Hepatology & GastroenterologyEvidence-Based Golden Standard
MELD-Na (2016 UNOS) & Child-Pugh Cirrhosis Staging
End-stage liver disease mortality prognostication and liver transplant allocation using the official 2016 OPTN/UNOS MELD-Na equation and classic Child-Pugh classification.
MELD(i) = 9.57 × ln(Cr) + 3.78 × ln(Bili) + 11.2 × ln(INR) + 6.43
If MELD(i) > 11: MELD-Na = MELD(i) + 1.32 × (137 - Na) - [0.033 × MELD(i) × (137 - Na)]
Child-Pugh: Class A (5-6 pts), Class B (7-9 pts), Class C (10-15 pts)
Published Clinical Benchmark Cases
Clinical Parameters & Inputs
Unit: mg/dL
mg/dL
Unit: mg/dL
mg/dL
Unit: mEq/L
mEq/L
Unit: g/dL
g/dL
Computed OutputMELD-Na 28 • Child-Pugh Class C
28MELD-Na
Diagnostic Interpretation
MELD-Na Score is 28 (Estimated 90-day waiting list mortality: 20% – 50%). Child-Pugh Score is 12 (Class C: 45% 1-year, 35% 2-year survival). MELD-Na ≥ 15 meets the national clinical threshold for liver transplantation evaluation and listing.
Calculation Breakdown
Clamped Values (UNOS Bounds)
Cr = 1.8 mg/dL, Bili = 3.2 mg/dL, INR = 2.1, Na = 130 mEq/L =Initial MELD = 25
MELD-Na 2016 Equation
25 + 1.32 × (137 - 130) - [0.033 × 25 × (137 - 130)] =28 points
Child-Pugh Classification
Bilirubin (3.2) + Albumin (2.7) + INR (2.1) + Ascites + Encephalopathy =12 points (Class C)
Clinical Decision Pearls
- MELD-Na incorporates serum sodium because dilutional hyponatremia is an independent predictor of mortality and hepatorenal syndrome in advanced cirrhosis.
- Child-Pugh score remains the standard clinical measure for surgical risk assessment (e.g. non-hepatic abdominal surgery in cirrhotic patients).
Limitations & Confounders
- INR reflects liver synthesis but can be confounded by anticoagulants (warfarin) or sepsis without liver failure.
Evidence & Citations
- Kim WR, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018-1026.
- Pugh RN, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-649.