PROGNOSTIC UTILITY OF LILLE SCORE IN ALCOHOLIC HEPATITIS

Background: Alcoholic liver disease is a spectrum of alcohol induced injury that includes fatty liver, alcoholic hepatitis and alcoholic cirrhosis. Corticosteroids are used in cases of severe alcoholic hepatitis with Maddrey’s Discriminant Function score > 32. However, many of the patients who are being managed by corticosteroids are non responders and mortality increases in such patients. Lille model is a prognostic model which helps in identification of steroid responders and non responders within 7 days of start of treatment. In the present study we identified the alcoholic hepatitis patients with Lille score < 0.45 and with > 0.45. Survival in the patients was compared with the Lille score. Method:  Prospective study of 100 patients of alcoholic hepatitis aged 18 to 85 years was done for a period of six months. All of the patients were managed with similar treatment protocols including general supportive measures and treatment of associated complications. Oral or Intravenous corticosteroid therapy was given for 28 days and then tapered off over next two weeks in the subgroup of patients with Lille score < 0.45. Patients were followed up till the end of 6 months. Result: Lille score was significantly (p < 0.005) lower in survival group (mean 0.35 ± 0.17) compared to non survival group (mean 0.72 ± 0.15). Using Receiver Operating curve, we found that cut off points for Lille Score in our population is 0.47. These patients are not benefitted from steroid therapy and should be considered for alternative therapy like liver transplant. Conclusion: brief summary and potential implications: Lille score is a valuable marker for identifying the patients who could be benefitted by corticosteroids. This study indicates a need for developing a new cut off point for Lille Score.