Lille Score — Alcoholic Hepatitis Steroid Response
Assess steroid response at day 7 of prednisolone therapy (Maddrey DF ≥ 32)
Detaylı rehber yakında
Lille Score (Alcoholic Hepatitis) için kapsamlı bir eğitim rehberi hazırlıyoruz. Adım adım açıklamalar, formüller, gerçek hayat örnekleri ve uzman ipuçları için yakında tekrar ziyaret edin.
The Lille Score is a validated clinical model used to predict response to corticosteroid therapy in patients with severe alcoholic hepatitis who have been started on prednisolone. Developed by Mathurin and colleagues in 2007 at the University of Lille, France, the score is calculated at day 7 of steroid therapy and uses changes in serum bilirubin alongside baseline clinical and laboratory parameters collected at the time of steroid initiation (day 0). The Lille model was developed from a large multi-centre cohort of over 300 patients and validated in a separate international cohort, making it one of the most rigorously evaluated response-assessment tools in hepatology. The critical clinical value of the Lille score is its identification of steroid non-responders — patients whose liver function is not improving on prednisolone — so that futile continuation of steroid therapy can be discontinued. Continuing prednisolone in non-responders not only fails to improve survival but is associated with increased serious infection risk. A Lille score of 0.45 or above at day 7 defines non-response, with an associated 6-month mortality of approximately 75%. Patients with Lille scores below 0.45 are classified as responders (complete response if Lille <0.16, partial response if 0.16–0.45) and benefit from completing the 28-day course. Some centres perform Lille score assessment at both day 4 and day 7 as part of early response evaluation protocols. The Lille score is now embedded in international guidelines (EASL, AASLD) as a mandatory assessment point during steroid therapy for severe alcoholic hepatitis.
Lille Score = 3.19 − 0.101×(age years) − 0.0165×(albumin g/L at day 0) − 0.206×(renal insufficiency: 1 if creatinine >115 µmol/L, else 0) − 0.0065×(bilirubin µmol/L at day 0) − 0.0096×(PT seconds at day 0) + 0.0003×(bilirubin µmol/L at day 7); Lille ≥ 0.45 = non-responder
- 1At day 0 (start of prednisolone), collect: patient age (years), serum albumin (g/L), serum creatinine (µmol/L), serum total bilirubin (µmol/L), and prothrombin time (PT in seconds).
- 2Determine renal insufficiency: assign 1 if serum creatinine exceeds 115 µmol/L at day 0; assign 0 if creatinine is 115 µmol/L or below.
- 3At day 7 of prednisolone therapy, measure serum total bilirubin again (in µmol/L). This is the key variable that captures whether the liver is responding to steroid therapy.
- 4Calculate the Lille score: start with the constant 3.19, then subtract 0.101×age, 0.0165×albumin(g/L), 0.206×renal insufficiency (0 or 1), 0.0065×bilirubin day 0, and 0.0096×PT day 0; then add 0.0003×bilirubin day 7.
- 5Interpret the Lille score: <0.16 = complete responder (excellent prognosis); 0.16–0.45 = partial responder (continue steroids, prognosis intermediate); ≥0.45 = non-responder (stop prednisolone — no benefit, increased infection risk).
- 6For non-responders (Lille ≥0.45), discontinue prednisolone and provide supportive care. Evaluate for early liver transplantation at specialist centres with established AH transplant protocols.
- 7Note: all bilirubin values in the Lille score must be in µmol/L (the original model was derived using SI units, unlike the Maddrey DF which uses mg/dL).
Complete responder (Lille < 0.16) — complete 28-day prednisolone course
A substantial fall in bilirubin from day 0 to day 7 (70 µmol/L reduction) combined with younger age and no renal failure indicates excellent steroid response. This patient should complete the full treatment course.
Partial responder — complete steroid course; prognosis intermediate
A modest bilirubin reduction (30 µmol/L) suggests some response. The patient should complete the 28-day course with close monitoring for infection and serial reassessment.
Non-responder (Lille ≥ 0.45) — discontinue prednisolone; assess for transplant
Absent bilirubin fall with baseline renal failure, old age, low albumin, and severely prolonged PT all contribute to a high Lille score. Continuing steroids offers no survival benefit and significantly increases infection risk.
Despite renal failure adding 0.206 to the score, bilirubin improvement suggests ongoing response
The renal insufficiency flag adds a fixed 0.206 penalty, worsening the Lille score. However, a 60 µmol/L bilirubin reduction at day 7 indicates hepatic response, and the overall Lille may fall below 0.45.
