High risk but not always lethal: The effect of cirrhosis on thermally injured adults

The aim of this article was to determine the effect of cirrhosis on mortality in thermally injured adult patients. We conducted a retrospective review of patients admitted to our burn center during 2003 to 2010. Eight hundred eight patients were included in this study, of whom 24 had the diagnosis of cirrhosis established from electronic medical records and/or autopsy reports. The mortality rate for the cirrhotic patients was 50%, and for the noncirrhotic patients it was 14.8%. On logistic regression, age (odds ratio [OR], 1.08; confidence interval [CI], 1.06-1.10), TBSA (OR, 1.08; CI, 1.06-1.10), inhalation injury (OR, 3.17, CI, 1.61-6.25), and cirrhosis (OR, 8.78; CI, 2.97-25.98) had independent effects on mortality. Of the 24 cirrhotic patients in this study, the admission Model for End-Stage Liver Disease score for the patients who survived hospitalization was 12.1 ± 4.0, and for the patients who died it was 13.8 ± 6.0 (P = .4). When comparing patients with 10 to 50% TBSA burn, the mortality rate for cirrhotic patients was 83.3% (10/12), and for the noncirrhotic patients it was only 12.7% (50/394), P < .0001. Adults with cirrhosis are rarely able to survive burn injuries > 10% TBSA. Although we did not detect a significant association between admission Model for End-Stage Liver Disease score and death, the presence of cirrhosis is a high premorbid contributor and, therefore, new strategies are needed to improve outcomes.