🫁 Lille Score Calculator

The Lille score answers one question on day 7 of corticosteroids for severe alcoholic hepatitis: is the treatment working? It combines age, albumin, bilirubin change, PT, and renal function into a probability-like score. At 0.45 or above, the patient is a non-responder: steroids are unlikely to help and their harms (infection, in particular) argue for stopping.

Enter day-0 albumin and bilirubin, day-7 bilirubin, PT, age, and renal status. The calculator converts US units to the formula's units internally and returns the score with its response class. In the original studies, responders had roughly 85% six-month survival versus about 25% for non-responders.

How to Use This Calculator

Use labs from the day steroids started (day 0) and day 7 of treatment. Enter bilirubin in mg/dL and albumin in g/dL; the calculator converts to micromol/L and g/L. Mark renal insufficiency if creatinine is 1.3 mg/dL or higher. Read the score against the 0.45 cutoff and discuss stopping or continuing steroids with the hepatology team.

The Lille Formula

The formula is a logistic regression: R is the linear predictor and the exponential transform squeezes it into a 0-to-1 score. Bilirubin change dominates because it is the direct readout of whether steroids are calming the liver injury. Age and PT capture baseline severity, albumin captures synthetic function, and renal insufficiency captures the hepatorenal axis. Louvet and colleagues derived it in 2007 from patients with severe alcoholic hepatitis on prednisolone, defining non-response at 0.45 because that cutoff best separated 6-month survivors from non-survivors. The model also refines the older Maddrey discriminant function approach, which only decided who starts steroids, not who should stop.

Worked Example

Age 52, albumin 2.8, bilirubin falling from 18 to 14, PT 18, no renal failure: the Lille score is 0.267, a Responder. The bilirubin drop of 4.0 mg/dL over 7 days does most of the work in the formula. Had bilirubin risen to 22 instead, the score would cross 0.6, firmly in non-responder territory.

Responder, Partial, or Non-Responder

Under 0.35 is a responder: continue the 28-day steroid course. Between 0.35 and 0.45 is partial response, a gray zone where clinicians weigh trajectory and complications. At or above 0.45 is non-response: continuing steroids adds infection risk without survival benefit, so guidelines favor stopping. The score is one input among others: active infection, GI bleeding, or renal failure can override the number in either direction.

A Hepatology Decision Tool

The Lille score guides a high-stakes call (continuing immunosuppression in a critically ill patient) and belongs to the treating hepatology team. Steroid decisions interact with infection screening, nutrition, and alcohol abstinence planning, none of which a calculator sees. Patients and families can use this to understand the day-7 conversation, not to direct it. For informational purposes only, not medical advice. Consult a healthcare professional.

Related tools: MELD score, INR calculator and NAFLD fibrosis score.

For informational purposes only, not medical advice. Consult a healthcare professional.