TOPLINE:

In patients admitted to the burn ICU, cholestasis was common, and the development of burn‑associated cholestasis (BAC) type B or C, characterised mainly by high bilirubin levels, was associated with increased risks for in‑hospital and overall mortality after 2 weeks.

METHODOLOGY:

• Researchers conducted a retrospective cohort study in an Austrian hospital to determine the frequency of cholestasis after a burn injury, describe its clinical course, and validate published criteria for BAC.
• They analysed data of 532 adult patients admitted to the burn ICU (median age, 49 years; 65.8% men) between January 2013 and December 2022; burns involving 20% or more of the total body surface area were considered severe (n = 234).
• BAC was categorised as BAC-A (alkaline phosphatase [ALP] level 1.5 times or more of 130 U/L in men or 105 U/L in women and gamma-glutamyltransferase [GGT] level three times or more of 60 U/L in men or 40 U/L in women, without hyperbilirubinemia), BAC-B (elevated levels of ALP and GGT with total bilirubin level two times or more of 1.2 mg/dL), and BAC-C (hyperbilirubinemia without elevated levels of ALP and GGT).
• The primary outcome was in-hospital mortality, and the secondary outcome was overall mortality.

TAKEAWAY:

• In-hospital mortality occurred in 19% of patients after a median of 17 days, and overall mortality occurred in 23% during a median follow-up duration of 5 years. The rate of 90-day mortality was higher in patients with severe vs non-severe burns (30.4% vs 6.4%).
• The incidence of BAC was also higher in patients with severe burns than in those with non-severe burns (36.3% vs 11.1%; P < .001).
• By day 14, patients who developed BAC type B or C had a higher risk for in‑hospital mortality (hazard ratio [HR], 3.52; P < .001) and overall mortality (HR, 11.47; P < .001), corresponding to a 90‑day survival rate of 46% vs 95% for those who did not.
• The Abbreviated Burn Severity Index score at ICU admission, the use of ketamine, mechanical ventilation, and parenteral nutrition were independently associated with an increased risk for BAC.

IN PRACTICE:

"Although simple criteria for clinical routine should be encouraged, we show that cholestasis in burn patients is highly dynamic. Here, trajectories of cholestasis parameters, especially bilirubin, seem to provide early prognostic information and should be further exploited," the authors of the study wrote.

SOURCE:

This study was led by Lorenz Semmler, Medical University of Vienna, Vienna, Austria. It was published online on January 14, 2026, in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

The study was retrospective in nature, and limitations regarding standardised documentation and potential loss of information may have occurred. Treatment was not standardised, and the availability of laboratory parameters depended on the length of hospital stay. Data on preexisting liver disease were limited to patient records and self-report, likely underestimating the actual prevalence.

DISCLOSURES:

This study did not report any specific funding. One author reported receiving travel support from Amgen. Another author reported receiving grant and travel support, honoraria for consulting, and speaker fees from various companies including Albireo, AbbVie, Novartis, and GSK; he also reported being a co-inventor on patents for the medical use of 24-norursodeoxycholic acid filed by the Medical University of Graz.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.