A patient with severe biopsy-proven alcoholic hepatitis is started on prednisolone 40 mg daily. On day 7 of therapy the Lille score is calculated as 0.56. What is the correct interpretation and action?
- A Good response, continue full 28-day course
- B Borderline result, double the steroid dose
- C Non-response, discontinue steroids as benefit is unlikely ✓
- D Score irrelevant unless MELD exceeds 25
Correct answer: C. Non-response, discontinue steroids as benefit is unlikely
Explanation
The Lille model uses the change in bilirubin at day 7 relative to baseline to measure early steroid response. A score below 0.45 indicates response and justifies completing the 28-day course, whereas a score of 0.45 or higher predicts lack of six-month survival benefit, and continued steroids only add infection risk. Stopping at day 7 in non-responders is standard practice derived from the STOPAH-era validation data.
Reference: Sherlock's Diseases of the Liver and Biliary System, 13th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.