Lille Score Calculator for Alcoholic Hepatitis Treatment Response

The Lille score is a critical tool for assessing the response of patients with alcoholic hepatitis to corticosteroid treatment. This comprehensive guide explains the formula, its components, and how to interpret the results effectively.

Understanding the Lille Score Formula

Background Knowledge

Alcoholic hepatitis is an acute form of liver inflammation caused by excessive alcohol consumption. Corticosteroids are often used as part of the treatment regimen, but not all patients respond equally well. The Lille score helps clinicians determine whether a patient is responding adequately to corticosteroid therapy.

The formula for calculating the Lille score is:

\[ LS = 0.953 \times \log\left(\frac{\text{Bilirubin Day 7}}{\text{Bilirubin Day 0}}\right) - 0.101 \times (\text{Age}) + 0.147 \times (\text{Albumin Day 0}) - 0.02 \times (\text{Prothrombin Time Day 0}) + 2.53 \]

Where:

• Bilirubin Day 7: Total bilirubin level on day 7 of treatment.
• Bilirubin Day 0: Total bilirubin level at the start of treatment.
• Age: Patient’s age in years.
• Albumin Day 0: Serum albumin level at the start of treatment.
• Prothrombin Time Day 0: Prothrombin time at the start of treatment.

A higher Lille score indicates a poorer response to treatment and a greater risk of mortality, suggesting that alternative treatments may be necessary.

Practical Example

Let’s calculate the Lille score for a hypothetical patient using the following data:

• Bilirubin Day 7: 2.5 mg/dL
• Bilirubin Day 0: 1.8 mg/dL
• Age: 45 years
• Albumin Day 0: 3.2 g/dL
• Prothrombin Time Day 0: 14.5 seconds

Step 1: Calculate the logarithm of the ratio of bilirubin levels: \[ \log\left(\frac{2.5}{1.8}\right) = \log(1.3889) = 0.1427 \]

Step 2: Multiply by 0.953: \[ 0.1427 \times 0.953 = 0.1359 \]

Step 3: Subtract the product of age and 0.101: \[ 0.1359 - (45 \times 0.101) = 0.1359 - 4.545 = -4.4091 \]

Step 4: Add the product of albumin level and 0.147: \[ -4.4091 + (3.2 \times 0.147) = -4.4091 + 0.4704 = -3.9387 \]

Step 5: Subtract the product of prothrombin time and 0.02: \[ -3.9387 - (14.5 \times 0.02) = -3.9387 - 0.29 = -4.2287 \]

Step 6: Add 2.53: \[ -4.2287 + 2.53 = -1.6987 \]

The final Lille score is approximately -1.70, indicating a favorable response to corticosteroid treatment.

FAQs About the Lille Score

Q1: What does a high Lille score mean?

A high Lille score suggests that the patient is not responding well to corticosteroid treatment and is at higher risk of mortality. Alternative treatments, such as pentoxifylline or liver transplantation, may be considered.

Q2: Can the Lille score predict long-term outcomes?

While the Lille score primarily assesses short-term response to corticosteroid therapy, it can provide insights into long-term prognosis. Patients with consistently high scores may require more aggressive interventions.

Q3: Is the Lille score applicable to all forms of hepatitis?

No, the Lille score is specifically designed for patients with alcoholic hepatitis receiving corticosteroid treatment. It may not be accurate for other types of hepatitis or treatments.

Glossary of Terms

• Bilirubin: A yellow compound produced during the breakdown of red blood cells. Elevated levels indicate liver dysfunction.
• Albumin: A protein made by the liver. Low levels suggest impaired liver function.
• Prothrombin Time: A measure of how long it takes for blood to clot. Prolonged times indicate reduced liver function.
• Corticosteroids: Anti-inflammatory medications used to treat severe cases of alcoholic hepatitis.

Interesting Facts About the Lille Score

1. Development Context: The Lille score was developed in France and has become a widely accepted tool for evaluating treatment response in alcoholic hepatitis.

2. Clinical Relevance: Studies have shown that patients with a Lille score above 0.45 at day 7 have a significantly higher risk of mortality compared to those with lower scores.

3. Global Adoption: Although initially studied in European populations, the Lille score has been validated across diverse ethnic groups, demonstrating its universal applicability.