1MELD Score — Mortality by Score
| MELD Score | 3-Month Mortality | Transplant Priority |
|---|---|---|
| < 9 | ~1.9% | Low — outpatient management |
| 10–19 | ~6% | Moderate — transplant listing consideration |
| 20–29 | ~20% | High — active transplant evaluation |
| 30–39 | ~53% | Very High — urgent listing |
| ≥ 40 | >71% | Critical — highest priority (1A status) |
MELD Formula
Minimum values: Bili ≥1.0, INR ≥1.0, Cr ≥1.0, Cr max 4.0
MELD-Na = MELD − Na − (0.025 × MELD × (140 − Na)) + 140
Na range clamped to 125–137 mmol/L
MELD-Na vs MELD — Why Sodium Matters
Hyponatraemia in cirrhosis is a marker of advanced disease, portal hypertension, and activated renin-angiotensin-aldosterone system. Patients with the same MELD score but lower serum sodium have significantly higher 90-day waitlist mortality. The United Network for Organ Sharing (UNOS) adopted MELD-Na in January 2016, replacing MELD as the primary organ allocation score.
MELD-Na ranges from 6 to 40. A patient with MELD 20 and sodium 128 mmol/L has MELD-Na ≈ 25 — significantly higher priority for organ allocation than their MELD alone would suggest.
MELD 3.0 — The Newest Formula
MELD 3.0 was introduced in 2021 to address sex-based disparities in liver transplantation (women historically had lower access despite equivalent illness severity). MELD 3.0 adds serum albumin and a female sex coefficient: MELD 3.0 = 4.56 × ln(Bili) + 0.82 × (137 − Na) − 0.24 × (137 − Na) × ln(Cr) + 9.09 × ln(INR) + 11.14 × ln(Cr) + 1.85 × (3.5 − Alb) + 1.33 (if female) + 7. Some UNOS regions are transitioning to MELD 3.0.
Clinical Uses Beyond Transplantation
- Surgical risk assessment: MELD predicts 30-day post-operative mortality in cirrhotic patients. MELD <10 = low risk (~4%). MELD 10–15 = moderate risk (~9%). MELD >15 = high risk (>25%). Elective surgery should generally be avoided if MELD >20
- Acute alcoholic hepatitis: Maddrey Discriminant Function (MDF) is used alongside MELD. MELD >20 in alcoholic hepatitis predicts high mortality and may guide corticosteroid therapy decisions
- Acute-on-chronic liver failure (ACLF): CLIF-C ACLF score has largely replaced MELD for short-term prognosis in ACLF, but MELD is still used for organ allocation
- Variceal bleeding: MELD at admission predicts 6-week mortality after variceal haemorrhage
2Frequently asked questions
What is a dangerous MELD score?
A MELD score ≥15 indicates significant mortality risk and is the threshold for listing for liver transplantation in most centres. MELD 15–19 carries ~20% 3-month mortality without transplantation. MELD 20–29 carries 40–50% 3-month mortality. MELD ≥30 carries 70–80% 3-month mortality. MELD ≥40 has >90% 3-month mortality without transplantation.
What is the difference between MELD and MELD-Na?
MELD-Na adds serum sodium to the original MELD score because hyponatraemia is an independent predictor of mortality in cirrhosis not captured by the original MELD formula. MELD-Na = MELD − serum Na − (0.025 × MELD × (140 − serum Na)) + 140. UNOS adopted MELD-Na in 2016 for organ allocation. Patients with the same MELD but lower sodium have higher waitlist mortality — MELD-Na corrects for this.
Medical disclaimer: This calculator is for educational and clinical decision-support purposes only. It does not replace clinical judgment or specialist consultation. RxMedCalc is not liable for clinical decisions made solely on this tool.