MELD and MELD-XI scores

MELD and MELD-XI scores

Model for End-Stage Liver Disease (MELD) score is a logarithmic function of creatinine, total bilirubin and International Normalized Ratio (INR):

MELD = 9.57(log_eCreatinine) + 3.78(log_eBilirubin) + 11.21(log_eINR) + 6.43.

MELD score was originally developed to assess prognosis in patients undergoing transjugular intrahepatic portosystemic shunts (TIPS) for cirrhosis liver [1]. 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 [2].

An important limitation for using MELD score in cardiovascular conditions is that the INR value does not indicate liver function in those receiving warfarin. Hence a new score – MELD score eXcluding INR (MELD-XI score) was developed and validated:

MELD-XI = 11.76(log_e creatinine)+5.112(log_e 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 score has also been used to predict cardiac mortality and need for cardiac transplantation in long term survivors of Fontan surgery for congenital heart disease [3].

References

1. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000 Apr;31(4):864-71.
2. Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation. 2010 Jan 19;121(2):214-20.
3. Assenza GE, Graham DA, Landzberg MJ, Valente AM, Singh MN, Bashir A, Fernandes S, Mortele KJ, Ukomadu C, Volpe M, Wu F. MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery. Heart. 2013 Apr;99(7):491-6.