Lille Score Calculator

Q: What is the Lille score formula?

The Lille score comes from two steps. First you build a number called R: R = 3.19 − (0.101 × age) + (1.47 × albumin in g/dL) + (0.28215 × bilirubin drop in mg/dL) − (0.206 × kidney flag) − (0.11115 × day 0 bilirubin in mg/dL) − (0.0096 × prothrombin time in seconds) The kidney flag is 1 if creatinine is above 1.3 mg/dL, and 0 if it is not. Then R is turned into a score from 0 to 1: Lille = e −R ÷ (1 + e −R )

Q: What is a complete, partial, and null response on the Lille score?

Doctors sometimes split the score into three groups instead of two: Complete responder: score 0.16 or less. Partial responder: score between 0.16 and 0.56. Null responder: score 0.56 or higher. 3 In a pooled study of five trials, 28-day survival was 91.1%, 79.4% and 53.3% in these groups, and steroids helped complete and partial responders but not null responders. 3 The single 0.45 cut-off is still the one used most often for stopping or continuing steroids. 2

Q: Can the Lille score be checked on day 4 instead of day 7?

Possibly. A Lille score built from a day 4 bilirubin has shown similar accuracy to the day 7 score, although this still needs more study. 2 That could stop steroids that are not working a few days sooner. Day 7 is still the timing the AASLD guidance uses. 2

Q: What is the difference between the Maddrey discriminant function and the Lille score?

They are used at different times. Maddrey DF is used before treatment. A value of 32 or more means the hepatitis is severe and steroids may help. 2 Lille score is used after 7 days of steroids. It shows whether the drug is actually working. So Maddrey helps you start treatment, and Lille helps you decide to keep going or stop.

Q: How long is prednisolone given for alcohol-related hepatitis?

The usual plan is prednisolone 40 mg by mouth each day for 28 days. 2 Some teams then taper the dose over 2 to 3 weeks, and others just stop. At day 7, the Lille score is checked. If the score is 0.45 or higher, steroids are usually stopped early because they are not helping. 2 They also raise the risk of serious infection. 6

Q: Why is prednisolone used instead of prednisone in liver disease?

Prednisone is not active until the body changes it into prednisolone. In active liver disease that change is incomplete. Prednisolone is already in the active form, so it skips that step. That is why liver guidelines name prednisolone for severe alcohol-related hepatitis. Methylprednisolone by IV is used when a patient cannot swallow pills.

Q: How do you convert bilirubin from µmol/L to mg/dL?

Divide by 17.1. µmol/L ÷ 17.1 = mg/dL mg/dL × 17.1 = µmol/L For example, 250 µmol/L ÷ 17.1 = 14.6 mg/dL. The Lille formula was built with bilirubin in µmol/L, so units must match before you do the math.

Q: Can someone with a high Lille score still get a liver transplant?

Yes, in some centers. Early liver transplant is offered to carefully picked non-responders after a full psychosocial assessment, usually when severe alcohol-related hepatitis is their first sign of liver disease. 2 In the first French study of this approach, 6-month survival was 77%, against 23% in similar patients from earlier years. 2 Rules differ by center and country.

Q: Does an infection change the Lille score?

It can. A serious infection, a blocked bile duct, or a medicine can push bilirubin up and make the score look worse than the liver really is. Liver guidance asks for cultures, a chest X-ray and imaging of the abdomen before steroids start, to look for infection and other causes of jaundice. 2 An infection on its own has not been shown to drive short-term deaths, and a response to steroids on the Lille score goes with better survival even when an infection is present. 2 The number should always be read with the whole clinical picture.

Q: Does the Lille score work for patients not taking steroids?

