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The relative importance of dysfunction or failure of different organ systems to recovery from critical illness is unclear. The purpose of this study was to evaluate the contribution of hepatic dysfunction to outcome after injury.We retrospectively evaluated patients admitted to our trauma center from 1994 to 1998 for the development of hepatic dysfunction, defined as serum bilirubin ≥ 2.0 mg/dL. Additional variables on patient demographics, injuries, hospital course, and development of other organ system dysfunction were collected from the trauma registry and hospital records.Using logistic regression analysis, hepatic dysfunction was significantly associated with increased intensive care unit length of stay (LOS) and death. The added development of hepatic dysfunction significantly increased LOS in patients with no other organ dysfunction, those with renal dysfunction, and those with respiratory dysfunction.Hepatic dysfunction influences recovery after injury independent of the dysfunction of other organ systems. The development of hepatic dysfunction prolongs LOS and increases mortality.