MELD-Na (Model for End-Stage Liver Disease – Sodium) Calculator

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The MELD-Na (Model for End-Stage Liver Disease – Sodium) Calculator is a clinical tool used to assess the severity of chronic liver disease and predict the short-term mortality risk in patients with end-stage liver disease. This score is widely used to prioritize patients for liver transplantation, as it provides an objective measure of disease severity that helps determine the urgency of transplant need. The MELD-Na score incorporates the traditional MELD components—bilirubin, creatinine, and International Normalized Ratio (INR)—with the addition of serum sodium, which improves the accuracy of mortality predictions, especially in patients with conditions like cirrhosis where hyponatremia is common.

The MELD-Na score is calculated using the following formula:

MELD-Na = MELD + 1.32 × (137 – Na) – 0.033 × MELD × (137 – Na)

where:

  • MELD is calculated using the formula:
    MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43
  • Na represents the serum sodium level, capped between 125 and 137 mEq/L to avoid extreme values influencing the score excessively.

To use the MELD-Na Calculator, the healthcare provider enters the patient’s serum bilirubin, creatinine, INR, and sodium levels into the tool. The calculator then uses these values to compute the MELD-Na score, which ranges from 6 (less severe liver disease) to 40 (most severe liver disease). A higher MELD-Na score indicates a higher risk of mortality, and patients with scores at the higher end of the spectrum are generally prioritized for liver transplantation.

Interpreting the MELD-Na score helps guide clinical decision-making, particularly in the context of liver transplantation. For example, patients with a high MELD-Na score may be fast-tracked for transplant evaluation and listing due to their increased risk of death without intervention. Conversely, those with lower scores may have a lower priority, as their risk of short-term mortality is less immediate. The score also aids in counseling patients and their families about the expected course of the disease and the potential need for urgent medical interventions.

The MELD-Na score is especially valuable because it adjusts for hyponatremia, a common complication in advanced liver disease that is associated with poor outcomes. By incorporating sodium into the MELD score, the MELD-Na score provides a more accurate reflection of a patient’s overall prognosis, improving the prioritization process for liver transplant candidates. This adjustment has been shown to better predict mortality in patients with cirrhosis and is now widely adopted in transplant centers worldwide.

MELD-Na (Model for End-Stage Liver Disease Sodium) Calculator

Enter the following patient details: