MELD & Child-Pugh Score Calculator

About the MELD & Child-Pugh Score Calculator

The Model for End-Stage Liver Disease (MELD) ranks patients with chronic liver disease by their risk of death within about 3 months, and sets priority on the liver transplant waiting list. This calculator gives all three versions the US transplant network (OPTN) has used:

• MELD 3.0, the current version, which adds sex and serum albumin and resets the creatinine cap to 3.0 mg/dL;
• MELD-Na, MELD with serum sodium;
• the original MELD, from bilirubin, INR and creatinine.

Each applies its published bounds — lab values below 1.0 count as 1.0, sodium and albumin are bounded, dialysis in the past week sets the creatinine — and the table shows exactly which values were used. The Child-Pugh score (bilirubin, albumin, INR, ascites, encephalopathy) is calculated from the same results. Bilirubin and creatinine can be entered in mg/dL or µmol/L, albumin in g/dL or g/L. Written for clinicians; nothing leaves your browser.

Common uses

• Checking a patient’s MELD 3.0 alongside the MELD-Na they were listed with.
• Seeing how a lab result moves the score — the equation table shows each term.
• Recording the Child-Pugh class with each of its five measures.
• Converting µmol/L and g/L results without a separate converter.

The equations

• MELD 3.0 = 1.33 (if female) + 4.56 × ln(bilirubin) + 0.82 × (137 − sodium) − 0.24 × (137 − sodium) × ln(bilirubin) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5 − albumin) − 1.83 × (3.5 − albumin) × ln(creatinine) + 6, rounded to the nearest whole number. Bilirubin and creatinine in mg/dL, albumin in g/dL, sodium in mmol/L.
• Bounds for MELD 3.0: bilirubin, INR and creatinine below 1.0 are set to 1.0; creatinine is capped at 3.0, and set to 3.0 after two or more dialysis treatments (or 24 hours of CVVHD) in the past 7 days; sodium is bounded at 125–137 and albumin at 1.5–3.5. For candidates aged 12 to 17, the OPTN adds the 1.33 points whatever the sex. Scores above 40 count as 40 for allocation.
• MELD (OPTN) = 10 × (0.957 × ln(creatinine) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643), with the term rounded to the tenth before multiplying. Values below 1.0 are set to 1.0, creatinine is capped at 4.0 and set to 4.0 with dialysis.
• MELD-Na = MELD + 1.32 × (137 − sodium) − 0.033 × MELD × (137 − sodium), applied only when MELD is above 11, with sodium bounded at 125–137; rounded.

Child-Pugh score

• Bilirubin: below 2 mg/dL (below 34 µmol/L) 1 · 2–3 mg/dL (34–50 µmol/L) 2 · above 3 mg/dL (above 50 µmol/L) 3. Cholestatic bands for PBC and PSC: below 4 mg/dL (68 µmol/L) 1 · 4–10 mg/dL 2 · above 10 mg/dL (170 µmol/L) 3.
• Albumin: above 3.5 g/dL 1 · 2.8–3.5 g/dL 2 · below 2.8 g/dL 3 (35 and 28 g/L).
• INR: below 1.7 1 · 1.7–2.3 2 · above 2.3 3. Pugh’s original table used the prothrombin time prolonged by less than 4, 4–6 or more than 6 seconds instead.
• Ascites: none 1 · mild, or controlled with medication 2 · moderate to severe, or refractory 3.
• Hepatic encephalopathy: none 1 · grade I–II 2 · grade III–IV 3.

The total is 5–15: class A 5–6, class B 7–9, class C 10–15. Bilirubin is scored in the unit you enter, because the published µmol/L bands are rounded rather than exact conversions.

What the numbers mean

MELD was validated as a predictor of death within 3 months, with a c-statistic of 0.78 to 0.87 in four groups of patients with chronic liver disease. On the US waiting list, 3-month mortality was 1.9% with a MELD below 9 and 71.3% at 40 or more. In the MELD 3.0 development data the average candidate scored 20, with a predicted 90-day mortality of 5.4%; the worked examples in the paper run from 2.6% at a score of 16 to 79.1% at 39. MELD 3.0 discriminated better than MELD-Na (concordance 0.869 against 0.862), moved a net 8.8% of the patients who died into a higher score tier — particularly women — and in simulated allocation led to fewer waiting-list deaths (7,788 against 7,850 over three years).

In studies outside transplantation, a systematic review found that MELD did not perform better than Child-Pugh for prognosis in cirrhosis; the two are complementary.

Units

Bilirubin: 1 mg/dL = 17.1 µmol/L. Creatinine: 1 mg/dL = 88.4 µmol/L. Albumin: 1 g/dL = 10 g/L. Sodium in mmol/L is the same number as mEq/L. The INR has no unit. Switch a unit after typing and the number converts if it can only have been in the other unit; otherwise it is kept as typed.

Sources

• Kim WR et al. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era — equation, bounds and Table 4
• MELD 3.0 for adolescent liver transplant candidates — the OPTN equations, the 12–17 rule and the dialysis rule
• Kamath PS et al. A model to predict survival in patients with end-stage liver disease · Wiesner R et al. Model for end-stage liver disease (MELD) and allocation of donor livers · Kim WR et al. Hyponatremia and mortality among patients on the liver-transplant waiting list
• Pugh RN et al. Transection of the oesophagus for bleeding oesophageal varices — the Child-Pugh table · Guidelines for the management of primary biliary cirrhosis — cholestatic bilirubin bands
• Cholongitas E et al. Systematic review: the model for end-stage liver disease — should it replace Child-Pugh’s classification for assessing prognosis in cirrhosis?

Limitations

• Transplant listing uses the transplant programme’s own laboratory values, dates and calculation; this calculator is for understanding and checking, not for registration.
• MELD reflects laboratory values that change: it is only as current as the blood test. An INR raised by warfarin does not reflect liver function.
• For age 12 and over. Children under 12 are scored with PELD, which is not included.
• Child-Pugh grades of ascites and encephalopathy are clinical judgements, so two clinicians can score the same patient differently.
• Neither score is a tool for drug dosing; follow each medicine’s own labelling for hepatic impairment.

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