Healthcare & Clinical Calculations
Lille Model Score (Day-7 Steroid Response in Severe Alcoholic Hepatitis)
Calculate Alexandre Louvet’s Day-7 Lille Score (0–1) from Age, Day-0 Albumin (g/L), Day-0 & Day-7 Bilirubin (umol/L), Renal Insufficiency, and PT (sec) to stop futile prednisolone when Lille >= 0.45.
Decide at Day 7 whether to complete 28-day prednisolone or stop futile immunosuppression!
Patients hospitalized with severe alcohol-associated hepatitis (Maddrey Discriminant Function >= 32 or MELD > 20) start prednisolone 40 mg/day—yet ~35–40% are steroid non-responders in whom continuing corticosteroids for a full 28 days only multiplies lethal fungal/bacterial sepsis without improving survival! Alexandre Louvet et al. (Hepatology 2007) developed the Day-7 Lille Model around early bilirubin clearance (Bili_Day0 - Bili_Day7 in umol/L): R = 3.19 - 0.101*Age + 0.147*Albumin_gL + 0.0165*(Bili0_umolL - Bili7_umolL) - 0.206*Renal_0_1 - 0.0065*Bili0_umolL - 0.0096*PT_sec, and Lille = EXP(-R) / (1 + EXP(-R))!
AASLD and EASL guidelines use the validated 0.45 cutoff: Lille < 0.45 predicts 85% 6-month survival (continue prednisolone to Day 28; <= 0.16 = Complete Responder), whereas Lille >= 0.45 predicts only 25% 6-month survival (Steroid Non-Responder — STOP prednisolone immediately and evaluate early liver transplant)! Watch how Day-7 bilirubin drives the score for a 52-year-old (Alb = 26 g/L, Bili_0 = 310 umol/L, Renal = 0, PT = 19.5 s): sluggish drop to Bili_7 = 285 umol/L gives Lille = 0.5074 (>= 0.45 -> Stop Steroids!), whereas brisk clearance to Bili_7 = 140 umol/L gives Lille = 0.0861 (<= 0.16 -> Complete Responder)!
| Day-7 Bilirubin Trajectory (Bili0 = 310 umol/L) | Day-7 Lille Score (0–1) | 6-Month Survival Tier | AASLD / EASL Prednisolone Action |
|---|---|---|---|
| Brisk Drop (Bili7 = 140 umol/L) | 0.0861 (<= 0.16) | Complete Steroid Responder | Complete Full 28-Day Prednisolone Course |
| Partial Drop (0.17 to 0.44) | < 0.45 Responder | ~85% 6-Month Survival | Continue Prednisolone to Day 28 |
| Stalled Bilirubin (Bili7 = 285 umol/L) | 0.5074 (>= 0.45) | ~25% Survival (Non-Responder) | STOP Prednisolone at Day 7 (Infection Risk!) |
Day-7 Lille Model Probability Score (0.0000 to 1.0000)
Evaluates EXP(-R) / (1 + EXP(-R)) using SI laboratory units (Albumin g/L, Bilirubin umol/L, Renal Cr > 115 umol/L [1.3 mg/dL] = 1 else 0, PT seconds).
=IF(OR(B2 <= 0, B3 <= 0, B4 <= 0, B5 <= 0, B6 < 0, B6 > 1, B7 <= 0), "Invalid Lille Lab Input", ROUND(EXP(-(3.19 - 0.101 * B2 + 0.147 * B3 + 0.0165 * (B4 - B5) - 0.206 * B6 - 0.0065 * B4 - 0.0096 * B7)) / (1 + EXP(-(3.19 - 0.101 * B2 + 0.147 * B3 + 0.0165 * (B4 - B5) - 0.206 * B6 - 0.0065 * B4 - 0.0096 * B7))), 4))AASLD / EASL Day-7 Corticosteroid Stopping Rule (< 0.45 vs. >= 0.45)
Classifies Lille >= 0.45 as Non-Responder (Stop Steroids), <= 0.16 as Complete Responder, and 0.16–0.45 as Partial Responder.
=IF(OR(B2 <= 0, B3 <= 0, B4 <= 0, B5 <= 0, B6 < 0, B6 > 1, B7 <= 0), "Invalid Lille Lab Input", IF((EXP(-(3.19 - 0.101 * B2 + 0.147 * B3 + 0.0165 * (B4 - B5) - 0.206 * B6 - 0.0065 * B4 - 0.0096 * B7)) / (1 + EXP(-(3.19 - 0.101 * B2 + 0.147 * B3 + 0.0165 * (B4 - B5) - 0.206 * B6 - 0.0065 * B4 - 0.0096 * B7)))) >= 0.45, "Steroid Non-Responder (Lille >= 0.45) — STOP Prednisolone at Day 7", IF((EXP(-(3.19 - 0.101 * B2 + 0.147 * B3 + 0.0165 * (B4 - B5) - 0.206 * B6 - 0.0065 * B4 - 0.0096 * B7)) / (1 + EXP(-(3.19 - 0.101 * B2 + 0.147 * B3 + 0.0165 * (B4 - B5) - 0.206 * B6 - 0.0065 * B4 - 0.0096 * B7)))) <= 0.16, "Complete Steroid Responder (Lille <= 0.16) — Continue 28-Day Course", "Partial Steroid Responder (0.16 < Lille < 0.45) — Continue 28-Day Course")))Try the example
Use the original values or change them to test your understanding.