It was built in patients on steroids, and that is who it is meant for. 5 The authors also tested it in 102 patients from earlier trials who were given a placebo. It was less accurate there, and 6-month survival was 25.7% with a score of 0.45 or higher and 63.9% below it. 5 So the survival figures on this page apply to patients on steroids. Doctors also judge the outlook in alcohol-related hepatitis with other lab-based scores, such as the Maddrey DF, MELD, ABIC or the Glasgow score. 2

Introduction

The Lille Score Calculator shows whether a patient with severe alcohol-related hepatitis is getting better on steroid treatment. After 7 days of steroids, the score tells you if the drug is working.

The score uses six things: age, kidney function, albumin, prothrombin time, bilirubin, and the change in bilirubin by day 7.¹ The tool also accepts an INR. The calculator turns these into one number between 0 and 1.

A score under 0.45 means the patient is a responder. About 85% live at least 6 more months.¹ A score of 0.45 or higher means the patient is a non-responder. About 25% live at least 6 more months.¹ In that case, the care team may stop steroids and look at other plans, like a transplant referral.²

Enter your lab values below in mg/dL, µmol/L, g/L, or g/dL. The tool converts units, shows the full math step by step, and flags values that look odd. Use it with your own clinical judgment, not in place of it.

How to use our Lille Score Calculator

Enter your patient's age, lab values from Day 0 of steroid treatment, and the bilirubin drawn on Day 7. The calculator returns the Lille score (0 to 1), tells you if the patient is a steroid responder or non-responder, shows the 6-month survival estimate, and gives a step-by-step breakdown of the math.

Age (years): Type the patient's age in whole years on the day steroids were started. If you would rather use a birth date, press "Switch to Date of Birth Entry" and pick the date. The age fills in for you, worked out on the Day 0 date below, or on today's date if that is blank.

Date of Admission / Day 0 (optional): Pick the day steroid therapy began. The tool then shows you the date the Day 7 bilirubin should be drawn. If you entered a birth date, the age is worked out on this day. Otherwise this date does not change the score.

Albumin at Day 0: Choose g/L or g/dL, then enter the serum albumin from the first day of treatment. If the patient got albumin infusions, use the value taken before the infusion.⁴

Creatinine at Day 0: Choose mg/dL or µmol/L, then enter the creatinine. The score only checks if it is above 1.3 mg/dL (115 µmol/L), which counts as kidney trouble.

Bilirubin at Admission (Day 0): Choose mg/dL or µmol/L, then enter the total bilirubin from the day steroids started.

Bilirubin at Day 7: Enter the total bilirubin after 7 days of steroids. A drop from Day 0 lowers the score.⁵ Use the "Switch both bilirubin fields" button to change both units at once.

Coagulation (PT or INR): Pick "Prothrombin Time (sec)" and enter the patient PT plus your lab's control PT. If you only have an INR, pick "INR" and enter it. For centers using INR instead of prothrombin time in seconds, the authors provided a formula using INR instead of prothrombin time, and the tool uses it.⁵

Press Calculate to see the result, the charts, and the worked steps. Press Reset to start over with a new patient.

What Is the Lille Score?

The Lille Score shows whether a patient with severe alcohol-associated hepatitis (also called alcoholic hepatitis) is getting better on steroid medicine. It is checked after 7 full days of steroid treatment.² The score is a number between 0 and 1. A lower number is better.

Why Day 7 Matters

Steroids like prednisolone can help some people with severe liver swelling from alcohol. But they do not help everyone, and they raise the risk of infection.⁶ The Lille Score uses one week of data to show who is responding. This lets the care team stop steroids early in people who are not being helped.²

What the Score Uses

Age: older age lowers the chance of a good outcome.
Albumin on Day 0: a blood protein made by the liver. Higher is better.
Bilirubin on Day 0 and Day 7: the yellow pigment that causes jaundice. A drop over 7 days is a good sign.
Creatinine on Day 0: shows kidney trouble. Above 1.3 mg/dL (115 µmol/L) counts as kidney problems in the formula.⁵ The study's own definition of kidney problems also included a creatinine clearance below 40 mL/min.⁵
Prothrombin time (or INR): how long blood takes to clot. Slow clotting can be a sign of liver disease.

