Calculator Guides
MELD Score and Child-Pugh: Liver Disease Severity Guide
MELD (Model for End-Stage Liver Disease) uses bilirubin, INR, and creatinine to predict 3-month mortality in cirrhosis and drives organ allocation in the US. MELD-Na adds serum sodium and is now the US standard for transplant listing. Child-Pugh uses five parameters (some subjective) to classify severity as A/B/C. Both tools are essential; neither tells the full story alone.
TL;DR: MELD uses bilirubin, INR, and creatinine to predict 3-month mortality in cirrhosis and drives organ allocation in the US. MELD-Na adds serum sodium and is now the US standard for transplant listing. Child-Pugh uses five parameters (some subjective) to classify severity as A/B/C. Both tools are essential; neither tells the full story alone. MELD predicts mortality; Child-Pugh predicts surgical risk and guides prognosis in daily practice.
Why Liver Severity Scoring Matters
Liver cirrhosis is a common endpoint for chronic liver disease from any cause. Once decompensated, the annual mortality is 20–57% depending on severity. Two questions drive clinical decisions: How sick is this patient right now, and when do they need a transplant?
MELD Score
MELD = 9.57 × ln(creatinine) + 3.78 × ln(bilirubin) + 11.20 × ln(INR) + 6.43
| MELD Score | 3-Month Mortality | Clinical Status |
|---|---|---|
| <9 | <2% | Low severity |
| 10–19 | 6–20% | Moderate |
| 20–29 | 20–45% | High; transplant listing priority |
| 30–39 | 45–75% | Very high |
| ≥40 | >75% | Critical |
UNOS listing threshold: MELD ≥15.
MELD-Na Score
MELD-Na = MELD − Na − [0.025 × MELD × (140 − Na)] + 140
Adopted by UNOS in 2016 as the US organ allocation score.
Child-Pugh Score
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Bilirubin | <2 | 2–3 | >3 |
| Albumin | >3.5 | 2.8–3.5 | <2.8 |
| INR | <1.7 | 1.7–2.3 | >2.3 |
| Ascites | None | Mild | Moderate–severe |
| Encephalopathy | None | Grade I–II | Grade III–IV |
| Score | Class | 1-Year Survival | Surgical Risk |
|---|---|---|---|
| 5–6 | A | 100% | Low |
| 7–9 | B | 80% | Moderate |
| 10–15 | C | 45% | Prohibitive |
Evidence and Guidelines
Ruf A et al. (2021) reviewed the 20-year history of MELD score development. The shift from waiting-time-based to MELD-based allocation in 2002 significantly reduced waitlist mortality. Ann Hepatol. 2021;27(1):100535. PMID: 34560316.
Asrani SK et al. (2020) developed MELD-GRAIL-Na, which replaces serum creatinine with eGFR. It was a significantly better predictor of waitlist mortality than MELD-Na, particularly in women. Hepatology. 2020;71(5):1766–1774. PMID: 31523825.
Jalan R et al. (2014) developed CLIF-C ACLF score, which outperformed MELD, MELD-Na, and Child-Pugh for ACLF prognostication. J Hepatol. 2014;61(5):1038–1047. PMID: 24950482.
References
- Ruf A et al. Ann Hepatol. 2021;27(1):100535. PMID: 34560316.
- Asrani SK et al. Hepatology. 2020;71(5):1766–1774. PMID: 31523825.
- Jalan R et al. J Hepatol. 2014;61(5):1038–1047. PMID: 24950482.
- Malinchoc M et al. Hepatology. 2000;31(4):864–871. PMID: 10733541.
Related calculators
- MELD Score Calculator - Gastroenterology
- Child-Pugh Score Calculator - Gastroenterology