Detection of Liver Dysfunction in Severe Burn Injury with Bedside Measurement of Perfusion

TL;DR

This study explores using a bedside test to detect liver dysfunction in severe burn patients earlier than traditional methods, which could improve treatment and outcomes.

Contribution

The study introduces a dynamic bedside method (LiMON®) for early detection of liver dysfunction in severe burn patients.

Findings

LiMON® detected liver dysfunction earlier than static lab tests in 67% of patients.

Four liver function patterns were identified based on PDR progression, linked to treatment differences.

PDR correlated well with aminotransferase levels, suggesting its reliability as a marker.

Abstract

Background and Objectives: Severe burn injuries are still associated with high mortality. The length of intensive care stay is strongly influenced by the severity of organ failure, with multi-organ failure being the main cause of death in up to 40% of cases. Liver dysfunction is the second most common organ failure. Conventional diagnosis relies on static laboratory parameters that reflect damage already caused. Measuring the hepatic clearance of indocyanine green (LiMON®) offers a dynamic, bedside method for detecting liver dysfunction early, enabling timely therapy adjustments. Materials and Methods: In this prospective single-centre observational study, all patients admitted to the Unfallkrankenhaus Berlin Burns Centre from October 2022 to September 2024 with ≥30% TBSA burns were included. Liver function was assessed via LiMON® within 24 h post-injury and every 48 h until day 14 or ICU discharge. Static liver parameters were measured in parallel. Results: We included a total of 23 patients. An initial measurement was only successful in 18 cases. On admission, six patients (33%) had normal liver function with a plasma duration rate (PDR) > 18% (PDR 30.9 ± 7.3%), while 12 (67%) showed reduced clearance (PDR 14.5 ± 2.6%). In 75% of cases (n = 9), function recovered within 48 h. Based on PDR progression, four liver function patterns were defined: “stable”, “recovery”, “late insufficiency”, and “failure”; a fifth pattern included all patients who were deceased during this study (“death”). These groups differed in fluid therapy, plasma transfusion, and catecholamines administered. PDR correlated well with aminotransferase levels. Conclusions: Dynamic liver function monitoring enables earlier detection of impairment than static markers. Early identification of at-risk patients could guide fluid management and improve outcomes. LiMON® is a valuable tool in burn care, though alternative methods may be needed in patients with severe systemic hypoperfusion.

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