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MELD-Na and MELD 3.0

Estimates 90-day mortality in cirrhosis from creatinine, bilirubin, INR and sodium (MELD-Na), with MELD 3.0 adding sex and albumin.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Classic MELD 2001/2003; MELD-Na with the coefficients of the OPTN policy implemented in 2016; MELD 3.0 with the adult formula from Kim (2021) and the OPTN allocation limits implemented in 2023, according to the policy of October 1, 2026.

MELD, MELD-Na and MELD 3.0 are distinct versions, with their own variables, interactions and limits. The original model was assessed for three-month mortality in advanced liver disease; it does not automatically confirm current organ-allocation rules. Inputs and interpretation must match the edition and clinical context. The variant presented here is for adults: the OPTN policy of October 1, 2026 distinguishes people registered at age 18 or older from people registered before age 18; the pediatric formula is not implemented in this tool. Under the dialysis definition in that policy, there must have been two dialysis sessions or at least 24 hours of continuous venovenous hemodialysis in the preceding seven days. The original MELD-Na formula from Kim (2008), with sodium between 125 and 140 mmol/L, differs from the coefficients and sodium limits in this edition. The analysis by Kim (2021) did not cap MELD 3.0 at 40; in this edition, that limit comes from the allocation policy. Reading these sources and checking the numbers do not establish approval of eligibility, transplant priority, diagnosis or clinical decisions.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Creatinine · mg/dL
Total bilirubin · mg/dL
INR
Sodium · mEq/L
Dialysis 2 or more times in the last week (or 24 h of continuous hemodialysis)?
Sex
Albumin (for MELD 3.0) · g/dL

3/3 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Limits: bilirubin, INR and creatinine minimum 1.0; creatinine maximum 4.0 (MELD) or 3.0 (MELD 3.0), assumed at maximum if on dialysis; sodium 125–137; albumin 1.5–3.5.

MELD(i) = 10 × [0.957 × ln(Cr) + 0.378 × ln(Bil) + 1.120 × ln(INR) + 0.643], rounded.

MELD-Na (if MELD(i) > 11) = MELD(i) + 1.32 × (137 − Na) − 0.033 × MELD(i) × (137 − Na).

MELD 3.0 = 1.33 (female) + 4.56 × ln(Bil) + 0.82 × (137 − Na) − 0.24 × (137 − Na) × ln(Bil) + 9.09 × ln(INR) + 11.14 × ln(Cr) + 1.85 × (3.5 − Alb) − 1.83 × (3.5 − Alb) × ln(Cr) + 6.

All capped at 40.

The displayed MELD-Na formula uses the coefficients of the OPTN policy implemented in 2016, reproduced by Kim (2021); it is not the original MELD-Na formula from Kim (2008). The cap of 40 and the creatinine value of 3.0 mg/dL during dialysis in MELD 3.0 follow the adult OPTN policy of October 1, 2026; Kim (2021) did not apply the cap of 40 in the analysis.

References

Identifier: meld

Original clinical content: Brazilian Portuguese.

Method version

meld@native-2026-10-03+5d3fc8b67a80

OPTN Policies effective October 1, 2026. Policy 9.1D: adult MELD score, dialysis definition and bounds.

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (3)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Creatinine: 1 mg/dL
Total bilirubin: 1 mg/dL
INR: 1
Sodium: 137 mEq/L
Dialysis 2 or more times in the last week (or 24 h of continuous hemodialysis)?: No
Sex: Female
Albumin (for MELD 3.0): 3.5 g/dL

{
  "cr": 1,
  "bili": 1,
  "inr": 1,
  "na": 137,
  "dialise": "0",
  "sexo": "F",
  "alb": 3.5
}

Expected result

{
  "meld": 6,
  "meldna": 6,
  "meld3": 7
}

Actual result

{
  "meld": 6,
  "meldna": 6,
  "meld3": 7
}

Case 2

reference-002

Inputs

Creatinine: 2 mg/dL
Total bilirubin: 4 mg/dL
INR: 2
Sodium: 130 mEq/L
Dialysis 2 or more times in the last week (or 24 h of continuous hemodialysis)?: No
Sex: Male
Albumin (for MELD 3.0): 2.5 g/dL

{
  "cr": 2,
  "bili": 4,
  "inr": 2,
  "na": 130,
  "dialise": "0",
  "sexo": "M",
  "alb": 2.5
}

Expected result

{
  "meld": 26,
  "meldna": 29,
  "meld3": 30
}

Actual result

{
  "meld": 26,
  "meldna": 29,
  "meld3": 30
}

Case 3

reference-003

Inputs

Creatinine: 1.5 mg/dL
Total bilirubin: 2 mg/dL
INR: 1.3
Sodium: 120 mEq/L
Dialysis 2 or more times in the last week (or 24 h of continuous hemodialysis)?: Yes
Sex: Male

{
  "cr": 1.5,
  "bili": 2,
  "inr": 1.3,
  "na": 120,
  "dialise": "1",
  "sexo": "M"
}

Expected result

{
  "meld": 25,
  "meldna": 31
}

Actual result

{
  "meld": 25,
  "meldna": 31,
  "meld3": null
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.