MELD score was originally developed to assess prognosis in patients undergoing transjugular intrahepatic portosystemic shunts (TIPS) for cirrhosis liver . Later MELD score has been used in cardiovascular conditions like patients undergoing left ventricular assist device (LVAD) placement to operative transfusion requirements, morbidity, and mortality .
An important limitation for using MELD score in cardiovascular conditions is the INR value does not indicate liver function those receiving warfarin. Hence a new score MELD score eXcluding INR (MELD-XIscore) was developed and validated:
MELD-XI = 11.76(loge creatinine)+5.112(loge total bilirubin)+9.44.
It is interesting to note that even this score was developed initially for potential liver transplant patients who needed anticoagulation so that INR cannot be included in the calculation of MELD score. MELD-XI has also been used to predict cardiac mortality and need for cardiac transplantation in long term survivors of Fontan surgery for congenital heart disease .