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MELD-XI Score for Evaluating a Cirrhotic Patient Being Treated with Oral Anticoagulants

Purpose: To calculate the MELD-XI score for an end-stage cirrhotic patient who is being treated with oral anticoagulants.

Description

The MELD score may give misleading results for survival if the cirrhotic patient is taking an oral anticoagulant. Heuman et al proposed the MELD-XI (MELD without the INR) score for these patients. The authors are from Virginia Commonwealth University and the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia.


Parameters:

(1) serum total bilirubin in mg/dL

(2) serum creatinine in mg/dL

 

MELD XI =

= (5.11 * LN(bilirubin)) + (11.76 * LN(creatinine)) + 9.44

 

where:

• The minimum value for bilirubin and creatinine is 1 mg/dL.

• The maximum value for serum creatinine ins 4 mg/dL.

• The serum creatinine is set to 4 mg/dL if the patient has been dialyzed 3 or more times in the preceding week.

• The score is rounded to the nearest whole number.

 

Interpretation:

• minimum MELD-XI: 9

• maximum MELD-XI: approximately 50

• Patients with a MELD-XI > 25 had a 90 day pretransplantation mortality of 75-79% (page 33).

• A MELD-XI score is comparable to a MELD score of the same value (using the MELD score modification of Kamath et al, in which the original MELD score is multiplied by 10).


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Specialty

Objective

ICD-10