Lille Score Calculator
Assess response to corticosteroid therapy at day 7 in patients with severe alcoholic hepatitis. Identify non-responders who should discontinue steroids.
Calculate Lille Score
In g/L (multiply g/dL by 10)
Start of steroid therapy (μmol/L = mg/dL × 17.1)
After 7 days of steroid therapy
Renal failure if >1.3 mg/dL
Formula and Interpretation
Lille Score Formula
Lille = 3.19 - 0.101×Age + 0.147×Albumin(g/L) + 0.0165×(Bili₀ - Bili₇) - 0.206×RF - 0.0065×Bili₀ - 0.0096×PTRF = Renal Failure (1 if present, 0 if absent)
Interpretation
| Lille Score | Response | 6-Month Survival | Action |
|---|---|---|---|
| < 0.45 | Responder | 85% | Continue steroids for 28 days |
| ≥ 0.45 | Non-Responder | 25% | Discontinue steroids |
Clinical Application
When to Calculate
The Lille score should be calculated exactly 7 days after starting corticosteroid therapy (prednisolone 40mg daily) for severe alcoholic hepatitis (Maddrey Discriminant Function ≥32).
For Responders (Lille <0.45)
- •Continue prednisolone 40mg daily to complete 28 days
- •Monitor for infection and other complications
- •Continue nutritional support and alcohol counseling
- •6-month survival approximately 85%
For Non-Responders (Lille ≥0.45)
- •Discontinue corticosteroids immediately
- •Consider alternative therapies (NAC, pentoxifylline)
- •Urgent liver transplant evaluation if eligible
- •6-month survival approximately 25%
Understanding the Lille Score
Development and Validation
The Lille score was developed by Philippe Mathurin and colleagues in Lille, France, and published in 2000. It was validated in multiple subsequent studies and has become the standard tool for assessing early response to corticosteroid therapy in severe alcoholic hepatitis.
Clinical Importance
The Lille score is important because:
- Identifies non-responders early (day 7) rather than waiting 28 days
- Prevents unnecessary exposure to corticosteroid side effects in non-responders
- Allows early consideration of alternative therapies or transplant
- Strongly predicts 6-month survival (85% vs 25%)
- Approximately 40% of patients are non-responders (Lille ≥0.45)
Unit Conversions
The Lille score uses specific units. Convert as needed:
- Albumin: Must be in g/L (multiply g/dL by 10)
- Bilirubin: Must be in μmol/L (multiply mg/dL by 17.1)
- Creatinine: Threshold of 1.3 mg/dL (115 μmol/L) defines renal failure
- PT: Use prothrombin time in seconds
Limitations
- Only applicable to patients already on corticosteroids for severe alcoholic hepatitis
- Must be calculated at exactly day 7 for accurate interpretation
- Does not apply to patients with contraindications to steroids
- Some patients with scores near 0.45 may have intermediate outcomes
Frequently Asked Questions
What is the Lille score?
The Lille score is a model that predicts response to corticosteroid therapy in severe alcoholic hepatitis. Calculated at day 7, it identifies non-responders (score ≥0.45) who should discontinue steroids and consider alternative treatments.
Why is day 7 important?
Day 7 provides the optimal time point to assess early response to therapy. It's early enough to prevent prolonged unnecessary steroid exposure in non-responders, yet late enough to distinguish true responders from non-responders based on bilirubin changes.
What if my score is close to 0.45?
Scores very close to 0.45 (e.g., 0.43-0.47) represent an intermediate zone. Clinical judgment is important. Some experts suggest continuing steroids with close monitoring, while others apply the cutoff strictly. Consider overall clinical trajectory and discuss with hepatology specialists.
Can the Lille score be used without prior corticosteroid therapy?
No. The Lille score specifically measures response to 7 days of corticosteroid therapy. It requires bilirubin values from both the start of steroid treatment (day 0) and after 7 days. It cannot predict who will respond before starting treatment.
What are alternatives for non-responders?
For non-responders (Lille ≥0.45), options include: N-acetylcysteine (limited evidence), pentoxifylline (recent studies show minimal benefit), early liver transplant evaluation (increasingly accepted even without traditional 6-month abstinence), or best supportive care with intensive nutrition.
How accurate is the Lille score?
The Lille score is highly predictive of 6-month mortality. Multiple validation studies have confirmed its accuracy across diverse populations. Responders (<0.45) have ~85% 6-month survival, while non-responders (≥0.45) have ~25% 6-month survival.
Should I taper steroids when discontinuing in non-responders?
After only 7 days of prednisone 40mg, tapering is generally not necessary. Abrupt discontinuation is safe and allows rapid transition to alternative therapies. However, follow your institution's protocols and clinical judgment.
Is liver transplant an option for non-responders?
Yes. Early liver transplantation for carefully selected patients with severe alcoholic hepatitis who don't respond to medical therapy is increasingly accepted. Candidates need thorough psychosocial evaluation, commitment to abstinence, and support systems, but the traditional 6-month rule is being reconsidered.
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