. Transplant referral is commonly considered from a MELD of about 15.
If the patient had dialysis at least twice in the past week, or 24 hours of continuous venovenous hemodialysis within the past week, creatinine is set to the cap: 4.0 mg/dL for MELD and MELD-Na, 3.0 mg/dL for MELD 3.0. Tick the dialysis box to apply this.
Women have less muscle and therefore lower creatinine for the same kidney function, so MELD underestimated their risk and they were less likely to receive a transplant. MELD 3.0 adds 1.33 points for female sex, and its developers found it reclassified more women who died on the waiting list into higher tiers.
Yes. It began as a model for survival after TIPS and is used to estimate risk before surgery in cirrhosis and to judge severity in alcohol-associated hepatitis, where a MELD above 20 marks severe disease. For children under 12 the separate PELD score is used.
Further reading
8 references with PubMed and DOI links
8
references
5
free full text
From Kamath PS et al., Hepatology 2001 to the newest case reports.
References
clinical grade of aneurysmal subarachnoid hemorrhage, I to V.
total calcium adjusted for albumin, in mg/dL or mmol/L.
stroke severity from 15 bedside items, 0 to 42.
MAP from systolic and diastolic pressure, against the 65 mm Hg target.
eye, verbal and motor scores for preverbal children, 3 to 15.
oxygenation ratio with the Berlin ARDS severity ranges.
serum sodium corrected for high glucose, Katz or Hillier factor.
sodium − (chloride + bicarbonate), with the albumin-corrected gap.
urea nitrogen to creatinine ratio, in US or SI units.
estimated creatinine clearance with actual, ideal or adjusted weight.
cardiac output and index from oxygen consumption and saturations.
ANC from the white cell count, neutrophils and bands.
insulin resistance from fasting glucose and insulin, in US or SI units.
FENa from plasma and urine sodium and creatinine: prerenal, indeterminate or tubular pattern.
three-item stroke severity screen for large vessel occlusion, 0 to 4.
water deficit in hypernatremia from sodium, weight and body water.
expected PaCO2 in metabolic acidosis, 1.5 × HCO3 + 8 ± 2.
corrected QT interval by Bazett, Fridericia, Framingham or Hodges.
head CT decision rule for children with minor head trauma.
blood loss before hemoglobin or hematocrit reaches a chosen lowest value.
eye, verbal and motor response, 3 to 15, with GCS-Pupils.
Devine ideal body weight and adjusted weight from height and sex.
cuffed and uncuffed tube size and oral depth by age.
calculated osmolality, osmolal gap and ethanol correction.
severity of alcohol-associated hepatitis from prothrombin time and bilirubin.
early stroke risk after a transient ischemic attack.
Which published the original MELD papers, with its current metrics.
Contributed by Dr. Meng Zhao (MD · Former Neurosurgeon · Medical AI Researcher), from the original publications listed here. Last updated November 13, 2026. LinkedIn
The calculator code is tested against every worked example on this page before each release.
This calculator supports, and does not replace, clinical judgment. It is meant for healthcare professionals and is not medical advice for patients. Report an error through the contact page.