Chronic liver injury scores are superior prognostic indicators of outcomes in severe alcohol-related burns

TL;DR

Chronic liver injury scores, not blood alcohol levels, better predict outcomes in severe burn patients with alcohol-related injuries.

Contribution

Non-invasive liver fibrosis scores are shown to be superior to blood alcohol concentration in predicting mortality in burn patients.

Findings

FIB-4 and APRI scores showed strong prognostic accuracy (AUC 0.781 and 0.736, respectively).

FIB-4 score was an independent predictor of mortality in multivariate analysis.

Blood alcohol concentration had no significant predictive value for mortality.

Abstract

Acute and chronic alcohol abuse are common among burn patients and may be associated with chronic liver injury, a potential factor influencing outcomes. This study evaluates the predictive power of the blood alcohol concentration (BAC) and non-invasive liver fibrosis scores and their applicability in burn patients. A retrospective analysis was conducted on patients admitted to a high-volume supraregional burn center in Northern Germany between 2007 and 2024. Patients were categorized based on their BAC at admission: low (< 100 mg/dL) vs. high (≥ 100 mg/dL). Data collected included demographics, comorbidities, and outcomes. Non-invasive liver fibrosis markers such as the Fibrosis-4 (FIB-4) score, aspartate transaminase-to-platelet ratio index (APRI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score were applied to both groups. Among 121 large-surface burn patients (mean total body surface area: 16.4%), no significant differences were observed between BAC groups in demographics, comorbidities, or ICU admission rates. The serum ethanol concentration showed no significant predictive value for mortality (AUC = 0.515). In contrast, the FIB-4 score (AUC = 0.781) and APRI (AUC = 0.736) demonstrated strong prognostic accuracy. In multivariate analysis, the Abbreviated Burn Severity Index (OR = 2.42; p = 0.001), serum albumin (OR = 0.29; p = 0.016), and FIB-4 score (OR = 1.50; p = 0.033) emerged as independent predictors of mortality. Propensity score matching analysis confirmed that BAC was not associated with increased mortality after adjustment for burn depth and extent. Non-invasive liver fibrosis markers, such as FIB-4 score, provide valuable prognostic insights in burn patients, independent of acute alcohol intoxication and should be considered a routine screening tool for large surface burn patients. Incorporating chronic liver dysfunction into existing burn severity models may enhance risk stratification and outcome prediction.

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