Lille Score Calculator
The Lille model predicts six-month survival in patients with severe alcoholic hepatitis who have completed seven days of corticosteroid therapy. Enter six lab values from admission (day 0) and one bilirubin value from day 7. A score above 0.45 identifies non-responders with only a 25% chance of six-month survival, for whom alternative therapies or transplant evaluation should be considered. A score below 0.45 indicates a favorable response with approximately 85% six-month survival.
What is the Lille score?
The Lille model (also called the Lille score) is a prognostic tool developed to evaluate the response to corticosteroid therapy in patients with severe alcoholic hepatitis. It was introduced by Louvet and colleagues in 2007 after analysis of 320 patients in a development cohort and 118 patients in a validation cohort. The score combines six clinical and laboratory variables measured at admission with a single bilirubin measurement taken after seven days of steroid treatment, generating a probability score from 0 to 1. The key insight is that bilirubin trajectory over the first week of steroids, combined with baseline hepatic and renal function, predicts who will survive to six months far better than admission values alone.
How to use this calculator
Enter the patient's age in years, albumin at admission (day 0), total bilirubin at admission and after exactly 7 days of corticosteroid therapy, creatinine, and prothrombin time. Switch between mg/dL and umol/L for bilirubin and creatinine, and between g/dL and g/L for albumin, using the unit selectors. The calculator converts all values internally before applying the formula. A score of 0.45 or above identifies non-responders: patients in whom continued steroids carry no meaningful survival benefit and who should be considered for liver transplantation evaluation or alternative medical therapy. A score below 0.45 indicates a favorable response; these patients should continue their steroid course.
The Lille score formula explained
The model is based on logistic regression. Six variables are combined into an intermediate value R: age, albumin (g/dL), the difference between day-0 and day-7 total bilirubin (mg/dL), a binary renal-insufficiency flag (creatinine above 1.3 mg/dL), day-0 bilirubin (mg/dL), and prothrombin time (seconds). The final Lille score is the logistic transformation of -R: score = exp(-R) / (1 + exp(-R)). Because the formula was validated in mg/dL, bilirubin and creatinine values in umol/L are divided by 17.1 and 88.4 respectively before insertion into R. Albumin in g/L is divided by 10. The formula coefficients reflect the weight each variable carries in predicting six-month mortality: a larger bilirubin drop from day 0 to day 7 lowers R (and therefore lowers the Lille score, indicating a better response), while older age, lower albumin, higher baseline bilirubin, and longer prothrombin time all push the score higher.
Clinical context: when to apply the Lille score
Severe alcoholic hepatitis is defined by a Maddrey discriminant function (MDF) score of 32 or above, or by a MELD score of 20 or above. Corticosteroids (prednisolone 40 mg/day for 28 days) are the only pharmacotherapy with demonstrated survival benefit in this setting. The Lille model is applied after exactly seven days of therapy to distinguish responders from non-responders. The European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) both recommend stopping steroids if the Lille score at day 7 is 0.45 or above. Liver transplantation is increasingly offered to carefully selected non-responders who meet sobriety and psychosocial criteria, with five-year post-transplant survival exceeding 70% in published series. The Lille model has an AUROC of 0.85 in the original validation cohort, making it one of the strongest single-time-point predictors of steroid response in this disease.
Lille score interpretation
| Lille Score | Response category | 6-month survival | Recommendation |
|---|---|---|---|
| < 0.45 | Responder | ~85% | Continue corticosteroid therapy |
| >= 0.45 | Non-responder | ~25% | Stop steroids; consider transplant evaluation |
Based on Louvet A, et al. Hepatology 2007;45:1348-1354. Cutoff of 0.45 derived from the original validation cohort of 438 patients.
Frequently asked questions
What does a Lille score of 0.45 or above mean?
A score of 0.45 or above classifies the patient as a non-responder to corticosteroid therapy. In the original validation study, patients with a score at or above this cutoff had approximately 25% six-month survival, compared to 85% for those below the threshold. Continuing steroids in this group does not improve outcomes and exposes patients to infection risk. The clinical team should consider stopping steroids and exploring alternatives such as liver transplantation in eligible candidates.
Why is bilirubin measured at day 7 specifically?
Bilirubin is a direct marker of hepatocellular function and biliary excretion. The first seven days of steroid therapy represent the critical window in which the liver either begins to recover (bilirubin falls) or continues to deteriorate (bilirubin plateaus or rises). The trajectory of bilirubin over this window adds information that baseline values alone cannot capture. Day 7 was chosen by Louvet et al. because it struck the optimal statistical balance between sensitivity and specificity for predicting six-month outcomes.
Can the Lille score be used without prior corticosteroid therapy?
No. The day-7 bilirubin value is measured after seven days of steroid treatment, so the score is only valid in patients who have received corticosteroids. Applying it to untreated patients or using a day-0 bilirubin in place of the day-7 value would produce a meaningless result. The admission variables (albumin, creatinine, prothrombin time, baseline bilirubin) reflect baseline severity, but the model was designed and validated as a response assessment tool, not a purely admission-based predictor.
How is renal insufficiency defined in the formula?
Creatinine above 1.3 mg/dL (approximately 115 umol/L) is classified as renal insufficiency and given a value of 1; creatinine at or below that threshold is given a value of 0. This binary variable was chosen in the original regression analysis because it captured the sharp increase in mortality risk associated with hepatorenal syndrome and acute kidney injury in this population. The threshold of 1.3 mg/dL corresponds roughly to the upper limit of normal for serum creatinine in most labs.
What is the difference between the Lille score and the Maddrey discriminant function?
The Maddrey discriminant function (MDF) is an admission-only score that determines severity and whether to start steroids: an MDF score of 32 or above indicates severe disease and steroid eligibility. The Lille score is a response assessment tool applied after seven days of treatment to decide whether to continue or stop steroids. They are used sequentially: MDF at admission to select candidates, then Lille at day 7 to evaluate response. Neither can substitute for the other.
Does a low Lille score guarantee survival?
Not individually. The score reflects group-level probabilities derived from regression analysis. An 85% six-month survival rate for responders (Lille below 0.45) means that roughly 15% of patients in this favorable group still die within six months. Individual outcomes depend on factors not captured in the model, including intercurrent infections, gastrointestinal bleeding, or other organ failures. The score guides therapy decisions at a population level and should always be interpreted alongside the full clinical picture.
Sources
- Louvet A, et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007;45:1348-1354.
- European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018;69:154-181.