Why was sodium added to create MELD-Na from the original MELD score?

The original MELD score (bilirubin, creatinine, INR, etiology) underestimated waitlist mortality in patients with hyponatremia. Serum sodium is an independent predictor of mortality in cirrhosis — sodium <130 mEq/L more than doubles 90-day waitlist mortality. MELD-Na = MELD + 1.32 × (137 − Na) − [0.24 × MELD × (137 − Na)]. UNOS adopted MELD-Na for liver allocation in 2016. MELD-Na caps sodium at 125 (minimum) and 137 (maximum) for calculation purposes.

What MELD-Na score thresholds guide clinical management?

MELD-Na 10 years without transplant. MELD-Na 10–19: Decompensation risk increasing; benefit from transplant modest. MELD-Na 20–24: Significant 90-day mortality (~15%); transplant benefit moderate. MELD-Na 25–29: ~20% 90-day mortality; listing for transplant typically warranted. MELD-Na 30–39: ~30–40% 90-day mortality; urgent transplant listing. MELD-Na ≥40: >70% 90-day mortality; highest urgency listing (Status 1B in some systems).

MELD-Na Score (Liver Disease)

Calculate MELD-Na score incorporating serum sodium for liver transplant prioritization and 90-day mortality prediction in patients with end-stage liver disease.

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Frequently Asked Questions

Why was sodium added to create MELD-Na from the original MELD score?

What MELD-Na score thresholds guide clinical management?