Liver · Model for End-Stage Liver Disease

MELD 3.0

90-day mortality in cirrhosis, and priority for a liver transplant.

TellBilirubin, INR, creatinine, sodium and albumin are five ways of asking how much work the liver, and the kidney that depends on it, can still do.

Sex

Bilirubinmg/dLINRCreatininemg/dLSodiummEq/LAlbuming/dL

Dialysis twice or more in the past week, or 24 hours of continuous dialysis

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Nothing you enter is saved or sent. US units. Education, not medical advice.

When I reach for it

Every patient with cirrhosis, each time labs come back. At 15 or more, they should be seen at a transplant center.

Where it misleads

It reads labs, not people. Encephalopathy, ascites that keeps coming back, frailty and liver cancer can matter more than the number. An INR raised by warfarin makes it meaningless.

How it is built

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. Bilirubin, INR and creatinine are floored at 1; creatinine is capped at 3, and set to 3 with dialysis; sodium is held between 125 and 137 and albumin between 1.5 and 3.5. Reported up to 40.

Built on

Kim WR et al., Gastroenterology 2021; OPTN allocation policy, 2023; AASLD guidance on transplant referral.