How to Read the Result

The cut-off is 0.45.

Score under 0.45: responder. About 85% of these patients are alive at 6 months.¹ Steroids are usually continued for the full course.
Score 0.45 or higher: non-responder. About 25% are alive at 6 months.¹ Doctors often stop steroids and think about other care, such as a liver transplant referral or a clinical trial.²

Things to Keep in Mind

The Lille Score is made for patients who started steroids for severe alcohol-associated hepatitis, usually those with a Maddrey Discriminant Function of 32 or more.¹ It is not meant for other liver diseases. If a patient was given albumin through an IV, use the albumin level drawn before that infusion.⁴ Other things can raise bilirubin too, such as a serious infection, a blocked bile duct, or a medicine, so the number should always be read next to the full clinical picture. The score supports a decision. It does not make it.

Where It Comes From

The score was created by Louvet and colleagues in Lille, France, and published in 2007.¹ The American Association for the Study of Liver Diseases recommends using it after 7 days of steroids.²

Formulas used

Linear predictor R ⁵

R = 3.19 - 0.101\,\text{Age} + 0.147\,\text{Albumin}_{\text{g/L}} + 0.0165\,(\text{Bili}_{D0} - \text{Bili}_{D7})_{\mu\text{mol/L}} - 0.206\,\text{RenalIns} - 0.0065\,\text{Bili}_{D0,\,\mu\text{mol/L}} - 0.0096\,\text{PT}_{\text{sec}}

Lille Score (logistic transform of R) ⁵

\text{Lille} = \frac{e^{-R}}{1 + e^{-R}}

Renal insufficiency indicator ⁵

\text{RenalIns} = \begin{cases} 1 & \text{if Creatinine} > 1.3\ \text{mg/dL}\ (115\ \mu\text{mol/L}) \\ 0 & \text{otherwise} \end{cases}

Response classification threshold ¹

\text{Lille} < 0.45 \Rightarrow \text{Responder}; \quad \text{Lille} \ge 0.45 \Rightarrow \text{Non-responder}

INR version of the prothrombin term ⁵

\text{INR version: } 0.0096 \times \text{INR} \text{ replaces } 0.0096 \times \text{PT}_{\text{sec}}

Unit conversions to model units

\text{Albumin}_{\text{g/dL}} = \frac{\text{Albumin}_{\text{g/L}}}{10}, \quad \text{Bili}_{\text{mg/dL}} = \frac{\text{Bili}_{\mu\text{mol/L}}}{17.1}, \quad \text{Cr}_{\text{mg/dL}} = \frac{\text{Cr}_{\mu\text{mol/L}}}{88.4}; \quad \text{in mg/dL units: } 1.47 = 0.147 \times 10,\; 0.28215 = 0.0165 \times 17.1,\; 0.11115 = 0.0065 \times 17.1

Prothrombin time ratio (displayed)

\text{PT ratio} = \frac{\text{PT}_{\text{patient}}}{\text{PT}_{\text{control}}}

Frequently asked questions

What is the Lille score formula?

The Lille score comes from two steps. First you build a number called R:

R = 3.19 − (0.101 × age) + (1.47 × albumin in g/dL) + (0.28215 × bilirubin drop in mg/dL) − (0.206 × kidney flag) − (0.11115 × day 0 bilirubin in mg/dL) − (0.0096 × prothrombin time in seconds)

The kidney flag is 1 if creatinine is above 1.3 mg/dL, and 0 if it is not.

Then R is turned into a score from 0 to 1:

Lille = e^−R ÷ (1 + e^−R)

What is a complete, partial, and null response on the Lille score?

Doctors sometimes split the score into three groups instead of two:

Complete responder: score 0.16 or less.
Partial responder: score between 0.16 and 0.56.
Null responder: score 0.56 or higher.³

In a pooled study of five trials, 28-day survival was 91.1%, 79.4% and 53.3% in these groups, and steroids helped complete and partial responders but not null responders.³

The single 0.45 cut-off is still the one used most often for stopping or continuing steroids.²

Can the Lille score be checked on day 4 instead of day 7?

