Contributing factors and outcomes of burn-associated cholestasis

Abstract Background The effect of cholestasis in patients with severe burn injuries is unknown. Methods We investigated the relation between burn-associated cholestasis (BAC) and clinical outcomes in a retrospective cohort of patients admitted to our unit for severe burn injuries between 2012 and 2015. BAC was defined as an increased level of serum alkaline phosphatase (ALP) ≥ 1.5 times the upper limit of normal (ULN) with an increased level of γ-glutamyl-transpeptidase (γGT) ≥ 3 ULN or as an increased level of total bilirubin ≥ 2 ULN. Results A total of 214 patients were included: 111 (52%) patients developed BAC after a median (IQR) stay of 9 (5-16) days. At ninety-days, mortality rate was 20%, including 34 and 9 patients with and without BAC (p Conclusion BAC is prevalent among patients with severe burn injuries and is associated with short-term outcomes, especially when total bilirubin levels were increased without elevated ALP and γGT levels. BAC survivors are at risk of developing sclerosing cholangitis. Lay summary Cholestasis is common after burn injuries and is associated with burn severity, sepsis, organ failure and mortality. Patients with hyperbilirubinemia without elevated ALP and γGT levels after the burn injury have a poor prognosis. Patients with burn-associated cholestasis may develop sclerosing cholangitis and secondary biliary cirrhosis.