Scoring Chronic Liver Disease
Published October 11, 2026 · Last updated October 11, 2026
How the liver calculators divide the work: MELD and MELD-Na for transplant prognosis, Child-Pugh and ALBI for liver function, APRI, FIB-4, and the NAFLD Fibrosis Score for non-invasive fibrosis estimation, the Maddrey Discriminant Function for alcoholic hepatitis, and the SAAG for ascites.
Liver-related calculators answer several distinct questions: how urgently a patient with advanced disease needs transplant assessment, how well the liver is functioning, how likely significant fibrosis is without a biopsy, whether alcoholic hepatitis is severe, and why a patient has ascites. Each question has its own instrument, and using one in place of another changes what the number means.
This guide groups the liver calculators in the library by the question each answers and explains the model behind each one.
Severity and transplant prognosis: MELD and MELD-Na
The MELD score models 3-month mortality in adults with end-stage liver disease from bilirubin, INR, and creatinine, and it underpins liver transplant prioritisation in many systems. The MELD-Na score adds serum sodium, which improves 3-month mortality prediction. MELD is recalibrated periodically and allocation policies vary, so the version your centre reports should be confirmed before acting on a number.
Liver function and prognosis: Child-Pugh and ALBI
The Child-Pugh score combines bilirubin, albumin, INR, ascites, and hepatic encephalopathy into a severity class for chronic liver disease and cirrhosis, and it has long been used to gauge prognosis. The ALBI grade uses only albumin and bilirubin, making it objective and easier to apply; it was primarily validated in hepatocellular carcinoma for prognostic stratification as an alternative to Child-Pugh.
Non-invasive fibrosis estimation: APRI, FIB-4, and the NAFLD Fibrosis Score
APRI uses the AST level relative to the platelet count and was developed to predict significant fibrosis and cirrhosis in chronic hepatitis C. FIB-4 combines age, AST, ALT, and platelet count and was derived to estimate advanced fibrosis. The NAFLD Fibrosis Score estimates the probability of advanced fibrosis in NAFLD/MASLD from routine clinical and laboratory variables. These indices are triage tools that estimate likelihood, not replacements for elastography or biopsy.
Alcoholic hepatitis severity: the Maddrey Discriminant Function
The Maddrey Discriminant Function identifies severe alcoholic hepatitis, the setting in which corticosteroid therapy may be considered. It is a severity marker tied to a specific disease and treatment decision rather than a general liver-function score.
Ascites classification: the Serum-Ascites Albumin Gradient
The SAAG compares serum and ascitic fluid albumin to classify ascites as portal-hypertensive or not. It answers a mechanistic question about why fluid has accumulated and is used alongside — not instead of — the severity scores above.
Using the liver calculators together
These tools describe different dimensions of liver disease, and a single patient may need several of them at once: one for allocation, another for an objective functional grade, another for fibrosis triage. The numbers are population-calibrated estimates and should be read with the clinical picture, the stage of disease, and the version conventions of the reporting laboratory.
Calculators in this guide
References
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