The Hepatic Response to Severe Injury

After severe injury, such as thermal injury, a variable degree of liver injury is present and it is usually related to the severity of the thermal injury. Fatty changes, a very common finding, are per se reversible and their significance depends on the cause and severity of accumulation [1]. However, autopsies of burned children who died have shown that fatty liver infiltration was associated with increased bacterial translocation, liver failure, and endotoxemia, thus delineating the crucial role of the liver during the post-burn response [2–4]. In a recent study in 102 children, 41 females and 61 males with a total body burn size of 58 ± 2% and third degree burns in 45 ± 2%, we found that liver size and weight significantly increased during the first week post-burn (+85 ± 5%), peaked at 2 weeks post-burn (+126 ± 19%), and was increased by +89 ± 10% at discharge. At 6, 9, and 12 months the liver weight was increased by 40–50% compared to predicted liver weight. In addition, liver protein synthesis was impaired for a 6-month period with a shift from constitutive hepatic proteins to acute phase proteins [5]. Liver enzymes were significantly elevated over the first 3 weeks post-burn, normalizing over time. These findings indicate that the hepatic acute phase response perseveres for a longer time period than previously thought [5, 6].