MELD Score Calculation
For this patient with bilirubin 3.59 mg/dL, INR 1.99, and creatinine 1.3 mg/dL, the MELD score is 19.
Formula and Calculation
The MELD score uses a logarithmic formula incorporating three objective laboratory values that reflect hepatic excretory function (bilirubin), coagulation function (INR), and renal function (creatinine) 1, 2:
MELD = 3.78 × ln(bilirubin mg/dL) + 11.2 × ln(INR) + 9.57 × ln(creatinine mg/dL) + 6.43 3, 2
For this patient:
- 3.78 × ln(3.59) = 3.78 × 1.278 = 4.83
- 11.2 × ln(1.99) = 11.2 × 0.688 = 7.71
- 9.57 × ln(1.3) = 9.57 × 0.262 = 2.51
- Constant = 6.43
- Total MELD = 4.83 + 7.71 + 2.51 + 6.43 = 19.48 ≈ 19
Clinical Interpretation
A MELD score of 19 indicates significant liver disease with approximately 20% risk of 90-day mortality and represents a threshold where liver transplantation evaluation should be strongly considered 3.
Prognostic Significance:
- MELD ≥18-21 indicates poor prognosis in patients with alcoholic hepatitis and advanced liver disease 3
- MELD >20 identifies patients at high risk of 90-day mortality in cirrhosis 3
- MELD ≥15 generally represents the threshold for liver transplant listing consideration 4
- This score of 19 falls into the intermediate-to-high risk category where 90-day mortality without transplantation is substantial 3, 5
Mortality Risk Stratification:
Studies demonstrate that patients with MELD 19-25 have significantly elevated short-term mortality 3, 6:
- MELD 19 corresponds to approximately 20% 90-day mortality risk 3
- MELD >18 shows survival benefit from liver transplantation in Japanese cohorts 5
- MELD cutoffs maximizing negative predictive value for in-hospital mortality include MELD ≤27, meaning this patient's score of 19 places them in an intermediate risk zone 6
Important Clinical Considerations
Interfering Factors to Verify:
Before finalizing clinical decisions based on this MELD score, confirm the following 2, 7:
- INR elevation: Ensure the INR of 1.99 reflects liver synthetic dysfunction and not oral anticoagulation therapy (warfarin, direct oral anticoagulants), which would artificially elevate the MELD score 2, 7
- Creatinine elevation: Verify the creatinine of 1.3 mg/dL represents true renal function and not medication effects (trimethoprim, cimetidine) or acute kidney injury unrelated to hepatorenal syndrome 2, 7
- Renal insufficiency: Calculate eGFR to determine if creatinine elevation is due to chronic kidney disease rather than liver-related renal dysfunction 7
Additional Prognostic Factors Not Captured by MELD:
MELD deliberately excludes clinical parameters that may significantly impact prognosis 3, 4:
- Hepatic encephalopathy: Presence and grade significantly increase mortality risk (contributes 42.2% to mortality in decision tree models) 6
- Ascites: Not included in MELD but captured in Child-Pugh scoring 3, 4
- Serum sodium: Hyponatremia is an independent predictor of death; MELD-Na may provide better prognostic accuracy in patients with low sodium 2, 6
- Infection: Admission infections contribute 22.2% to mortality risk in cirrhotic patients 6
MELD Score Range Context:
The MELD score produces a numerical scale from 6 (less ill) to 40 (gravely ill) 3, 1:
- MELD 6-9: Minimal liver disease
- MELD 10-14: Moderate liver disease (corresponds approximately to Child-Pugh B) 7
- MELD 15-20: Severe liver disease requiring transplant evaluation 4, 5
- MELD 21-27: High mortality risk 6
- MELD ≥28: Very high mortality risk 6
This patient's MELD of 19 places them in the severe liver disease category where transplant evaluation is warranted and 90-day mortality risk is substantial 3, 5.