Possibly. A Lille score built from a day 4 bilirubin has shown similar accuracy to the day 7 score, although this still needs more study.² That could stop steroids that are not working a few days sooner.

Day 7 is still the timing the AASLD guidance uses.²

What is the difference between the Maddrey discriminant function and the Lille score?

They are used at different times.

Maddrey DF is used before treatment. A value of 32 or more means the hepatitis is severe and steroids may help.²
Lille score is used after 7 days of steroids. It shows whether the drug is actually working.

So Maddrey helps you start treatment, and Lille helps you decide to keep going or stop.

How long is prednisolone given for alcohol-related hepatitis?

The usual plan is prednisolone 40 mg by mouth each day for 28 days.² Some teams then taper the dose over 2 to 3 weeks, and others just stop.

At day 7, the Lille score is checked. If the score is 0.45 or higher, steroids are usually stopped early because they are not helping.² They also raise the risk of serious infection.⁶

Why is prednisolone used instead of prednisone in liver disease?

Prednisone is not active until the body changes it into prednisolone. In active liver disease that change is incomplete.

Prednisolone is already in the active form, so it skips that step. That is why liver guidelines name prednisolone for severe alcohol-related hepatitis. Methylprednisolone by IV is used when a patient cannot swallow pills.

How do you convert bilirubin from µmol/L to mg/dL?

Divide by 17.1.

µmol/L ÷ 17.1 = mg/dL
mg/dL × 17.1 = µmol/L

For example, 250 µmol/L ÷ 17.1 = 14.6 mg/dL. The Lille formula was built with bilirubin in µmol/L, so units must match before you do the math.

Can someone with a high Lille score still get a liver transplant?

Yes, in some centers. Early liver transplant is offered to carefully picked non-responders after a full psychosocial assessment, usually when severe alcohol-related hepatitis is their first sign of liver disease.²

In the first French study of this approach, 6-month survival was 77%, against 23% in similar patients from earlier years.² Rules differ by center and country.

Does an infection change the Lille score?

It can. A serious infection, a blocked bile duct, or a medicine can push bilirubin up and make the score look worse than the liver really is.

Liver guidance asks for cultures, a chest X-ray and imaging of the abdomen before steroids start, to look for infection and other causes of jaundice.² An infection on its own has not been shown to drive short-term deaths, and a response to steroids on the Lille score goes with better survival even when an infection is present.² The number should always be read with the whole clinical picture.

Does the Lille score work for patients not taking steroids?

It was built in patients on steroids, and that is who it is meant for.⁵ The authors also tested it in 102 patients from earlier trials who were given a placebo. It was less accurate there, and 6-month survival was 25.7% with a score of 0.45 or higher and 63.9% below it.⁵ So the survival figures on this page apply to patients on steroids.

Doctors also judge the outlook in alcohol-related hepatitis with other lab-based scores, such as the Maddrey DF, MELD, ABIC or the Glasgow score.²

Why does the Lille score treat creatinine as yes or no instead of a number?

The original study scored kidney trouble as present or absent, not as a level.⁵ So the model uses a flag: 1 if creatinine is above 1.3 mg/dL (115 µmol/L), and 0 if it is at or below.

That means a creatinine of 1.5 and a creatinine of 3.0 push the score the same way. Kidney failure is still a serious warning sign on its own.

What counts as severe alcohol-related hepatitis?

Severe disease usually means a Maddrey discriminant function of 32 or more, and a MELD score of 20 or more has also been proposed.² The agreed definition of alcohol-related hepatitis itself, used in clinical studies, includes jaundice that started within the past 8 weeks, heavy drinking for 6 months or more, an AST above 50 that is more than 1.5 times the ALT with both under 400 IU/L, and a total bilirubin above 3.0 mg/dL.⁷

Only patients in this severe group are considered for steroids, and only they should have a Lille score checked.

Sources

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