MELD-XI Score Calculator
MELD-XI Score Calculator
MELD excluding INR — the two-variable version for patients whose INR is set by warfarin rather than by their liver. Bilirubin and creatinine only, and the bounding is an open question this page states plainly.
MELD-XI score
Two labs, no INRBilirubin 3.2 mg/dL, creatinine 1.6 mg/dL, MELD convention bounding
Formula
- why INR comes out
- a therapeutic INR measures the dose of warfarin, not hepatic synthetic function. On a vitamin K antagonist the INR term inflates MELD by several points for a reason that has nothing to do with the liver
- the coefficients
- 5.11 on ln(bilirubin), 11.76 on ln(creatinine), constant 9.44. The Front Cardiovasc Med 2022 and PLoS One 2017 full texts quote these identically and both cite Heuman’s 2007 derivation
- the bounding, stated honestly
- neither source states a floor or a cap, and the derivation paper could not be read from here. So this page makes it a visible input rather than a silent default. With no bounds the equation is exactly as published; with the MELD convention it behaves like the rest of the family
- the floor value
- with a bilirubin and a creatinine both at 1.0 mg/dL the equation returns exactly 9.44, because both logarithms are zero. That is some way above MELD’s own floor of 6, so a well patient scores higher on MELD-XI than on MELD and the two scales are not interchangeable at the bottom
- where it is used
- well beyond hepatology — heart failure, adult congenital heart disease, mechanical circulatory support and intensive care, as a marker of cardiohepatic and cardiorenal interaction
Worked example
Bilirubin 3.2 mg/dL, creatinine 1.6 mg/dL, MELD convention bounding
Neither value is below the floor and the creatinine is below 4.0, so bounding changes nothing here
5.11 × ln(3.2) = 5.9437 · 11.76 × ln(1.6) = 5.5272 · constant 9.44
Total 20.9
The same patient's original MELD is 22 with an INR of 1.8 — close, because an INR of 1.8 is roughly what this bilirubin and creatinine would predict. Put the INR up to 3.0 on warfarin and MELD rises to 28 while MELD-XI does not move at all, which is the entire reason the score exists
Set the bilirubin to 0.5 and the creatinine to 0.8. With the MELD convention both are raised to 1.0 and the answer is 9.4; with bounding off the raw equation returns 3.3. A 6-point gap from a setting most reproductions never mention
Set the creatinine to 6.0. Capped it gives 31.7; uncapped, 36.5
What the bounding setting is worth, in points
| Bilirubin | Creatinine | No bounds | Floor only | Floor + 4.0 cap |
|---|---|---|---|---|
| 0.5 mg/dL | 0.8 mg/dL | 3.3 | 9.4 | 9.4 |
| 1.0 mg/dL | 1.0 mg/dL | 9.4 | 9.4 | 9.4 |
| 3.2 mg/dL | 1.6 mg/dL | 20.9 | 20.9 | 20.9 |
| 3.2 mg/dL | 6.0 mg/dL | 36.5 | 36.5 | 31.7 |
| 12.0 mg/dL | 8.0 mg/dL | 46.6 | 46.6 | 38.4 |
MELD-XI against the rest of the family
| Score | Inputs | Takes INR? | Usual setting |
|---|---|---|---|
| MELD-XI | Bilirubin, creatinine | No | Anticoagulated patients; heart failure; intensive care |
| MELD (original) | Bilirubin, creatinine, INR | Yes | Pre-2016 literature and trial criteria |
| MELD-Na | and sodium | Yes | US allocation 2016–2023 |
| MELD 3.0 | and sodium, albumin, sex | Yes | US allocation from July 2023 |
The score for a patient whose INR belongs to their warfarin
MELD’s INR term is there to measure hepatic synthetic function. In a patient taking a vitamin K antagonist it measures the dose instead. A therapeutic INR of 2.5 contributes about ten points to MELD regardless of how the liver is doing, so a cirrhotic patient anticoagulated for atrial fibrillation or portal vein thrombosis has a MELD that is systematically inflated — and in an allocation system that is not a rounding error, it is a queue position. MELD-XI was derived to fix exactly that: the same prediction, built from bilirubin and creatinine alone.
Creatinine dominates it. The coefficient on ln(creatinine) is 11.76 against 5.11 on ln(bilirubin), a ratio of better than two to one, where original MELD’s ratio of 9.57 to 3.78 is similar but spread across three terms rather than two. The practical consequence is that MELD-XI behaves substantially like a renal score with a bilirubin adjustment, and most of its subsequent literature is not hepatological at all: it has been used as a marker of cardiohepatic and cardiorenal interaction in heart failure, in adult congenital heart disease, before mechanical circulatory support, and in general intensive care, where Jung’s cohort of 4,381 medical patients gave it an area under the curve of 0.71 for mortality.
One thing about this page is less certain than the rest, and it is better said than hidden. The equation is reproduced exactly — two independent full texts quote the same three numbers — but neither states whether the MELD convention of a 1.0 floor and a creatinine cap applies, and the derivation paper could not be read from this environment. So bounding is an input here rather than an assumption. It matters: at a bilirubin of 0.5 and a creatinine of 0.8 the two conventions differ by six points. When comparing a MELD-XI against a published cohort, use whichever convention that cohort used, and if the paper does not say, treat the comparison as approximate.
A score is not a diagnosis and a risk derived from a cohort is not a probability for one patient. This states what the number predicted in a named study; the clinician in front of the patient decides what follows. Thresholds and reference intervals are method- and laboratory-dependent, and your own laboratory’s interval takes precedence over any figure quoted here.
Frequently asked questions
What is MELD-XI for?
Patients whose INR is determined by anticoagulation rather than by liver disease. A vitamin K antagonist raises the INR and therefore raises MELD by several points for a reason that has nothing to do with hepatic function. MELD-XI drops the INR term and predicts from bilirubin and creatinine alone.
What is the MELD-XI formula?
MELD-XI = 5.11 × ln(bilirubin in mg/dL) + 11.76 × ln(creatinine in mg/dL) + 9.44. With both values at 1.0 mg/dL both logarithms are zero and the score is exactly 9.44, which is its effective floor under the usual bounding convention.
Should bilirubin and creatinine be bounded in MELD-XI?
The sources disagree by silence. Neither full text that quotes the equation states a bound, and the derivation paper could not be read here. MELD-XI was derived in registry data where MELD’s floor of 1.0 and cap of 4.0 mg/dL were already in force, while most of the cardiology and intensive-care literature applies none. Use the convention your comparison cohort used.
Can I use MELD-XI in a patient who is not anticoagulated?
It will compute, but it is not equivalent. Removing a variable that carries genuine prognostic information costs discrimination, and no allocation system uses MELD-XI. Where the INR is valid, use the version your allocation system or your comparison literature is written in.
Is MELD-XI on the same scale as MELD?
Roughly, and not at the ends. A well patient floors at 9.44 on MELD-XI against 6 on MELD, and MELD-XI has no ceiling of 40 — nothing in the published equation caps it. Treat the two as comparable in the middle of the range and as different scales at the top and the bottom.
Related calculators
References
- Heuman DM, Mihas AA, Habib A, et al. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl. 2007;13(1):30–7.
- Jung C, Fuernau G, Eitel I, et al. Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: easily available and of prognostic relevance. PLoS One. 2017;12(2):e0170987.
- Frontiers in Cardiovascular Medicine. MELD-XI in cardiovascular disease. Front Cardiovasc Med. 2022;9:985503.
- Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797–805.
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/