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This study evaluates the predictive power of the blood alcohol concentration (BAC) and non-invasive liver fibrosis scores and their applicability in burn patients. A retrospective analysis was conducted on patients admitted to a high-volume supraregional burn center in Northern Germany between 2007 and 2024. Patients were categorized based on their BAC at admission: low (&lt;\u2009100\u00a0mg\/dL) vs. high (\u2265\u2009100\u00a0mg\/dL). Data collected included demographics, comorbidities, and outcomes. Non-invasive liver fibrosis markers such as the Fibrosis-4 (FIB-4) score, aspartate transaminase-to-platelet ratio index (APRI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score were applied to both groups. Among 121 large-surface burn patients (mean total body surface area: 16.4%), no significant differences were observed between BAC groups in demographics, comorbidities, or ICU admission rates. The serum ethanol concentration showed no significant predictive value for mortality (AUC\u2009=\u20090.515). In contrast, the FIB-4 score (AUC\u2009=\u20090.781) and APRI (AUC\u2009=\u20090.736) demonstrated strong prognostic accuracy. In multivariate analysis, the Abbreviated Burn Severity Index (OR\u2009=\u20092.42; <jats:italic>p<\/jats:italic>\u2009=\u20090.001), serum albumin (OR\u2009=\u20090.29; <jats:italic>p<\/jats:italic>\u2009=\u20090.016), and FIB-4 score (OR\u2009=\u20091.50; <jats:italic>p<\/jats:italic>\u2009=\u20090.033) emerged as independent predictors of mortality. Propensity score matching analysis confirmed that BAC was not associated with increased mortality after adjustment for burn depth and extent. Non-invasive liver fibrosis markers, such as FIB-4 score, provide valuable prognostic insights in burn patients, independent of acute alcohol intoxication and should be considered a routine screening tool for large surface burn patients. Incorporating chronic liver dysfunction into existing burn severity models may enhance risk stratification and outcome prediction.<\/jats:p>","DOI":"10.1038\/s41598-025-07499-0","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T08:12:09Z","timestamp":1750839129000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic liver injury scores are superior prognostic indicators of outcomes in severe alcohol-related burns"],"prefix":"10.1038","volume":"15","author":[{"given":"Martynas","family":"Tamulevicius","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadjib","family":"Dastagir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Dastagir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"Vogt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Bucher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"unstructured":"World Health Organization (WHO). https:\/\/www.who.int\/news\/item\/25-06-2024-over-3-million-annual-deaths-due-to-alcohol-and-drug-use-majority-among-men (online article). 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