GIHep

Gastroenterology & Hepatology Resources

Model for End Stage Liver Disease (MELD) Na

On Dialysis :
Creatinine :
Total Bilirubin:
INR :
Sodium :

The Model for End-Stage Liver Disease (MELD) is a reliable measure of mortality risk in patients with end-stage liver disease. It is used as a disease severity index to help prioritize allocation of organs for transplant. The MELD Na adds the sodium to the calculation to better categorize patients with cirrhois with mortality.

Formula :

MELDNa − [0.025 × MELD × (140 − Na)] + 140

Explanation of Result :

3 Month Mortality :

MELD score > 40 : 71.3% mortality
MELD score 30–39 : 52.6% mortality
MELD score 20–29 : 19.6% mortality
MELD score 10–19 : 6.0% mortality
MELD score < 9 : 1.9% mortality

* Please verify all calculations prior to clinical use.

References

  • Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007 Mar;45(3):797-805. PMID: 17326206.

  • Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R; United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003 Jan;124(1):91-6. PMID: 12512033.

  • Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008 Sep 4;359(10):1018-26. PMID: 18768945.

  • Evan Lewis

    There is a typo in this equation. The equals sign is missing and it would be better re-arranged. Starting with the old standard

    MELD = 3.8 ln(Bili) + 11.2 ln(INR) + 9.6 ln(creatinine) +6.43

    where ln is the natural log (base e). This can be converted to log base 10 by multiplying each log constant by 2.303 = ln(10). That makes it easier to understand exactly what it means. Change the order so the most significant factor comes first. So

    MELD = 25.8 log(INR) + 22.1 log(creatinine) + 8.75 log(Bili) + 6.43.

    Now you can see a 10-fold increase in INR increases MELD by 4.86 since log(10)=1.
    Since normals are about Bili=1; INR=1; Creatinine=1 and log 1=0 then a normal MELD is 6.
    If each of these increases 10 fold MELD= 25.8 + 22.1 + 8.75 +6.43 =63.0.

    However since Jan 2016 sodium has officially been added to the MELD score:

    MELD-Na = MELD + (140 – Na)(1 – 0.025*MELD)

    valid for for
    sodium=125 to 140
    MELD < 40 and
    Creatinine < 4.
    If a patient has higher creatinine or is on hemodialysis a creatinine of 4 is used.