Fatty Infiltration of the Liver in Severely Burned Pediatric Patients: Autopsy Findings and Clinical Implications

BACKGROUND: Trauma induces hypermetabolic responses that are characterized by the mobilization of all available substrates. The marked increase of peripheral lipolysis after a burn can lead to the development of fatty liver, which has been associated with immunodepression and increased mortality. METHODS: All autopsies of pediatric burn patients between January 1988 and January 1998 were reviewed. Patient demographics, hospital course, cause of death, and hepatic and septic macroscopic and microscopic findings were recorded. RESULTS: Thirty-seven pediatric patients (4 +/- 1 years old) were included in the study. The mean burn size was 69% +/- 5% total body surface area burned. Eighty percent of the patients presented with fatty infiltration of the liver. Liver weight/body weight ratio was 77 +/- 5 gm/kg, representing 2.1 times the liver weight of age- and sex-matched controls (p < 0.001). Patients with severe fatty infiltration of the liver had a higher incidence of sepsis (p < 0.001). CONCLUSION: Fatty infiltration of the liver is a common condition in fatal burns. Severe fatty infiltration of the liver is associated with an increased incidence of sepsis, although a causative effect could not be found. It is notable that fatty infiltration of the liver occurred in the complete absence of parenteral nutrition.