Incidence of septic complications and multiple organ failure in severely injured patients is sex specific.
BACKGROUND
Sexual hormones are potent regulators of various immune functions. Although androgens are immunosuppressive, estrogens protect against septic challenges in animal models. This study correlates sexual dimorphism with the incidence of posttraumatic complications in severely injured patients.


METHODS
From January of 1991 to February of 1996, 1,276 consecutive injured patients (Injury Severity Score [ISS] > or = 9 points) were studied. Males (n = 911) did not differ from females (n = 365) with regard to severity of injury (ISS) and injury pattern.


RESULTS
The incidence of posttraumatic sepsis (30.7%) and multiple organ dysfunction syndrome (29.6%) was significantly increased in severely injured males with ISS > or = 25 points in comparison to the equivalent group of females (sepsis, 17.0%; multiple organ dysfunction syndrome, 16.0%). No difference was found in patients with ISS < 25 points. Moreover, plasma levels of procalcitonin and interleukin-6 were elevated (p < 0.05) in severely injured males compared with females.


CONCLUSIONS
Sex influences posttraumatic morbidity in severely injured patients and supports the concept that females are immunologically better positioned toward a septic challenge.
Oberholzer
A
A
Division of Trauma Surgery, University Hospital Zurich, Switzerland.
Keel
M
M
Zellweger
R
R
Steckholzer
U
U
Trentz
O
O
Ertel
W
W
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D009017:Morbidity; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology*; D009104:Multiple Trauma / Q000097:blood / Q000150:complications* / Q000276:immunology; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*; D012727:Sex Characteristics; D017678:Sex Distribution; D016019:Survival Analysis
D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide