Lille Score Calculator

Understanding Alcoholic Hepatitis

Alcoholic hepatitis is acute hepatic inflammation triggered by heavy alcohol consumption, distinct from simple fatty liver or cirrhosis. The liver attempts to metabolise excess ethanol, generating toxic acetaldehyde and reactive oxygen species that damage hepatocytes and trigger immune-mediated inflammation.

This condition presents a clinical spectrum. Mild cases may resolve with alcohol cessation alone. Severe cases—characterised by elevated bilirubin, coagulopathy, and encephalopathy—carry mortality rates exceeding 50% without intervention. Corticosteroids reduce short-term mortality by roughly 30%, but only benefit patients with a favourable inflammatory profile.

The distinction between responders and non-responders to steroid therapy is crucial because continued corticosteroids in those unlikely to recover may increase infection risk without survival benefit.

The Lille Score Calculation

The Lille model uses a logistic regression equation that incorporates baseline patient factors and the trajectory of bilirubin over the first week of therapy. Laboratory values must be converted to consistent units before calculation.

• Age — Patient age in years at admission
• Albumin — Serum albumin in g/L at admission (normal ~35–50)
• PT — Prothrombin time in seconds; reflects synthetic liver function
• Bilirubin day 0 — Total bilirubin in µmol/L at admission
• ΔBilirubin — Change in bilirubin from day 0 to day 7 (day 7 − day 0)
• Renal insufficiency — Binary variable: 1 if creatinine >115 µmol/L (1.3 mg/dL), else 0

Interpreting the Lille Score

The Lille score ranges from 0 to 1. A score below 0.45 indicates a responder—the patient is likely to benefit from continued corticosteroid therapy and has a reasonable prognosis. A score of 0.45 or above suggests a non-responder; bilirubin is not falling despite steroids, and alternative or additional therapies should be considered.

The score's predictive power lies in incorporating both static markers (age, albumin, synthetic function) and dynamic response (bilirubin trajectory). This combination outperforms admission values alone.

A Lille score above 0.45 carries approximately 75–80% 6-month mortality without treatment change, whereas a favourable score (<0.45) is associated with 25–30% mortality. This discrimination guides urgent clinical decisions about escalation, transplant referral, or palliative care planning.

Practical Considerations and Pitfalls

Apply the Lille score with awareness of these real-world limitations and measurement challenges.

1. Unit conversion errors — Bilirubin, creatinine, and albumin must be in the exact units the equation expects. Check whether your lab reports µmol/L or mg/dL for bilirubin and creatinine. A single order-of-magnitude mistake will invalidate the entire score. Convert early and double-check.
2. Prothrombin time versus INR — The Lille equation requires PT in seconds, not INR. These are not interchangeable. If your laboratory reports only INR, ask for the actual PT value or request the PT/control ratio from the lab. Substituting INR will produce an incorrect score.
3. Timing of day 7 bilirubin measurement — The calculator requires bilirubin measured precisely around day 7 of steroid therapy. Measurements on day 5 or day 10 weaken the prognostic accuracy. If the patient was transferred or day-7 labs are missing, consider waiting for a later timepoint or acknowledging uncertainty when counselling the patient.
4. Score is not destiny — The Lille score is a statistical probability tool, not a deterministic outcome predictor. Individual patients sometimes survive with unfavourable scores or deteriorate despite favourable ones. Use it alongside clinical judgment, imaging, other markers of organ function, and patient and family values.

Clinical Background and Evidence

The Lille score was derived and validated by researchers at Lille University Hospital in France using a cohort of patients with biopsy-proven alcoholic hepatitis treated with prednisolone. It has been validated in multiple independent populations and remains one of the most widely used prognostic tools in hepatology.

Compared to simpler indices like the MELD score or discriminant function, the Lille model is more specific for predicting steroid response. Its main limitation is that it requires day-7 laboratory data, making it unsuitable for early prognostication. Additionally, it was developed in populations with access to intensive supportive care; its generalisability to resource-limited settings is uncertain.

Recent guidelines recommend using the Lille score at day 7 to decide whether to continue, modify, or discontinue corticosteroids. Non-responders may benefit from alternative agents such as pentoxifylline (weak evidence) or consideration for early transplant evaluation in appropriate candidates.