MELD Score (fígado)

MELD score: 90-day mortality in chronic liver disease

The MELD (Model for End-Stage Liver Disease) score is used to estimate 90-day mortality in people with chronic liver disease, and it's what ranks patients on transplant waiting lists. The formula is MELD = 3.78·ln(bilirubin) + 11.2·ln(INR) + 9.57·ln(creatinine) + 6.43. Every lab value is floored at 1.0 first, so the logs never go negative. Results run from 6–40 (anything higher is capped). How to read it: <10 low risk, then 10–19 intermediate, 20–29 high, and ≥30 very high. Once a patient passes >15, transplant usually comes onto the table. As an example, bilirubin 4 mg/dL, INR 1.8, and creatinine 1.5 mg/dL land around MELD ≈ 21.

Clinical context

Adopted by UNOS (USA, 2002) and the Brazilian National Transplant System to allocate deceased-donor livers. Variants: MELD-Na (adds sodium, captures hyponatremia in advanced cirrhosis) and MELD 3.0 (2023), which re-incorporates bilirubin, INR, creatinine, sodium, albumin, and female sex — correcting historical inequities for women. Used in hepatology, decisions about TIPS, prognosis in decompensated cirrhosis, and management of hepatorenal syndrome.

FAQ

Does MELD apply to acute liver failure? No. It was validated for chronic liver disease. Acute failure uses King's College Criteria or other models.

Why floor lab values at 1.0? The natural log of values below 1 is negative and would artificially lower the score; flooring keeps the formula monotonic.

What does MELD 3.0 add? Albumin and a correction for female sex (since women have lower creatinine for the same renal function, the classic MELD underestimated severity).

Can MELD decrease? Yes — treating ascites, varices, encephalopathy, or HCV may improve labs and lower the score, removing the patient from the priority list.