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Hvad er MELD Score (Liver Failure)?
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The Model for End-Stage Liver Disease (MELD) score is a validated, objective scoring system used to predict short-term mortality in patients with chronic liver disease and cirrhosis. Originally developed in 2001 at the Mayo Clinic to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) procedures, it was later adopted by the United Network for Organ Sharing (UNOS) in 2002 to prioritise liver transplant allocation in the United States. The MELD score is calculated using three routinely measured laboratory values: serum bilirubin (reflecting liver synthetic and excretory function), international normalised ratio of prothrombin time (INR, reflecting coagulation factor production), and serum creatinine (reflecting renal function — a major determinant of mortality in cirrhosis). The logarithmic formula weights these variables to produce a score typically ranging from 6 to 40. Higher scores indicate greater 90-day mortality risk without transplantation. The updated MELD-Na score, also called MELD 3.0 in some iterations, incorporates serum sodium to better capture patients with dilutional hyponatraemia who are at higher mortality risk than the standard MELD suggests. MELD-Na is now the primary allocation score used by UNOS/OPTN. A MELD score of 40 corresponds to a 90-day mortality of approximately 71% without transplant, underscoring its utility in urgent clinical decision-making.
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Formel
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MELD = 3.78 × ln(bilirubin mg/dL) + 11.2 × ln(INR) + 9.57 × ln(creatinine mg/dL) + 6.43; MELD-Na = MELD + 1.32 × (137 − Na) − [0.033 × MELD × (137 − Na)]Variabelbeskrivelse
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| Symbol | Navn | Enhed | Beskrivelse |
|---|---|---|---|
| Bili | Serum Bilirubin | mg/dL | Reflects the liver's ability to conjugate and excrete bile pigments. Elevated in cholestasis, hepatocyte failure, and haemolysis. |
| INR | International Normalised Ratio | dimensionless ratio | Measures the extrinsic coagulation pathway. Elevated INR in cirrhosis reflects impaired hepatic synthesis of clotting factors II, VII, IX, and X. |
| Cr | Serum Creatinine | mg/dL | Marker of renal function. Renal impairment in cirrhosis (hepatorenal syndrome) is a major independent predictor of mortality. |
| Na | Serum Sodium | mEq/L | Used in MELD-Na. Hyponatraemia in cirrhosis reflects fluid retention and portal hypertension and independently predicts waitlist mortality. |
Sådan MELD Score (Liver Failure)
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- 1Collect three lab values: serum bilirubin (mg/dL), INR, and serum creatinine (mg/dL). If the patient has been dialysed twice in the past week, creatinine is set to 4.0 mg/dL.
- 2Apply a minimum value of 1.0 to each variable before taking the natural logarithm to avoid negative or undefined values (ln of numbers below 1 is negative).
- 3Calculate the natural logarithm (ln) of each lab value and multiply by the respective coefficients: bilirubin × 3.78, INR × 11.2, creatinine × 9.57.
- 4Sum the three weighted terms and add the constant 6.43 to obtain the raw MELD score. Round to the nearest whole number.
- 5For MELD-Na, measure serum sodium (capped between 125 and 137 mEq/L). Apply the sodium correction formula to adjust for hyponatraemia.
- 6Interpret the final score against the UNOS mortality risk table: scores of 10–19 carry roughly 6% 90-day mortality; scores 30–39 carry approximately 52%; scores 40+ carry 71% or more.
- 7Reassess MELD regularly — every 7 days for scores ≥25, every 30 days for 18–24, every 90 days for 11–17, and every year for scores ≤10.
Løste eksempler
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Low-priority waitlist — 90-day mortality approximately 6%
With near-normal creatinine and only mildly elevated bilirubin and INR, this patient has well-compensated disease. MELD 11 places them at the lower end of the transplant waitlist.
High priority — 90-day mortality approximately 29%
Significant jaundice combined with coagulopathy and renal impairment substantially raises the MELD score. This patient should be evaluated urgently for transplant listing.
Very high mortality — requires urgent transplant evaluation
Hepatorenal syndrome drives creatinine to its maximum capped value, combined with severe jaundice and marked coagulopathy, resulting in a critically high MELD score indicating imminent risk of death.
Sodium correction increases priority significantly
Severe hyponatraemia signals higher actual mortality risk than MELD alone captures. The MELD-Na correction raised this patient's score by 7 points, moving them up the transplant waitlist.
Praktiske anvendelser
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Organ allocation: UNOS/OPTN uses MELD-Na as the primary score for ranking adults on the US liver transplant waitlist, ensuring the most critically ill patients receive priority access to donor organs.
