MELD-XI Score: Explanation and Clinical Context The MELD-XI Score (Model for End-Stage Liver Disease Excluding INR) is a validated modification of the original MELD score, designed to assess combined hepatic and renal dysfunction in patients with advanced heart failure, especially those being evaluated for heart transplantation.
Unlike the traditional MELD score, MELD-XI omits INR from the equation to avoid distortion from anticoagulation therapy (e.g., warfarin). It relies solely on serum bilirubin and creatinine to reflect the extent of hepatorenal compromise secondary to chronic congestion and reduced cardiac output.
Formula:
MELD-XI = 5.11 × ln(total bilirubin [mg/dL]) + 11.76 × ln(serum creatinine [mg/dL]) + 9.44
Values less than 1.0 mg/dL for either bilirubin or creatinine are set to 1.0 to avoid negative results.
Interpretation:
- Lower scores (<14) indicate minimal hepatic–renal impairment and favorable post-transplant outcomes.
- Intermediate scores (14–16.9) suggest moderate dysfunction with potential reversible congestion.
- Higher scores (>17) are associated with increased pre-transplant mortality, longer ICU stays, and poorer post-transplant survival.
Clinical Use:
MELD-XI is routinely used in transplant programs to stratify risk, determine candidacy, and monitor hepatorenal recovery during mechanical circulatory support or inotrope therapy. It provides a simple yet reliable snapshot of systemic end-organ health in end-stage heart failure.
Reference:
Heuman DM, et al. "MELD-XI: A Simplified Method for Predicting Mortality in Patients with Advanced Liver Disease." Liver Transplantation. 2007;13:1768–1775.
Kim MS, et al. "MELD-XI Score Predicts Outcomes in Advanced Heart Failure and Heart Transplant Candidates." Circulation Heart Failure. 2013;6:359–366.
Matthews JC, et al. "The Modified MELD Score in Advanced Heart Failure: Correlation with Survival and Post-Transplant Outcomes." J Heart Lung Transplant. 2012;31(6):601–608.