Lille Score (Alcoholic Hepatitis) Calculator

inputs

Age

years

Albumin at day 0 (start of steroids)

Bilirubin at day 0

Bilirubin at day 7

Renal insufficiency (creatinine >115 µmol/L / >1.3 mg/dL)

Prothrombin time at day 0

seconds

✓ when to use

Calculate at day 7 of prednisolone treatment in patients with severe alcoholic hepatitis (Maddrey DF ≥32). The key decision is whether to continue or stop steroids based on the trajectory of bilirubin from day 0 to day 7.

✗ when not to use

The Lille score is only applicable for patients already on corticosteroids for severe alcoholic hepatitis. It cannot be used at baseline — it requires day 7 data. The bilirubin change (day 0 → day 7) is the core driver of the score; ensure both measurements are available and accurate.

clinical pearls

The Lille score is fundamentally about bilirubin trajectory. If bilirubin is falling from day 0 to day 7, the patient is responding. If bilirubin is static or rising despite steroids, the patient is not responding.
Lille >0.45 is the key threshold. Above this, continuing steroids adds immunosuppression risk (infection) without mortality benefit. Below this, steroids should be continued for the full 28-day course.
The 'Lille window' (0.45–0.56) represents partial non-response where clinical judgement is most important. Consider the trend, overall clinical trajectory, and whether there are other reasons bilirubin may not have fallen (e.g., biliary obstruction, concurrent infection).
Some centres use a day 4 Lille calculation to identify early non-responders — preliminary data suggest this may allow earlier decisions, but day 7 remains the validated standard.
For patients with Lille >0.45 (non-responders), consider early transplant evaluation where institutional policy allows. The concept of 'early liver transplant for severe alcoholic hepatitis' has gained evidence from French and US studies.

✓ when to use

✗ when not to use

clinical pearls

The Lille score is fundamentally about bilirubin trajectory. If bilirubin is falling from day 0 to day 7, the patient is responding. If bilirubin is static or rising despite steroids, the patient is not responding.
Lille >0.45 is the key threshold. Above this, continuing steroids adds immunosuppression risk (infection) without mortality benefit. Below this, steroids should be continued for the full 28-day course.
The 'Lille window' (0.45–0.56) represents partial non-response where clinical judgement is most important. Consider the trend, overall clinical trajectory, and whether there are other reasons bilirubin may not have fallen (e.g., biliary obstruction, concurrent infection).
Some centres use a day 4 Lille calculation to identify early non-responders — preliminary data suggest this may allow earlier decisions, but day 7 remains the validated standard.
For patients with Lille >0.45 (non-responders), consider early transplant evaluation where institutional policy allows. The concept of 'early liver transplant for severe alcoholic hepatitis' has gained evidence from French and US studies.

Lille Score (Alcoholic Hepatitis)

inputs

✓ when to use

✗ when not to use

clinical pearls

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