GI & Liver

Model for End-Stage Liver Disease (MELD 3.0) Calculator

The US liver allocation score since July 2023: estimates 90-day mortality in chronic liver disease, with MELD-Na alongside.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

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Formula

MELD 3.0 = 1.33 (if female) + 4.56 × ln(bilirubin) + 0.82 × (137 − Na) − 0.24 × (137 − Na) × ln(bilirubin) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5 − albumin) − 1.83 × (3.5 − albumin) × ln(creatinine) + 6
Units: bilirubin and creatinine mg/dL, Na mEq/L, albumin g/dL
Bounds: bilirubin, INR and creatinine below 1.0 count as 1.0; creatinine above 3.0 counts as 3.0; Na 125–137; albumin 1.5–3.5
Dialysis: 2 or more sessions, or 24 hours of CVVHD, in the 7 days before the creatinine test sets creatinine to 3.0
Rounded to a whole number; maximum 40
90-day survival = 0.946 ^ exp(0.17698 × MELD 3.0 − 3.56)
MELD-Na (2016–2023): MELD(i) = 0.957 × ln(creatinine) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643, rounded to the tenth and × 10; if over 11, MELD-Na = MELD(i) + 1.32 × (137 − Na) − 0.033 × MELD(i) × (137 − Na); creatinine capped at 4.0 (4.0 with dialysis)

How it is used

• MELD 3.0 has ranked US candidates 12 and older for deceased-donor livers since 13 July 2023; children under 12 use PELD (OPTN 2023).
• Compared with MELD-Na it adds female sex and albumin and lowers the creatinine cap from 4.0 to 3.0; it predicted 90-day wait-list death better (C statistic 0.869 vs 0.862) and moved a net 8.8% of those who died to a higher tier (Kim 2021).
• MELD-Na, the allocation score from 2016 to July 2023, is shown for comparison with older studies and tools (OPTN 2016).
• Built on US wait-list registrations from 2016 to 2018: it estimates short-term mortality in chronic liver disease, not operative risk (Kim 2021).

Key points

• Ask about dialysis: 2 or more sessions or 24 hours of CVVHD in the 7 days before the creatinine sets it to 3.0 and can add many points.

Same formula as the app. Open it in the web app.

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• GI Bleeding, Liver Failure and Pancreatitis

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• Glasgow-Blatchford Bleeding Score (GBS)

For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.