MELD-XI (Excluding INR) Calculator

MELD-XI (Model for End-Stage Liver Disease — excluding INR): Explanation and clinical context MELD-XI is a modification of the original MELD score intended to provide a prognostic measure of hepatorenal dysfunction when INR is unreliable (for example, in patients on anticoagulation). The commonly used formula is: MELD-XI = 5.11 × ln(total bilirubin [mg/dL]) + 11.76 × ln(serum creatinine [mg/dL]) + 9.44. To avoid mathematically undefined or misleading values, implementations commonly follow UNOS/MELD conventions: any value < 1.0 (bilirubin or creatinine) is set to 1.0; creatinine is capped at 4.0 mg/dL; and patients who received dialysis recently are often assigned creatinine = 4.0 mg/dL.

A MELD-XI value greater than approximately 9.44 has been used by several studies as an indicator of elevated risk, but optimal cutoffs and exact prognostic implications vary by population and clinical context. Use MELD-XI as an objective marker of combined hepatic and renal dysfunction that may aid risk stratification, but interpret it together with clinical assessment and other prognostic indices. Reference (key sources): 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):30–37. (original description).

Wernly B, et al. Model for end-stage liver disease excluding INR (MELD-XI) score in critically ill patients: prognostic relevance. PLoS One.

2017;12(2):e0170987. UNOS/OPTN MELD implementation conventions (lower limits set to 1.0; creatinine capped at 4.0 for dialysis/upper bound) — see UNOS allocation documentation and MELD revisions.