What Lille score (Model for End-Stage Liver Disease score) indicates futility of corticosteroids (e.g. prednisone) and necessitates urgent liver transplantation?

From the Guidelines

A Lille score of >0.45 indicates futility of corticosteroids and necessitates urgent liver transplantation.

Rationale

• The Lille score is a prognostic model used to predict the survival of patients with alcoholic hepatitis, particularly those treated with corticosteroids 1.
• A Lille score of >0.45 at day 7 after therapy introduction is associated with a poor prognosis, with an expected survival of below 30% at 6 months 1.
• The combination of the Model for End-Stage Liver Disease (MELD) score and the Lille score can be used to select patients with the highest death risk, and adapt the length of the selection process to this mortality risk 1.
• A study demonstrated that the joint-effect model of MELD plus Lille outperformed other combinations, and a patient with a MELD score of 21 and Lille score of 0.45 had a 1.9-fold higher risk of death at 2 months than one with a MELD of 21 and Lille of 0.16 1.
• Key points to consider:
  • The Lille score should be used in conjunction with clinical judgment and other prognostic models, such as the MELD score, to determine the best course of treatment for patients with alcoholic hepatitis.
  • A Lille score of >0.45 indicates a poor response to corticosteroids and a high risk of mortality, and urgent liver transplantation should be considered in these patients 1.
  • The selection process for liver transplantation should be rigorous and multidisciplinary, and should take into account the patient's medical, psychiatric, and social factors 1.

From the Research

Lille Score and Futility of Corticosteroids

• The Lille score is used to assess the futility of corticosteroids in patients with severe alcoholic hepatitis 2, 3, 4, 5, 6.
• A Lille score of ≥ 0.45 is associated with poor response to corticosteroids and indicates futility of treatment 3, 4, 6.
• Patients with a Lille score of ≥ 0.45 have a lower 6-month survival rate compared to those with a Lille score < 0.45 3, 6.
• A Lille score of > 0.56 indicates null responders, and therapy should be stopped or changed to pentoxifylline 4, 5.

Urgent Liver Transplantation

• Patients with a Lille score of ≥ 0.45 may require urgent liver transplantation due to poor response to corticosteroids 4, 6.
• Liver transplantation is the ultimate option for treatment failure cases, but facilitating this service can be a challenge 4.

Prognostic Models

• The Lille model is a prognostic tool that combines six variables to predict death at 6 months in patients with severe alcoholic hepatitis treated with corticosteroids 6.
• The Lille model has a higher area under the receiver operating characteristic (AUROC) curve compared to other prognostic models, such as the Child-Pugh, Maddrey, and Glasgow scores 6.