Lille Score for Alcoholic Hepatitis Calculator

How does this Lille score for alcoholic hepatitis calculator work?

This is a health calculator that predicts mortality in patients with alcoholic hepatitis and stratifies risk in said cases that don’t respond to steroid therapy. It evaluates the patient condition for the past 7 days since the diagnosis has been put and corticosteroid medication has been initialized, considering these criteria:

■ Age is used as a risk factor in the prognosis score and is given an important weigh in the final result.

■ Albumin, measured in g/dL or g/L is used as one of the main proteins, the serum determination allows a quick check of the liver function. Normal values are between 3.5 – 5 g/dL.

■ Bilirubin level at admission and bilirubin determination from day 7 measured in either mg/dL or µmol/L in order to monitor evolution and see whether the patient has responded to the steroid treatment in the past week.

■ Creatinine measured in either mg/dL or µmol/L, providing information on the clearance job of the kidneys and in general presenting elevated levels in patients with history of significant alcohol consumption.

■ Prothrombin time in seconds that shows liver function in terms of blood clotting and evidences any metabolic issues still present.

The formula used by the Lille score for alcoholic hepatitis calculator accounts for the factors above and involves different weighs, according to each individual importance:

Lille Model Score = Exp(-R)/(1 + Exp(-R))

Where:

R = [3.19 - (0.101 x age in years)] + (1.47 x albumin in g/dL) + [0.28215 x (bilirubin initial - bilirubin day7 in mg/dL)] - (0.206 x creatinine in mg/dL) - (0.11115 x bilirubin initial in mg/dL) - (0.0096 x prothrombin time in seconds)

Lille score guidelines

The Lille model is a risk stratification tool aiming to give a prognostic in cases unresponsive to corticosteroids at around 7 days since the therapy has begun. The score originated in the CHRU Lille center is applied usually in cases in which the Maddrey score was above 32 and determined the urgent administration of the treatment.

If the patient status doesn’t improve and if bilirubin determinations don’t show any signs of amelioration, there might be the case of a poor prognosis.

The model guidelines describe scores below 0.45 to be consistent with a 6 month survival rate of 85% while what is above the 0.45 cut off, to predict a 6 month survival rate of 25%. In the second scenario, the clinical management should focus on finding alternative therapies and refer the patient for a transplant waiting list.

Response to steroid medication is often crucial in determining the outcome of a patient suffering from AH and such prognosis models are implemented after the other liver disease assessments such as the Child-Pugh severity score.

The original model supervised the evolution of 320 patients in the development cohort and of 118 in the validation program. Baseline data from admission was taken as well as another determination of bilirubin in the 7th day of the study. One of the conclusions was that in severe cases, nonresponders presented an increased mortality risk in the following 3 months from treatment.

References

1) Louvet A, Naveau S, Abdelnour M, Ramond MJ et al. (2007) The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology; 45(6):1348-54.

2) Sandahl TD, Jepsen P, Ott P, Vilstrup H. (2011) Validation of prognostic scores for clinical use in patients with alcoholic hepatitis. Scand J Gastroenterol; 46(9):1127-32.

3) Soultati AS, Dourakis SP, Alexopoulou A, Deutsch M, Vasilieva L, Archimandritis AJ. (2006) Predicting utility of a model for end stage liver disease in alcoholic liver disease. World J Gastroenterol; 12(25):4020-5.