Hepatocellular Damage Following Burn Injury
Demonstrated by a More Sensitive Marker:
Alpha-Glutathione S-Transferase
Gurkan Ozturk, MD,* Nurinnisa Ozturk, MD,† Hulya Aksoy, MD,†
Mufide Nuran Akcay, MD,* S. Selcuk Atamanalp, MD,* Hamit Acemoglu‡
Following burn injury, some complex reactions are initiated that are mainly managed by the
liver and that can cause injury at the liver. Alpha glutathione S-transferase (-GST) is a sen-
sitive marker that is very sensitive in the monitoring of hepatocellular damage. We tried, in
this study, to demonstrate liver injury in burn patients using -GST. Forty-four patients
with burn injury treated at the Burn Treatment and Care unit of the Atatu¨rk University
Medical School between July 2006 and July 2007 were included in the study. Patient data
were collected. Three blood samples were taken from the patients (at admittance first sam-
ple, 120 hours after admittance second sample, and on the fourteenth day third sample)
for the analysis of -GST, alanine amino transferase, aspartate amino transferase activities,
and albumin and c-reactive protein levels. There was a statistically significant difference be-
tween -GST activities of the study group at admission (P < .001), on the fifth day (P <
.001), and the 14th day (P < .001) and those of the control group. There was a decrease in
-GST activities during the hospitalization period. Alanine amino transferase and aspartate
amino transferase activities in all three samples of the study group were not different from
each other and from the values obtained from the control group. The albumin levels of the
study group were significantly different from those of the control group. The c-reactive protein
levels of the study group were different from those of the control group at admission, on the
fifth day, and fourteenth day (P < .001, P < .001, and P < .01). Our findings suggest that
burn injury causes liver injury, and -GST can be used to demonstrate this. (J Burn Care Res
2009;30:711–716)
The liver has been extensively investigated because
of its important role in metabolism, homeostasis,
and host defense systems after burn injury.
1
After
burn injury, some complex reactions are initiated to
overcome the insult and maintain the equilibrium,
which are known as inflammation.
2
Not only the
inflammatory reactions but also the immune func-
tions and the acute-phase response are modulated
by the liver.
3
Recent studies suggest that a severe
burn can change liver morphology in rats and de-
crease concentrations of proteins and DNA.
1
De-
spite its important role, the liver itself is damaged
after burn injury.
3
The exact mechanism of liver
damage during burn injury is not known, but the
association of oxidative stress in the liver of rats
with the original burn wound is shown. It is also
suggested that immediately after burn, the damage
of the liver may be associated with increased he-
patic edema formation.
3
Alpha glutathione S-transferase (-GST) is a new
marker that is sensitive in the monitoring of hepato-
cellular damage.
4
This intracellular enzyme is a mem-
ber of phase II detoxification enzymes and has an
important role in the detoxification of endogenous
and exogenous toxic compounds. The -GST is sen-
sitive because it is found in large amounts in the liver
cell cytoplasm, and because of its low molecular
weight, it passes freely through membranes and is
easily released to the circulation in case of cell dam-
From the Departments of *General Surgery, †Biochemistry, and
‡Medical Education, School of Medicine, Atatu¨rk University,
Erzurum, Turkey.
Presented as poster abstract at the National Surgery Congress 2008,
May 28 –31, Antalya, Turkey.
Address correspondence to Gurkan Ozturk, MD, Department of
General Surgery, Medical Faculty, Atatu¨rk University, 25240
Erzurum, Turkey.
Copyright © 2009 by the American Burn Association.
1559-047X/2009
DOI: 10.1097/BCR.0b013e3181abfd65
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