Histopathological Changes in Lungs, Liver, Kidneys, and Spleen in Thermal Burn Deaths in Relation to Total Body Surface Area and Survival Duration (≤72 hours): An Autopsy-Based 1-Year Cross-Sectional Study in Prayagraj, UP.

Thermal burns remain a major cause of preventable mortality and produce progressive microscopic changes in vital organs. Correlating these alterations with the extent of burns and post-injury survival duration may improve the interpretation of burn deaths in forensic autopsies.

To assess histopathological changes in lungs, liver, kidneys and spleen in fatal thermal burn cases and correlate these findings with total body surface area (TBSA) involvement and post-burn survival duration.

This cross-sectional study was conducted on 84 medicolegal autopsy cases that died within 72 hours of sustaining thermal burns. Sections from lungs, liver, spleen and kidneys were examined using routine histopathology. TBSA was categorized into 0–30%, 31–60%, 61–90% and >90%. Survival duration was grouped as up to 24 hours, 24–48 hours and 48–72 hours. Demographic variables (age and gender) and available clinical/investigative information were noted.

Most victims were females (83.3%) and belonged to the 21–40-year age group. The most pronounced histopathological alterations occurred in cases with 61–90% TBSA. In the lungs, alveolar congestion and edema predominated in deaths within 24 hours, whereas alveolar fibrin strands and widened septa were frequently observed after 48 hours. In the liver, hepatocytic congestion and portal inflammation were common in early deaths, progressing to focal hemorrhage and infarction/necrosis in prolonged-survival cases. Marked splenic congestion and hemorrhage were observed in early deaths, while infarction and follicular hyperplasia became more evident with increasing survival time. Renal changes shifted from interstitial edema and vascular congestion in early deaths to acute tubular necrosis and tubular/glomerular degeneration after 48 hours.

Thermal burns produce characteristic, time-dependent and TBSA-dependent histopathological changes in visceral organs. Severe burns (61–90% TBSA) and prolonged survival (48–72 hours) are associated with maximal tissue damage. These findings support the forensic interpretation of burn deaths and may assist in distinguishing antemortem burn responses during autopsy.