🫀 MELD-XI (Excluding INR)
MELD-XI is a version of the MELD score that excludes INR, designed for anticoagulated patients in whom INR is unreliable.
MELD-XI is most useful in mechanical-valve, VAD, or advanced heart-failure patients where warfarin distorts the INR term (original synthesis · not guideline verbatim).
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When to use
Enter total bilirubin and serum creatinine; the tool applies the standard bounds and returns the MELD-XI score.
How it works
MELD-XI = 5.11 × ln(bilirubin mg/dL) + 11.76 × ln(creatinine mg/dL) + 9.44; bilirubin and creatinine <1 set to 1, creatinine capped at 4 mg/dL.
Key points
- MELD-XI is most useful in mechanical-valve, VAD, or advanced heart-failure patients where warfarin distorts the INR term (original synthesis · not guideline verbatim).
- Higher scores predict worse survival in both hepatic and cardiac populations, including pre-transplant candidates.
- Because INR is dropped, MELD-XI can underestimate coagulopathy from intrinsic liver synthetic failure.
References
- Heuman DM, et al. MELD-XI: a rational approach to sickest first liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl. 2007.
- Grimm RA, et al. MELD-XI score and outcomes in heart failure. (Review of cardiac applications.)
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Total bilirubin | 34 μmol/L |
|---|---|
| Serum creatinine | 90 μmol/L |
→MELD-XI13.2
- Bilirubin：2 mg/dL
- Creatinine：1 mg/dL (capped at 4)
Frequently asked questions
- What is MELD-XI (Excluding INR)?
- MELD-XI is a version of the MELD score that excludes INR, designed for anticoagulated patients in whom INR is unreliable.
- How is MELD-XI (Excluding INR) calculated? What is the core formula?
- MELD-XI = 5.11 × ln(bilirubin mg/dL) + 11.76 × ln(creatinine mg/dL) + 9.44; bilirubin and creatinine <1 set to 1, creatinine capped at 4 mg/dL.
- When is MELD-XI (Excluding INR) used?
- Enter total bilirubin and serum creatinine; the tool applies the standard bounds and returns the MELD-XI score.
- What are the key clinical points for MELD-XI (Excluding INR)?
- MELD-XI is most useful in mechanical-valve, VAD, or advanced heart-failure patients where warfarin distorts the INR term (original synthesis · not guideline verbatim). Higher scores predict worse survival in both hepatic and cardiac populations, including pre-transplant candidates. Because INR is dropped, MELD-XI can underestimate coagulopathy from intrinsic liver synthetic failure.
- What are the limits and cautions when using MELD-XI (Excluding INR)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is MELD-XI (Excluding INR) calculated in practice? Can you show a worked example?
- Inputs: Total bilirubin 34 μmol/L, Serum creatinine 90 μmol/L → Result: MELD-XI 13.2（Bilirubin: 2 mg/dL, Creatinine: 1 mg/dL (capped at 4)）