Bedside Rounds

MELD 3.0 and MELD-Na calculator

MELD 3.0 estimates 90-day mortality in chronic liver disease and has been used for US liver transplant allocation since 2023. It adds albumin and sex to MELD-Na, which is also shown.

What goes into the MELD 3.0 and MELD-Na

  • Bilirubin (mg/dL)
  • INR
  • Creatinine (mg/dL)
  • Sodium (mEq/L)
  • Albumin (g/dL)
  • Sex: Male; Female
  • Dialysis ≥ 2× in past week (or 24 h CVVHD)

How to interpret the result

  • < 10: 90-day mortality under 2%
  • 10–19: about 6%
  • 20–29: about 20%
  • ≥ 30: about 50% or more; discuss with hepatology and transplant teams

Clinical pearls

  • Lab values under 1.0 are set to 1.0. Creatinine is capped at 3.0 for MELD 3.0 (4.0 for MELD-Na), and set to the cap with dialysis twice in the past week.
  • Sodium is bounded 125–137 mEq/L and albumin 1.5–3.5 g/dL.

Evidence

  1. Kim WR, et al. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology. 2021;161:1887-1895.
  2. Kim WR, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018-1026.

Related workups

Decompensated cirrhosis (ascites, SBP, hepatic encephalopathy)Alcohol-associated hepatitisAcetaminophen overdoseUpper GI bleed

Related calculators

Glasgow-BlatchfordCreatinine clearance (Cockcroft-Gault)All calculators

For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.