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Lille Model Scoring in Severe Alcoholic Hepatitis

Age: (Years)


Albumin on day 0:  



Serum Total Bilirubin (day 0):
 
  [Normal: < 1.2 mg/dL (0.1 -1.2 mg/dL)]


Serum Total Bilirubin (day 7:
 
  [Normal: < 1.2 mg/dL (0.1 -1.2 mg/dL)]


Serum creatinine  (day 0):



Prothrombin Time (PT) - Day 0:    sec
  [Normal: 11 - 13.5]

Lille Model Score

The Lille Model helps to identify patients 'early' with severe alcoholic hepatitis that are likely to respond to steroid therapy or who will require alternative treatment options.   Louvet A, Naveau S, et al. studied 320 patients with alcoholic hepatitis treated with corticosteroids for 7 days.  Simple baseline data was obtained (age, presense of renal insufficiency*, albumin, prothrombin time, and bilirubin level).  The bilirubin was monitored again at day 7 to look for a change.  The score was found to be  highly predictive of death at 6 months.  Scores under 0.45:  estimated 6 month mortality rate is ~25%.   Scores above 0.45:  estimated 6 month mortality is likely over 85%.1   

Equation:

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

Where R = 3.19 – 0.101*(age, years) + 0.147*(albumin day 0, g/L) + 0.0165* (evolution in bilirubin level, µmol/L) - 0.206*(renal insufficiency) - 0.0065*(bilirubin day 0, µmol/L) - 0.0096*(PT, seconds).

Evolution in bilirubin level:  baseline bilirubin level - bilirubin at day 7 (post steroid treatment).

*Renal insufficiency = 1 (if Cr >1.3 mg/dL (115 µmol/L)) or 0 (if </=1.3 mg/dL (115 µmol/L))



The model is based on the following variables
-Age (years),
-Albumin level at day 0 in g/L, 
-Initial bilirubin (umol/L)
-Bilirubin on day 7  (umol/L)
-Serum creatinine
-Prothrombin time (seconds)

References

1.   Louvet A, Naveau S, Abdelnour M, Ramond MJ, Diaz E, Fartoux L, Dharancy S, Texier F, Hollebecque A, Serfaty L, Boleslawski E, Deltenre P, Canva V, Pruvot FR, Mathurin P. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology. 2007 Jun;45(6):1348-54. Pubmed.



Abstract

Early identification of patients with severe (discriminant function > or = 32) alcoholic hepatitis (AH) not responding to corticosteroids is crucial. We generated a specific prognostic model (Lille model) to identify candidates early on for alternative therapies. Three hundred twenty patients with AH prospectively treated by corticosteroids were included in the development cohort and 118 in its validation. Baseline data and a change in bilirubin at day 7 were tested. The model was generated by logistic regression. The model combining six reproducible variables (age, renal insufficiency, albumin, prothrombin time, bilirubin, and evolution of bilirubin at day 7) was highly predictive of death at 6 months (P < 0.000001). The area under the receiver operating characteristic (AUROC) curve of the Lille model was 0.89 +/- 0.02, higher than the Child-Pugh (0.62 +/- 0.04, P < 0.00001) or Maddrey scores (0.66 +/- 0.04, P < 0.00001). In the validation cohort, its AUROC was 0.85 +/- 0.04, still higher than the other models, including MELD (0.72 +/- 0.05, P = 0.01) and Glasgow scores (0.67 +/- 0.05, P = 0.0008). Patients above the ideal cutoff of 0.45 showed a marked decrease in 6-month survival as compared with others: 25% +/- 3.8% versus 85% +/- 2.5%, P < 0.0001. This cutoff was able to identify approximately 75% of the observed deaths.

CONCLUSION:

In the largest cohort to date of patients with severe AH, we demonstrate that the term "nonresponder" can now be extended to patients with a Lille score above 0.45, which corresponds to 40% of cases. Early identification of subjects with substantial risk of death according to the Lille model will improve management of patients suffering from severe AH and will aid in the design of future studies for alternative therapies.

2.  Mathurin P, Abdelnour M, Ramond MJ, Carbonell N, Fartoux L, Serfaty L, Valla D, Poupon R, Chaput JC, Naveau S. Early change in bilirubin levels is an important prognostic factor in severe alcoholic hepatitis treated with prednisolone. Hepatology. 2003 Dec;38(6):1363-9. Pubmed.

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