title: The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Services d'Hépato-Gastroentérologie, Hôpital Claude Huriez, Avenue Michel Polonovski, CHRU Lille, 59037 Lille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naveau
authors.forename: Marcelle
authors.initials: M
authors.lastname: Abdelnour
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Ramond
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Diaz
authors.forename: Laetitia
authors.initials: L
authors.lastname: Fartoux
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.forename: Frédéric
authors.initials: F
authors.lastname: Texier
authors.forename: Antoine
authors.initials: A
authors.lastname: Hollebecque
authors.forename: Lawrence
authors.initials: L
authors.lastname: Serfaty
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.forename: Valérie
authors.initials: V
authors.lastname: Canva
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones