Hepatology
MELD Score
Severity of end-stage liver disease.
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Background
The Model for End-Stage Liver Disease (MELD) is an objective measure of the severity of chronic liver disease, originally developed to predict survival after transjugular intrahepatic portosystemic shunt and later adopted for transplant prioritisation. It is calculated from three laboratory values: serum bilirubin, INR and serum creatinine, combined in a logarithmic formula. Higher values reflect worse synthetic and excretory liver function and renal impairment. The score is typically reported on a scale from 6 to 40.
Interpreting the result
A lower MELD (roughly under 10) indicates less severe disease and good short-term survival, scores of 10–19 reflect moderate severity, and scores of 20 or above indicate high severity with markedly increased short-term mortality. The score is used to rank patients for liver transplantation, with higher scores given priority. It estimates short-term mortality risk and does not, by itself, determine transplant suitability, which depends on additional clinical assessment.
Worked example
A patient with a bilirubin of 4 mg/dL, an INR of 1.8 and a creatinine of 1.5 mg/dL has a MELD in the high teens, placing them in the moderate-severity band and signalling a meaningful increase in short-term mortality risk that warrants specialist review.
Critical actions
Bilirubin and creatinine in mg/dL. Creatinine is capped at 4.0; minimum value of 1.0 is used for each. This is the original MELD; MELD-Na and MELD 3.0 add further adjustments.
Pearls / pitfalls
- Bilirubin and creatinine must be entered in mg/dL, not the SI units (µmol/L) used in many UK laboratories — convert carefully.
- Creatinine is capped at 4.0 mg/dL, and a minimum value of 1.0 is applied to each variable, so very low values do not distort the score.
- Patients on renal replacement therapy are usually assigned the capped creatinine, reflecting severe renal impairment.
- This is the original MELD; MELD-Na and MELD 3.0 add sodium and other adjustments and may be used by current allocation systems.
Evidence & validation
Derived by Kamath and colleagues and validated as a predictor of short-term mortality in chronic liver disease. It was adopted by transplant allocation systems internationally; subsequent refinements (MELD-Na and MELD 3.0) incorporate sodium and additional adjustments to improve accuracy.
Frequently asked questions
What is a high MELD score?
A score of 20 or above indicates high severity with a substantially increased short-term mortality risk. Scores of 10–19 are moderate and below 10 reflect less severe disease.
Why does it use mg/dL not µmol/L?
The original MELD formula was derived using bilirubin and creatinine in mg/dL. UK laboratories report these in SI units (µmol/L), so values must be converted before entry to avoid a grossly incorrect score.
Why are bilirubin and creatinine capped?
Each variable has a minimum of 1.0 to prevent very low values from disproportionately lowering the score, and creatinine is capped at 4.0 mg/dL so that severe renal impairment does not over-dominate the result.
How does MELD differ from Child-Pugh?
MELD is a continuous score based purely on laboratory values, used mainly for transplant prioritisation. Child-Pugh grades cirrhosis into classes and includes clinical features such as ascites and encephalopathy.
What are MELD-Na and MELD 3.0?
These are refinements of the original score. MELD-Na adds serum sodium, and MELD 3.0 incorporates further adjustments including sex, both improving mortality prediction. Allocation systems may use these updated versions.
References
- Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470.
- Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91–96.
About the creator
Kamath PS et al.
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