Lille Score: Clinical Significance and Application in Alcoholic Hepatitis
The Lille score is a validated prognostic tool specifically designed for alcoholic hepatitis that must be calculated on day 7 of corticosteroid therapy to identify treatment non-responders and guide decisions about continuing or stopping corticosteroids. 1
What the Lille Score Measures
The Lille score is not a general cancer severity assessment tool. It is a disease-specific calculator for alcoholic hepatitis that predicts response to corticosteroid therapy and short-term mortality. 1
The score incorporates six variables measured at baseline (day 0) and day 7 of treatment:
- Age in years 1
- Albumin at day 0 (g/L) 1
- Total bilirubin at day 0 and day 7 (μmol/L) 1
- Prothrombin time (seconds) 1
- Renal insufficiency (creatinine ≥1.3 mg/dL) 1
Score Interpretation and Mortality Risk
The Lille score stratifies patients into three response categories with distinct survival outcomes:
- Complete responders (score ≤0.16): 91.1% 28-day survival 1
- Partial responders (score 0.16-0.56): 79.4% 28-day survival 1
- Null responders (score ≥0.56): 53.3% 28-day survival 1
Using the alternative threshold of 0.45, patients with scores ≥0.45 have only 20-30% six-month survival compared to 70-80% for responders with scores <0.45. 1
Treatment Decision Algorithm
For patients with Lille score ≥0.56 (null responders): Corticosteroid therapy must be stopped immediately. 1 These patients derive no benefit from continued steroid exposure and face significant mortality risk.
For patients with scores 0.45-0.56 (borderline zone): The decision to continue corticosteroids should be individualized based on:
- Presence of infection or other contraindications 1
- Trajectory of clinical deterioration
- Availability of liver transplantation 1
For patients with scores <0.45 (responders): Continue corticosteroid therapy as these patients demonstrate treatment benefit. 1
Timing Considerations
- Standard assessment: Day 7 of corticosteroid treatment is the validated timepoint for Lille score calculation 1
- Early assessment: Day 4 calculation shows similar prognostic performance but requires further validation before routine clinical use 1
Integration with Other Prognostic Tools
Combining the Lille score with the MELD score provides optimal risk stratification for both short-term (Lille) and medium-term (MELD) mortality prediction in alcoholic hepatitis. 1 This dual approach allows:
- Immediate treatment decisions based on Lille score at day 7
- Longer-term prognostication and transplant evaluation using MELD
Common Pitfalls to Avoid
- Do not use the Lille score at baseline - it requires day 7 bilirubin to calculate the critical "evolution in bilirubin" component 1
- Do not apply this score to cancer patients - despite the question's context about cancer, the Lille score has no validated role in oncology assessment
- Do not continue corticosteroids in null responders hoping for delayed response - the data clearly show futility and potential harm 1
Relevance to Cancer Patients
The Lille score has no established role in cancer severity assessment or treatment planning. For cancer patients requiring comprehensive assessment, validated tools include:
- Comorbidity assessment: ACE-27, Charlson Comorbidity Index, CIRS, or OARS questionnaire 2
- Geriatric assessment: G-8 screening tool, Mini-Cog for cognition, functional status measures 2
- Cancer-specific tools: CARG toxicity calculator for chemotherapy risk, disease-specific staging systems 2
If the question intended to ask about severity scoring in cancer patients with comorbidities, the appropriate approach involves comprehensive geriatric assessment when ≥3 comorbidities are present, with particular attention to how comorbidities affect treatment tolerance and life expectancy. 2