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Living with Lille

Debate as to the efficacy of corticosteroid treatment in alcoholic hepatitis continues to polarise opinions and generate more heat than light. One of the real issues for steroid treatment in alcoholic hepatitis is that in an individual patient, 40 mg of prednisolone for 28 days may do more harm than good. Therefore, early identification of those who are unlikely to respond is obviously desirable.

Louvet et al aimed to develop a model to identify steroid non-responders. All the patients included in the study had histological confirmation of alcoholic hepatitis and clinically severe disease with a Maddrey discriminant function of ⩾32 at entry. The Lille model was developed using data from 320 historical patients treated with steroids, then the performance of the model was validated using a prospective cohort of 118 patients. The model combining both pre-treatment and on-treatment variables (age, renal insufficiency, albumin, prothrombin time, bilirubin and evolution of bilirubin on day 7 of steroid treatment) was highly predictive of death at 6 months (p<0.001) with an area under the receiver operating characteristic curve of 0.89. The Lille model was superior to Child-Pugh, MELD, Glasgow and Maddrey scores. Those who were above a cut-off value of 0.45 on …

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