0.18
-2
mg/dL
-20
%
2
1
2
25
%
0.18
-2
mg/dL
-20
%
2
1
2
25
%
The Lille Score Calculator evaluates the response to corticosteroid therapy in severe alcoholic hepatitis after 7 days of treatment. Developed by Louvet et al. in 2007, the Lille model is the definitive tool for determining whether to continue or discontinue corticosteroids in patients with severe alcoholic hepatitis, a condition with high short-term mortality. The score uses six variables including a critical dynamic component: the change in bilirubin from day 0 to day 7 of prednisolone treatment.
Severe alcoholic hepatitis is defined by a Maddrey Discriminant Function (DF) of 32 or greater and is treated with prednisolone 40 mg daily for 28 days based on landmark clinical trials. However, not all patients respond to corticosteroids, and non-responders gain no benefit while remaining exposed to steroid side effects including infection risk. The Lille Score was developed to identify non-responders early, at day 7, so that futile therapy can be discontinued and alternative strategies considered.
The Lille formula incorporates: age, albumin at day 0, bilirubin at day 0, the change in bilirubin between day 0 and day 7 (the most important prognostic component), creatinine at day 0, and prothrombin time at day 0. The output is a probability score between 0 and 1. A Lille score below 0.45 identifies responders who should complete the 28-day steroid course. A score above 0.45 identifies non-responders in whom steroids should be discontinued.
The original study further refined response categories. Complete responders (Lille < 0.16) have approximately 15% 6-month mortality, confirming substantial benefit from corticosteroid therapy. Partial responders (Lille 0.16-0.56) have intermediate outcomes with approximately 25% mortality. Null responders (Lille > 0.56) have approximately 75% 6-month mortality despite steroid treatment, clearly identifying a population that does not benefit from continued corticosteroids. This three-tiered classification helps guide clinical decision-making and prognostic discussions.
The dynamic bilirubin component is physiologically meaningful. In corticosteroid-responsive alcoholic hepatitis, steroids reduce hepatic inflammation and improve bilirubin metabolism and excretion. A significant drop in bilirubin by day 7 indicates that the inflammatory process is responding to immunosuppression. Failure of bilirubin to improve suggests either overwhelming hepatocyte damage beyond the inflammatory component, or that the degree of inflammation is not the primary driver of liver failure in that patient.
For non-responders identified by the Lille Score, management options are limited but evolving. Early liver transplantation has shown dramatic survival benefit in highly selected non-responders in clinical studies, though ethical and practical considerations limit its widespread application. Pentoxifylline, once considered an alternative, has been shown to be ineffective in recent trials. Novel therapies targeting gut-liver axis dysfunction, granulocyte colony-stimulating factor, and N-acetylcysteine in combination with steroids are areas of active investigation.
R = 3.19 - 0.101(Age) + 0.147(Albumin g/L) + 0.0165(Bilirubin change umol/L) - 0.206(Renal failure) - 0.0065(Bilirubin day0 umol/L) - 0.0096(PT sec). Lille = exp(-R)/(1+exp(-R)). Score < 0.45: steroid responder. Score >= 0.45: non-responder. Complete/partial/null response categories further refine prognosis.
Lille < 0.16: Complete responder with good prognosis (~15% 6-month mortality). Continue steroids for full 28 days. Lille 0.16-0.56: Partial responder (~25% mortality). Continue steroids. Lille > 0.56: Null responder (~75% mortality). Stop steroids and consider alternative management including transplant evaluation.
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Results
Lille 0.108. Significant bilirubin drop indicates steroid response. Continue 28-day course.
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Results
Lille 0.89. Rising bilirubin indicates treatment failure. Discontinue steroids.
The Lille Score predicts corticosteroid response in severe alcoholic hepatitis after 7 days of treatment. It helps decide whether to continue or stop steroids by assessing the dynamic change in bilirubin along with baseline clinical parameters.
Exactly 7 days after starting prednisolone treatment. The critical input is the bilirubin change from day 0 to day 7, which reflects the liver's response to anti-inflammatory therapy.
Maddrey Discriminant Function >= 32, or MELD >= 21, in a patient with recent heavy alcohol use and clinical/laboratory features of acute hepatitis. Liver biopsy confirms diagnosis when clinical presentation is uncertain.
Stop steroids. Consider transplant evaluation in selected patients (requires 6 months sobriety in most programs, though early transplant protocols exist). Manage complications supportively. Novel therapies are under investigation.
Bilirubin improvement reflects resolution of hepatic inflammation and recovery of bilirubin metabolism. It is the most powerful component of the Lille model, directly measuring the liver's functional response to immunosuppression.
Prednisolone 40 mg daily for 28 days, then tapered over 2 weeks. Prednisolone is preferred over prednisone because prednisone requires hepatic conversion to its active form, which may be impaired in liver disease.
The STOPAH trial (2015) showed pentoxifylline provides no survival benefit in severe alcoholic hepatitis. It is no longer recommended as first-line therapy or as a rescue for steroid non-responders.
No. The score requires the 7-day bilirubin measurement to calculate the dynamic response. Earlier assessment would not provide the time necessary for steroids to demonstrate their anti-inflammatory effect.
Screen for spontaneous bacterial peritonitis (diagnostic paracentesis), urinary tract infection, pneumonia, and bacteremia. Active infection must be treated before or concurrent with steroid initiation. Some experts recommend prophylactic antibiotics.
Yes. Continued alcohol use dramatically worsens prognosis regardless of Lille Score. Complete abstinence improves survival and is the most important long-term intervention. Patients should receive addiction counseling and support.
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