Calculating Meld Score

MELD Score Calculator

Understanding the MELD Score: A Critical Tool for Liver Disease Assessment

The Model for End-Stage Liver Disease (MELD) score is a widely used, objective scoring system that assesses the severity of chronic liver disease. Developed initially to predict survival in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures, its application has expanded significantly. Today, the MELD score is most notably used by the United Network for Organ Sharing (UNOS) and other transplant organizations worldwide to prioritize patients for liver transplantation.

Why is the MELD Score Important?

The MELD score provides a numerical estimate of a patient's risk of death within three months due to liver disease. This makes it an invaluable tool for:

• Organ Allocation: It ensures that the sickest patients, who have the highest likelihood of dying without a transplant, receive available donor livers first.
• Prognosis: Clinicians use it to gauge the severity of liver disease and predict patient outcomes, helping to guide treatment decisions.
• Monitoring Disease Progression: Changes in a patient's MELD score over time can indicate whether their liver disease is worsening or stabilizing.

How is the MELD Score Calculated?

The MELD score is calculated using a formula that incorporates several routine laboratory values, reflecting different aspects of liver and kidney function. The original MELD formula included:

• Serum Bilirubin: A measure of how well the liver is clearing bile. High levels indicate impaired liver function.
• INR (International Normalized Ratio): A measure of the liver's ability to produce clotting factors. A high INR indicates poor liver synthetic function.
• Serum Creatinine: A measure of kidney function. Liver disease can impact kidney function (hepatorenal syndrome), and elevated creatinine is a poor prognostic sign.

More recently, the MELD score has been refined to include serum sodium, leading to the MELD-Na score. Sodium levels are important because hyponatremia (low sodium) is common in advanced liver disease and is associated with increased mortality. The MELD-Na formula also accounts for whether a patient is on dialysis, as this significantly impacts creatinine levels and overall prognosis.

The calculator above uses the MELD-Na formula, which is the current standard for liver transplant prioritization.

Understanding Your MELD Score: What Do the Numbers Mean?

The MELD score typically ranges from 6 (least severe) to 40 (most severe). Higher scores indicate more severe liver disease and a higher risk of short-term mortality. Here's a general interpretation:

• Less than 10: Generally indicates a lower risk of mortality from liver disease. Patients in this range may still require ongoing medical management.
• 10-19: Suggests a moderate risk of mortality. Patients often begin to experience more significant symptoms and complications.
• 20-29: Indicates a high risk of mortality. Patients in this range are typically considered for liver transplantation and are often prioritized.
• 30-40: Represents a very high risk of mortality. Urgent medical intervention and liver transplantation are critical for survival.

It's important to remember that the MELD score is a dynamic measure and can change over time. It is regularly recalculated for patients on the transplant waiting list.

Important Considerations and Limitations

• Not a Sole Determinant: While crucial, the MELD score is not the only factor in liver transplant decisions. Other factors like overall health, social support, and specific complications are also considered.
• Acute vs. Chronic: The MELD score is primarily designed for chronic liver disease. For acute liver failure, other prognostic tools may be used.
• Medical Interpretation: This calculator provides an estimate based on standard formulas. A MELD score should always be interpreted by a qualified healthcare professional in the context of a patient's complete medical history and clinical status. It is not a substitute for professional medical advice.

If you have concerns about liver health or your MELD score, please consult with your doctor or a liver specialist.