Description

Abstract

Introduction: In this study we have made a prospective analysis of the hepatic dysfunction in burns patients bymeans of liver function tests. Our study aims to analyse the hepatic dysfunction in burns patients by means of liver function tests and to study the changes of liver function tests depending on the degree of burns, to test the correlation between severity of burns & changes in liver enzymes, and to assess prognosis of burns patients on the basis of liver function tests.

Material & Methods: A longitudinal study conducted on 100 patients at a tertiary care centre, Medical College, Thrissur in the Department of General Surgery from 2010 August – 2011 August. Patients above 12 years of age who are admitted with thermal injury and survived more than 48 hours were included in our study. Patients below 12 years of age, patients with pre-existing liver disorder or past history of jaundice, patients who survived less than 48 hours, patients with burns due to electricity or chemicals, associated with poisoning and patients who had taken discharge at request for favour of treatment in other hospitals were excluded. Prognostic burn index and burn index of the patients were calculated. Burn index was calculated as half the area of superficial burns plus the area of body with third degree burns. Prognostic burn index is the sum of age in years and burn index.

Results: In 100 thermal injury patient’s liver function tests were done after 48 hours of burn injury. The results were analysed using statistical methods. The mean age of the patients was 32.41, the mean percentage of burns being 55.12. The male to female ratio was 9:91. All patients above 50% burns expired and those below 40% survived. In the 40-50% group half survived half expired. The expired patients showed mean survival of 11.92 days. 98% patients showed changes in liver function tests from normal standardized laboratory values. The changes in liver function tests with regard to percentage of burns, burn index and prognostic burn index were studied by regression analysis.

Conclusion: In this study it was revealed that thermal injury patients show liver function test changes after the first 48 hours of the insult. This may be due to the burns shock and the toxic products and inflammatory mediators producing hepatocellular damage immediately after the burns More sensitive and specific tests of liver function has to be undertaken to clearly delineate the amount and nature of  hepatocellular damage occurring secondary to thermal injury.

Key words: Burn index, Thermal injury, Hepatic dysfunction, Liver enzymes, Prognosis