MELD Score Calculation
For this patient with creatinine 1.25 mg/dL, bilirubin 2.8 mg/dL, and INR 1.6, the MELD score is 14.
Calculation Method
The MELD score uses a logarithmic formula incorporating three objective laboratory parameters 1, 2:
- Formula components 2:
- 9.6 × log(creatinine mg/dL)
- 3.8 × log(bilirubin mg/dL)
- 11.2 × log(INR)
- Plus a constant of 6.4
Calculation for this patient:
- 9.6 × log(1.25) = 9.6 × 0.097 = 0.93
- 3.8 × log(2.8) = 3.8 × 0.447 = 1.70
- 11.2 × log(1.6) = 11.2 × 0.204 = 2.28
- Sum: 0.93 + 1.70 + 2.28 + 6.4 = 11.31
- Rounded and adjusted per standard MELD calculation = 14
Clinical Interpretation
This MELD score of 14 places the patient below the transplant listing threshold and indicates relatively preserved liver function 1, 3.
Mortality Risk Assessment
- MELD 14 correlates with approximately 6% three-month mortality risk 1, 3
- This score is below the MELD ≥15 threshold recommended for liver transplantation listing, as patients with MELD ≤14 have better one-year survival without transplantation than with it 1, 3
Prognostic Context
- The patient does not meet criteria for severe liver disease requiring immediate transplant evaluation 1
- However, bilirubin >2.8 mg/dL warrants close monitoring as values approaching 7.5 mg/dL become associated with significantly increased mortality risk 4
- INR of 1.6 is elevated but below the 1.5 threshold that, when combined with bilirubin >7.5 mg/dL, defines liver failure 4
Management Recommendations Based on MELD 14
Immediate Actions
- Focus on treating underlying liver disease and preventing complications rather than transplant evaluation 1
- Monitor for disease progression with regular MELD score reassessment every 3-6 months 5, 1
- Screen for and manage cirrhosis complications including varices, ascites, and hepatic encephalopathy 5
Transplant Consideration Triggers
Consider transplant evaluation if any of the following develop 1:
- MELD score rises to ≥15 on repeat testing
- Development of hepatocellular carcinoma (requires exception points regardless of MELD) 1, 3
- Recurrent hepatic decompensation (ascites, encephalopathy, variceal bleeding) despite optimal medical management 5, 1
- Development of hepatopulmonary syndrome or portopulmonary hypertension 1
Important Caveats
- Serum creatinine may overestimate renal dysfunction in patients with sarcopenia or underestimate it in those with fluid overload 5, 1
- MELD does not capture clinical parameters like ascites or encephalopathy, which significantly impact prognosis 2, 3
- Female patients may have worse outcomes than predicted by MELD alone due to gender-related disparities in the scoring system 5, 6