Variability of INR and Its Effect on MELD Scores

Previously, Child-Pugh scores were used to prioritize patients for liver transplantation. Although these scores were useful for predicting mortality in cirrhotic patients, some of the variables used in this scoring system, such as degree of encephalopathy and ascites, were subjective, which can cause substantial variability in scoring. The Model for End-stage Liver Disease (MELD) scoring system has replaced Child-Pugh scores, because most experts believe that MELD scores — which are based on objective laboratory data (international normalized ratio, creatinine levels, total bilirubin levels) — minimize variability. However, questions have been raised about whether INR, which is used to standardize prothrombin time (PT) in anticoagulated pat…