Gender differences in trauma, shock and sepsis

Abstract

Despite efforts in prevention and intensive care, trauma and subsequent sepsis are still associated with a high mortality rate. Traumatic injury remains the main cause of death in people younger than 45 years and is thus a source of immense social and economic burden. In recent years, the knowledge concerning gender medicine has continuously increased. A number of studies have reported gender dimorphism in terms of response to trauma, shock and sepsis. However, the advantageous outcome following trauma-hemorrhage in females is not due only to sex. Rather, it is due to the prevailing hormonal milieu of the victim. In this respect, various experimental and clinical studies have demonstrated beneficial effects of estrogen for the central nervous system, the cardiopulmonary system, the liver, the kidneys, the immune system, and for the overall survival of the host. Nonetheless, there remains a gap between the bench and the bedside. This is most likely because clinical studies have not accounted for the estrus cycle. This review attempts to provide an overview of the current level of knowledge and highlights the most important organ systems responding to trauma, shock and sepsis. There continues to be a need for clinical studies on the prevailing hormonal milieu following trauma, shock and sepsis.

Differences in Outcomes Based on Sex for Pediatric Patients Undergoing Pyloromyotomy

“…Studies in the trauma literature suggest that males may have worse outcomes in the post-traumatic inflammatory state as their hormonal variations may predispose them to certain responses of the immune system that lead to increased susceptibility to organ damage. [21][22][23][24] As both trauma and surgery can cause a proinflammatory state, our findings of females having worse outcomes was contradictory to this theory. Another possible explanation for this disparity is differences in presentation leading to delays in diagnosis.…”

Who Is Afraid of CRP? Elevated Preoperative CRP Levels Might Attenuate the Increase in Inflammatory Parameters in Response to Lung Cancer Surgery

“…It is conceivable that this also holds true for mechanisms controlling the ATP-induced release of IL-1β. Women have a better outcome after trauma and hemorrhage, a finding that is mainly attributed to protective effects of 17β-estradiol [ 41 ] and immunosuppressive effects of androgens [ 38 ]. In our study, however, the median age of the patients was 66 years and less than 3% of them were younger than 50 years.…”

The PARP inhibitor olaparib exerts beneficial effects in mice subjected to cecal ligature and puncture and in cells subjected to oxidative stress without impairing DNA integrity: A potential opportunity for repurposing a clinically used oncological drug for the experimental therapy of sepsis

“…The outcomes of sepsis are markedly worse in the elderly [1,2]. On the other hand, the female gender (in the pre-menopausal stage) tends to provide some protection against sepsis-associated mortality [3,4]. Despite extensive research and despite a large number of pivotal clinical trials targeting various pathways in immune, inflammatory and coagulation abnormalities in sepsis/septic shock, no specific pharmacological or immunological therapies are approved for the treatment of this condition.…”