Hepatology
Lille Model for Alcoholic Hepatitis
The Lille score predicts survival benefit from corticosteroid therapy in severe alcoholic hepatitis after 7 days of treatment. Enter baseline and day-7 bilirubin, albumin, age, and renal status to determine steroid responsiveness.
Inputs (converted)
- Albumin: 28.0 g/L
- Bili day 0: 308 µmol/L
- Bili day 7: 239 µmol/L
Lille score
0.662
Non-response threshold ≥ 0.45
Lille ≥ 0.56 indicates poor response to steroid therapy in severe alcoholic hepatitis. Discontinue corticosteroids and consider alternative strategies or transplant evaluation.
Calculate Lille on day 7 (±1 day) of steroid therapy. Use alongside MELD, Maddrey DF, and clinical assessment.
How to Use This Calculator
Start with severe alcoholic hepatitis (Maddrey DF ≥ 32)
Initiate corticosteroids in eligible patients, then reassess at day 7 with Lille to gauge response.
Enter accurate day 0 and day 7 labs
Use mg/dL for bilirubin and g/dL for albumin; the calculator handles unit conversions to µmol/L and g/L.
Decide on continuation of steroids
Lille ≥ 0.45 generally warrants stopping steroids due to lack of benefit and elevated infection risk.
Formula
Lille score = e−R / (1 + e−R)
where R = 3.19 − 0.101 × Age (years) + 0.147 × Albumin (g/L) + 0.0165 × (Bilirubin day 0 − Bilirubin day 7) (µmol/L) − 0.206 × Renal insufficiency (1/0) − 0.0065 × Bilirubin day 0 (µmol/L).
Parenteral renal insufficiency is defined as creatinine ≥ 1.3 mg/dL or dialysis requirement.
Interpretation: <0.45 responder; 0.45–0.55 borderline; ≥0.56 non-responder.
Full Description
The Lille model stratifies prognosis after one week of corticosteroid therapy in severe alcoholic hepatitis, integrating early bilirubin change with baseline factors. A high Lille score correlates with modest survival benefit from steroids and a higher risk of complications, guiding clinicians to stop ineffective therapy.
Combine Lille with Maddrey DF, MELD-Na, and ABIC scores when considering transplant evaluation, pentoxifylline, or clinical trials. Management also includes aggressive nutritional support, infection surveillance, and sustained alcohol abstinence interventions.
Frequently Asked Questions
What if bilirubin increases by day 7?
An increase usually yields a high Lille score, indicating steroid non-response and poor prognosis.
How do infections impact Lille?
Infections can worsen bilirubin and negate steroid benefit. Screen aggressively before starting steroids.
Can Lille be calculated earlier than day 7?
Studies suggest day-4 measurements correlate but day 7 remains standard for validated decision making.
Does albumin infusion alter the score?
Albumin in the formula reflects serum concentration. Note recent albumin infusions when interpreting results.