- Enter the total bilirubin (mg/dL), INR, serum creatinine (mg/dL), and serum sodium (mEq/L). The MELD and MELD-Na scores update automatically.
- Tick Dialysis ≥2× in the past week (or ≥24 h of CVVHD) if applicable — this forces creatinine to 4.0 mg/dL, the maximum, reflecting that renal support marks severe renal dysfunction.
- Values of bilirubin, INR, and creatinine below 1.0 are floored at 1.0 before the logarithm (so their contribution is zero); creatinine is also capped at 4.0. Sodium is bounded to 125–137 mEq/L for the MELD-Na correction.
- Read the MELD, MELD-Na, and the estimated 90-day mortality band. MELD-Na is the value used for liver-transplant allocation.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use MELD-Na to grade the severity of chronic liver disease and estimate short-term (90-day) mortality in patients with cirrhosis or end-stage liver disease. Since 2016, MELD-Na has been the basis for prioritizing candidates on the liver-transplant waiting list — a higher score means a sicker patient and a higher allocation priority. For the nephrologist, the score is a reminder that creatinine and dialysis status are powerful, weighted inputs: an episode of AKI or hepatorenal syndrome can move a patient several MELD points and materially change prognosis and transplant standing.
Appropriate population
Adults with chronic liver disease / cirrhosis being assessed for severity, prognosis, or liver-transplant listing. Particularly relevant when there is concurrent kidney injury — hepatorenal syndrome, acute-on-chronic liver failure (ACLF), or AKI from any cause — where the renal contribution to the score and to prognosis is large.
When NOT to rely on it
MELD/MELD-Na is not validated for acute liver failure (fulminant hepatitis without pre-existing cirrhosis). It can be distorted by non-hepatic hyperbilirubinemia (hemolysis), by INR variation from anticoagulation or laboratory method, and by creatinine that does not reflect true GFR (low muscle mass, sepsis). Treat it as one input alongside the full clinical assessment, not a standalone decision rule.
Pearls & Pitfalls
Renal function drives the score
Creatinine carries one of the heaviest coefficients in MELD, and the dialysis rule pins it to the maximum (4.0 mg/dL). That means an AKI episode, hepatorenal syndrome, or starting renal replacement can lift the MELD by several points — and short-term mortality with it. Protecting kidney function (avoiding nephrotoxins, prompt HRS therapy, judicious volume) is also a way of protecting the MELD.
The hyponatremia correction
MELD-Na adds a penalty for hyponatremia, but only when the base MELD is > 11, and the sodium is bounded to 125–137 mEq/L. Low serum sodium in cirrhosis reflects circulatory dysfunction and predicts mortality independently of the other variables — so two patients with the same MELD but different sodium can have meaningfully different prognoses.
Pitfalls
(1) The score floors bilirubin, INR, and creatinine at 1.0 and caps creatinine at 4.0 — entering raw values without these bounds gives the wrong answer. (2) Not valid for acute (fulminant) liver failure. (3) INR is method-dependent (no international standardization for liver disease), so the same plasma can yield different scores between labs. (4) Bilirubin elevated from hemolysis or biliary obstruction, or creatinine that overstates GFR, can inflate the score without reflecting hepatic reserve. (5) MELD 3.0 (2023) refines the model further by adding sex and serum albumin and recalibrating the coefficients — mentioned here for awareness; this tool computes the classic MELD and MELD-Na.
Why Use It
MELD-Na converts four routine laboratory values into a single, validated estimate of how sick a patient with liver disease is and how likely they are to die within three months. Because the model is objective and reproducible, it replaced the older, subjective Child-Pugh class as the basis for fair organ allocation: patients are listed and prioritized by score rather than by waiting time alone. For nephrology, the score is a constant reminder that the kidney and the liver fail together — creatinine and dialysis status are weighted inputs, so an AKI or hepatorenal episode that a nephrologist treats can directly change a patient's prognosis and transplant standing. Computing MELD-Na at the bedside turns a vague impression of "decompensated cirrhosis" into a defensible severity estimate that guides escalation, referral, and listing.
MELD & MELD-Na — Liver Disease Severity
Enter bilirubin, INR, creatinine, and sodium. Tick the dialysis box if the patient had ≥2 sessions of hemodialysis (or ≥24 h of CVVHD) in the past week — this forces creatinine to 4.0 mg/dL. The MELD, MELD-Na, and estimated 90-day mortality update automatically.
⚕ Kamath PS et al. Hepatology. 2001 (MELD); Kim WR et al. N Engl J Med. 2008 (MELD-Na). MELD/MELD-Na grades chronic liver disease severity and predicts short-term mortality; it is not validated for acute liver failure. INR is laboratory-method dependent and bilirubin/creatinine may be raised by non-hepatic causes. MELD 3.0 (2021/2023) refines this further by adding sex and albumin. For licensed clinicians; not a substitute for individualized assessment.
Next Steps
Use the MELD-Na band to gauge urgency, prognosis, and the renal contribution to the score.
- Low score (MELD-Na ≤ 9): ~2% 90-day mortality. Continue routine cirrhosis surveillance and treat reversible factors; recheck if clinical status changes.
- Rising or high score (MELD-Na ≥ 15): prognosis worsens steeply. Refer for / advance liver-transplant evaluation, and address each driver — variceal prophylaxis, ascites and hyponatremia management, infection control.
- Creatinine or dialysis driving the score: stage and work up the AKI, evaluate for hepatorenal syndrome, withdraw nephrotoxins and diuretics as appropriate, and consider HRS-specific therapy. Use the KDIGO AKI staging tool alongside this score.
- Co-morbidity burden also shapes prognosis — pair with the Charlson Comorbidity Index when counseling on overall outlook.
- Remember MELD-Na is one input: integrate it with the patient's full clinical trajectory, sodium dynamics, and frailty before transplant-listing decisions.
Evidence & References
Formulas & bounds
| Quantity | Formula / rule |
|---|---|
| Variable bounds | Bilirubin, INR, creatinine floored at 1.0; creatinine capped at 4.0; if dialysis ≥2×/week → creatinine = 4.0 |
| MELD(i) | 10 × [0.957 × ln(Cr) + 0.378 × ln(bili) + 1.120 × ln(INR) + 0.643], rounded; floor 6, cap 40 |
| Sodium bound | Na limited to 125–137 mEq/L |
| MELD-Na (if MELD > 11) | MELD + 1.32 × (137 − Na) − [0.033 × MELD × (137 − Na)]; otherwise = MELD; rounded, cap 40 |
Estimated 90-day mortality by MELD-Na
| MELD-Na | Approx. 3-month mortality |
|---|---|
| ≤ 9 | ~2% |
| 10–19 | ~6% |
| 20–29 | ~20% |
| 30–39 | ~50% |
| ≥ 40 | ~70%+ |
Kamath and colleagues derived MELD to predict survival after TIPS and, later, in end-stage liver disease; Kim and colleagues showed that adding serum sodium (MELD-Na) improved mortality prediction on the transplant waiting list, leading to its adoption for organ allocation. MELD 3.0 subsequently recalibrated the model and added sex and albumin.
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.
- Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–1026.
- Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The Model for End-Stage Liver Disease updated for the modern era. Gastroenterology. 2021;161(6):1887–1895.
