Hepatic functional pathophysiology and morphological damage following severe burns: a systematic review and meta-analysis

Introduction Severe burns are devastating injuries affecting multiple organ systems. Little is known about the influence on the hepatic system and its physiology. This systematic review aimed to assess the current state of research on morphologic liver damage and its markers following burns.

Methods Adhering to PRISMA guidelines, a search was conducted in Pubmed, Web of Science and Cochrane databases. No publication date restrictions were applied. Publications were limited to English, German and Spanish language. Outcomes included serum levels of transaminases, fatty infiltration and necrosis. Weighted individual study estimates were used to calculate pooled transaminase levels and necrosis/fatty infiltration rates using a random-effects approach. Risk ratios or Odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe pooled estimates for risk factors.

Results The literature search retrieved 2548 hits, of which 59 studies were included into qualitative synthesis, and finally ten studies were included into meta-analysis. Studies were divided into those reporting autopsies and those reporting changes of serum transaminase levels. The majority of liver autopsies showed fatty infiltration 82%(95% CI 39%-97%) or necrosis of the liver 18%(95% CI 13%-24%).

Discussion Heterogeneity in studies on hepatic functional damage following severe burns was high. Few were well-designed and published in recent years. Many studies were included because of insufficient numerical data. Many patients deceasing from burns show fatty infiltration or necrosis of hepatic tissue. Transaminases were elevated during the first days after burn. Further research on how severe burns affect the hepatic function and outcome, especially long-term, is necessary.

Publication History

Article published online:
26 January 2022