Professionals in finance and lending use Meld Score as part of their standard analytical workflow to verify calculations, reduce arithmetic errors, and produce consistent results that can be documented, audited, and shared with colleagues, clients, or regulatory bodies for compliance purposes.
University professors and instructors incorporate Meld Score into course materials, homework assignments, and exam preparation resources, allowing students to check manual calculations, build intuition about input-output relationships, and focus on conceptual understanding rather than arithmetic.
Consultants and advisors use Meld Score to quickly model different scenarios during client meetings, enabling real-time exploration of what-if questions that would otherwise require returning to the office for detailed spreadsheet-based analysis and reporting.
Individual users rely on Meld Score for personal planning decisions — comparing options, verifying quotes received from service providers, checking third-party calculations, and building confidence that the numbers behind an important decision have been computed correctly and consistently.
Særlige tilfælde
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Extreme input values
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in meld score calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
Assumption violations
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in meld score calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
Rounding and precision effects
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in meld score calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
MELD Score and 90-Day Mortality Without Transplant
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| MELD Score | 90-Day Mortality (%) | UNOS Recalculation Interval |
|---|---|---|
| < 10 | < 2% | Annual |
| 10–19 | 6% | Every 90 days |
| 20–29 | 19% | Every 30 days |
| 30–39 | 52% | Every 7 days |
| ≥ 40 | 71%+ | Every 7 days (urgent) |
Ofte stillede spørgsmål
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What is the MELD score used for?
Meld Score is a specialized calculation tool designed to help users compute and analyze key metrics in the finance and lending domain. It takes specific numeric inputs — typically drawn from real-world data such as measurements, rates, or quantities — and applies a validated mathematical formula to produce actionable results. The tool is valuable because it eliminates manual calculation errors, provides instant feedback when exploring different scenarios, and serves as both a decision-support instrument for professionals and a learning aid for students studying the underlying principles.
What is the difference between MELD and MELD-Na?
In the context of Meld Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of finance and lending practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Why is creatinine capped at 4.0 mg/dL?
In the context of Meld Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of finance and lending practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
What MELD score qualifies for transplant?
In the context of Meld Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of finance and lending practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
What is the highest possible MELD score?
In the context of Meld Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of finance and lending practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Does MELD predict acute liver failure?
In the context of Meld Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of finance and lending practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
How often should MELD be recalculated?
To use Meld Score, enter the required input values into the designated fields — these typically include the primary quantities referenced in the formula such as rates, amounts, time periods, or physical measurements. The calculator applies the standard mathematical relationship to transform these inputs into the output metric. For best results, verify that all inputs use consistent units, double-check values against source documents, and review the output in context. Running the calculation with slightly different inputs helps reveal which variables have the greatest impact on the result.
Can MELD be used for alcoholic hepatitis?
In the context of Meld Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of finance and lending practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Almindelige fejl at undgå
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- !Using raw creatinine above 4.0 mg/dL without applying the UNOS cap, which artificially inflates the score beyond the validated range.
- !Forgetting to set minimum values of 1.0 for all three variables before taking the natural log — values below 1 yield negative logarithms, which will incorrectly reduce the total score.
- !Calculating MELD-Na with sodium outside the 125–137 mEq/L constraint window, producing erroneous adjustments.
- !Using MELD to prioritise in acute liver failure, where it was not validated and the King's College Criteria are more appropriate.
- !Confusing MELD with Child-Pugh — Child-Pugh includes subjective variables (ascites grade, encephalopathy grade) whereas MELD is entirely lab-based and objective.
- !Neglecting to recheck labs at the mandated intervals, allowing the score to become stale and misrepresent current disease severity on the waitlist.
Pro Tip
Always verify that bilirubin, INR, and creatinine are recent (ideally within 48 hours) before calculating a MELD score for transplant listing purposes. Stale labs can significantly misrepresent a patient's current status and affect waitlist priority.
Vidste du?
When MELD was first described in 2001 by Malinchoc and colleagues, the 'D' stood for 'Disease' — it was the Model for End-stage Liver Disease. The UNOS adopted it in 2002 to replace the purely time-based waitlist system that was criticised for favouring patients who had been waiting longest rather than those who were sickest.
Regional Guides
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🇺🇸 US▾
🇬🇧 UK▾
🇪🇺 EU▾
Referencer
- ›Kamath PS et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001.
- ›UNOS/OPTN MELD-Na Policy Documentation
- ›Kim WR et al. MELD-Na: Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List. NEJM 2008.
- ›AASLD Practice Guidance: Evaluation for Liver Transplantation in Adults
- ›MDCalc — MELD Score Calculator with clinical guidance
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