Chronic liver disease severity and 90-day mortality prognosis.
The MELD score (Model for End-stage Liver Disease) predicts 3-month mortality in cirrhosis. Developed by Kamath et al. (Hepatology, 2001) originally for TIPS risk, and since 2002 the primary criterion for US liver transplant allocation (UNOS). Formula: MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43. Minimum 6, maximum 40. Interpretation of 3-month mortality. <9 – 1.9%. 10-19 – 6%. 20-29 – 19.6%. 30-39 – 52.6%. >=40 – 71.3%. Patients with MELD >=17 are considered for transplant listing; >=25 – high priority. Clinical use. Liver transplant listing stratification. Survival prognosis in decompensated cirrhosis. Decisions on palliative care at end stage. Before MELD, Child-Pugh was widely used, but MELD discriminates severe patients more accurately. Limitations of original MELD. Does not capture hyponatremia, diuretic-refractory ascites, hepatorenal syndrome. Patients with relatively low MELD (<20) and severe ascites or hyponatremia have worse prognosis than predicted. Since 2016 the US uses MELD-Na (sodium-corrected); since 2023 – MELD 3.0 (sex, albumin, sodium-corrected). Exception points. Hepatocellular carcinoma within Milan criteria, hepatopulmonary syndrome, portopulmonary hypertension, amyloidosis, cystic fibrosis, primary hyperoxaluria. These patients receive UNOS exception points raising priority regardless of laboratory MELD.
Formula version: kamath-2001-v1
Calculators