The Hepatic Response to Thermal Injury: Is the Liver Important for Postburn Outcomes?

Abstract

Thermal injury produces a profound hypermetabolic and hypercatabolic stress response characterized by increased endogenous glucose production via gluconeogenesis and glycogenolysis, lipolysis, and proteolysis. The liver is the central body organ involved in these metabolic responses. It is suggested that the liver, with its metabolic, inflammatory, immune, and acute phase functions, plays a pivotal role in patient survival and recovery by modulating multiple pathways following thermal injury. Studies have evaluated the role and function of the liver during the postburn response and showed that liver integrity and function are essential for survival, and that hepatic acute phase proteins are strong predictors for postburn survival. This review discusses these studies and delineates the pivotal role of the liver in patients following severe thermal injury.

Up-regulation of tim-3 expression contributes to development of burn-induced T cell immune suppression in mice

“…1). These findings reconfirmed both liver and spleen are the primary target organs in host immune deficit after burn injury [20,29] .…”

“…The prominent character of post-burn T cell suppression is the depletion of T cells. Moreover, cumulative findings suggested that the liver with its immune, inflammatory and acute phase functions plays a pivotal role in survival and recovery of patients following burn injury [29,30] . Therefore, we confirmed the depletion of HMNCs as well as SMNCs after burn injury (data not shown).…”

Cellular and Molecular Cascades during Liver Regeneration

“…58,59 Investigating the pro-regenerative aspects of the cell types discussed above may assist in enhancing the recovery and survival of patients' post-hepatectomy and possibly after trauma, such as a severe burn. 60 Thus, despite the divergence, the compensatory response after liver resection is clinically essential and provides a great model to learn about growth and regeneration. A better understanding of how cells in the liver interact and respond to their microenvironment will give us the ability to pinpoint aberrant healing and develop novel therapies to treat liver disease.…”

Antifungal Pharmacokinetics and Dosing Considerations in Burn Patients

“…Blood flow is increased to both the liver and kidneys because of enhanced cardiac output. In the liver, the synthesis of constitutive proteins (eg, albumin and transferrin) is geared towards acute phase protein synthesis (eg, α 1 -acid glycoprotein and fibrinogen) to maintain immune function, wound healing, and coagulation processes [12]. These changes lead to alterations in the protein binding of drugs, especially highly protein-bound, acidic drugs.…”