Steroid discontinuation decisions: the Lille score is the primary tool used by hepatologists at day 7 to decide whether to stop prednisolone in severe alcoholic hepatitis patients who are not responding.
Professionals in health and medical use Lille Score as part of their standard analytical workflow to verify calculations, reduce arithmetic errors, and produce consistent results that can be documented, audited, and shared with colleagues, clients, or regulatory bodies for compliance purposes.
University professors and instructors incorporate Lille Score into course materials, homework assignments, and exam preparation resources, allowing students to check manual calculations, build intuition about input-output relationships, and focus on conceptual understanding rather than arithmetic.
Clinical trial primary endpoint: the Lille score has been used as a secondary or co-primary endpoint in alcoholic hepatitis trials, including evaluations of granulocyte colony-stimulating factor (G-CSF) and combination therapies.
Prognostic communication: hepatologists use Lille score results at day 7 to provide realistic prognostic information to patients and families, enabling informed decisions about goals of care and potential transplant listing.
Extreme input values
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in lille score calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
Assumption violations
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in lille score calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
Rounding and precision effects
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in lille score calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
| Lille Score | Response Category | 6-Month Mortality | Recommended Action |
|---|---|---|---|
| < 0.16 | Complete responder | ~15% | Complete 28-day prednisolone course |
| 0.16–0.45 | Partial responder | ~50–60% | Complete 28-day course with close monitoring |
| ≥ 0.45 | Non-responder | ~75% | Stop prednisolone; palliative/transplant assessment |
| — | Renal insufficiency flag | +0.206 to score | Creatinine > 115 µmol/L at day 0 = 1 point penalty |
What is the Lille score used for?
Lille Score is a specialized calculation tool designed to help users compute and analyze key metrics in the health and medical domain. It takes specific numeric inputs — typically drawn from real-world data such as measurements, rates, or quantities — and applies a validated mathematical formula to produce actionable results. The tool is valuable because it eliminates manual calculation errors, provides instant feedback when exploring different scenarios, and serves as both a decision-support instrument for professionals and a learning aid for students studying the underlying principles.
When exactly is the Lille score calculated?
Use Lille Score whenever you need a reliable, reproducible calculation for decision-making, planning, comparison, or verification in health and medical. Common triggers include evaluating a new opportunity, comparing two or more alternatives, checking whether a quoted figure is reasonable, preparing documentation that requires precise numbers, or monitoring changes over time. In professional settings, recalculating regularly — especially when key inputs change — ensures that decisions are based on current data rather than outdated estimates.
What happens if the Lille score is above 0.45?
In the context of Lille Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of health and medical practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Why are Lille score bilirubin values in µmol/L and not mg/dL?
In the context of Lille Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of health and medical practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Is the Lille score validated?
In the context of Lille Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of health and medical practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Can a Lille score be used without knowing the control PT?
In the context of Lille Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of health and medical practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
What is the difference between complete and partial response?
In the context of Lille Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of health and medical practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Can the Lille score predict long-term outcomes?
In the context of Lille Score, this depends on the specific inputs, assumptions, and goals of the user. The underlying formula provides a deterministic relationship between inputs and output, but real-world application requires interpreting the result within the broader context of health and medical practice. Professionals typically cross-reference calculator output with industry benchmarks, historical data, and regulatory requirements. For the most reliable results, ensure inputs are sourced from verified data, understand which assumptions the formula makes, and consider running multiple scenarios to bracket the range of likely outcomes.
Uzman İpucu
In clinical practice, the single most important variable in the Lille score is the day-7 bilirubin compared to day-0 bilirubin. A bilirubin that has not fallen (or has risen) by day 7 is a strong bedside indicator of non-response before formally computing the Lille score.
Biliyor muydunuz?
The Lille score was developed in France, and the original paper (Mathurin et al., 2007) was the first to formally challenge the dogma of completing a fixed steroid course regardless of response. By showing that stopping therapy early in non-responders was safe and rational, it effectively introduced personalised medicine principles to alcoholic hepatitis management a decade before 'precision medicine' became a mainstream concept.
Kaynaklar
- ›Mathurin P et al. Early change in bilirubin levels is an important prognostic factor in severe alcoholic hepatitis. Hepatology 2003.
- ›Louvet A et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007.
- ›Mathurin P et al. Early liver transplantation for severe alcoholic hepatitis. NEJM 2011.
- ›EASL Clinical Practice Guidelines: Liver Disease Related to Alcohol. J Hepatol 2018.
- ›MDCalc — Lille Model for Alcoholic Hepatitis