Enter the bilirubin level on day 7, bilirubin level on day 0, patient’s age, albumin level on day 0, prothrombin time (PT, seconds) on day 0, and serum creatinine on day 0 into the calculator to determine the Lille Score.
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Lille Score Formula
The Lille score is a day-7 response model used in patients with severe alcohol-associated hepatitis who are being assessed after corticosteroid therapy has started. It combines baseline severity with the change in bilirubin over the first 7 days of treatment. The final result ranges from 0 to 1, and in general, lower scores indicate a more favorable early treatment response.
The calculator first computes a linear predictor:
R = 3.19 - 0.101 \times \text{Age} + 0.147 \times \text{Albumin}_{day0} + 0.0165 \times (\text{Bilirubin}_{day0} - \text{Bilirubin}_{day7}) - 0.206 \times \text{RenalInsuff} - 0.0065 \times \text{Bilirubin}_{day0} - 0.0096 \times \text{PT}It then converts that value to the final Lille score:
\text{Lille} = \frac{e^{-R}}{1 + e^{-R}}In this formula, bilirubin is expressed in µmol/L, albumin in g/L, and PT in seconds. The renal insufficiency term is binary: it is set to 1 when serum creatinine is greater than 1.3 mg/dL (about 115 µmol/L) and 0 otherwise.
What each input means
| Input | What to enter | Important note |
|---|---|---|
| Bilirubin Day 0 | Total bilirubin at baseline | Use the value from the start of therapy; this is the reference point for change over time. |
| Bilirubin Day 7 | Total bilirubin after 7 days | Use the same unit system as Day 0 before any conversion. |
| Age | Patient age in years | Enter whole years unless your workflow uses decimals. |
| Albumin Day 0 | Baseline serum albumin | The formula uses g/L, so g/dL must be converted. |
| PT Day 0 | Baseline prothrombin time in seconds | Do not substitute INR; the classic Lille model uses PT in seconds. |
| Serum Creatinine Day 0 | Baseline serum creatinine | This is used to determine whether renal insufficiency is present. |
How the bilirubin change affects the score
The change term in the formula is baseline bilirubin minus day-7 bilirubin. That means a larger fall in bilirubin makes the change term more positive, which increases R and drives the final Lille score downward. A falling bilirubin trend therefore tends to support a more favorable result, while a flat or rising bilirubin tends to push the score higher.
Interpretation guide
The classic way to read the Lille score is with a 0.45 cutoff. Some clinicians also use a more detailed three-tier response pattern for additional context.
| Score range | Common interpretation | General meaning |
|---|---|---|
| < 0.45 | Favorable response | Suggests better early biochemical response to therapy. |
| ≥ 0.45 | Unfavorable response | Suggests poor early response and warrants full clinical reassessment. |
| ≤ 0.16 | Complete responder | Very strong response pattern. |
| > 0.16 to < 0.56 | Partial responder | Intermediate response pattern. |
| ≥ 0.56 | Null responder | Very poor response pattern. |
Because different interpretation schemes are used, it is best to read the score in context rather than relying on a single label by itself.
Unit conversions used by the calculator
If your lab reports bilirubin in mg/dL or albumin in g/dL, convert them before applying the formula:
\text{Bilirubin}_{\mu mol/L} = \text{Bilirubin}_{mg/dL} \times 17.104\text{Albumin}_{g/L} = \text{Albumin}_{g/dL} \times 10Use the same bilirubin unit convention for both Day 0 and Day 7. PT should remain in seconds exactly as reported by the laboratory.
How to calculate the Lille score
- Record baseline values on day 0: bilirubin, albumin, PT, creatinine, and age.
- Measure bilirubin again on day 7 of corticosteroid therapy.
- Convert bilirubin to µmol/L and albumin to g/L if needed.
- Set the renal insufficiency flag to 1 if creatinine is greater than 1.3 mg/dL; otherwise set it to 0.
- Substitute all values into the linear predictor R.
- Apply the logistic equation to convert R into the final Lille score.
Example
Assume the following values:
- Bilirubin Day 0 = 18 mg/dL
- Bilirubin Day 7 = 10 mg/dL
- Age = 48 years
- Albumin Day 0 = 3.0 g/dL
- PT Day 0 = 18 seconds
- Serum Creatinine Day 0 = 1.0 mg/dL
First convert the units:
\text{Bilirubin}_{day0} = 18 \times 17.104 = 307.872\ \mu mol/L\text{Bilirubin}_{day7} = 10 \times 17.104 = 171.040\ \mu mol/L\text{Albumin}_{day0} = 3.0 \times 10 = 30\ g/LCreatinine is not greater than 1.3 mg/dL, so renal insufficiency equals 0. Now compute R:
R = 3.19 - 0.101(48) + 0.147(30) + 0.0165(307.872 - 171.040) - 0.206(0) - 0.0065(307.872) - 0.0096(18) \approx 2.84
Then calculate the Lille score:
\text{Lille} = \frac{e^{-2.84}}{1 + e^{-2.84}} \approx 0.056This result is low and is generally consistent with a favorable early response pattern.
Common mistakes to avoid
- Using INR instead of PT in seconds.
- Entering albumin in g/dL without converting to g/L.
- Mixing bilirubin units between Day 0 and Day 7 values.
- Reversing the bilirubin change term; the formula uses Day 0 minus Day 7.
- Assuming creatinine is inserted directly into the equation; in the classic model it is used to create the renal insufficiency flag.
Clinical scope and limitations
The Lille score is not a general liver disease severity score and should not be used outside its intended setting. It is most relevant when the diagnosis is severe alcohol-associated hepatitis and the patient is being reassessed after about 7 days of corticosteroid therapy. It should be interpreted together with the overall clinical picture, including infection status, kidney function, bleeding risk, encephalopathy, nutrition, and other severity measures when available.
For safety, this calculator should be used as an educational and decision-support aid rather than a stand-alone determinant of treatment.
