The Role of Biological Sex in Severely Traumatized Patients on Outcomes

Trentzsch, Heiko; Lefering, Rolf; Nienaber, Ulrike; Kraft, Robert A.; Faist, Eugen; Piltz, Stefan

doi:10.1097/sla.0000000000000789

Cited by 41 publications

(51 citation statements)

References 52 publications

(139 reference statements)

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“…This more florid organ failure response by severely injured males is similar to previous findings as described by Sperry and others. (2, 5) While overall nosocomial infection rates were not different, ventilator associated pneumonia rates were significantly higher in males as opposed to females, which also has been shown in previous reports. (21-23) Additionally, our model interaction analysis suggested that male gender may confer greater risk of 28-day mortality, but not prolonged organ dysfunction, in patients receiving massive transfusion amounts of blood products in the first 12 hours.…”

Section: Discussionsupporting

confidence: 81%

“…Within these studies, there have been many reports of improved clinical outcomes for females as compared to males after severe traumatic injury. (1-5) However, published data remains conflicting on the magnitude and significance of these differences. (6-9) Results from varying animal models suggest that estrogen and testosterone influence the physiologic, immunologic and organ system responses to traumatic injury.…”

Section: Introductionmentioning

confidence: 99%

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Sex-based differences in the genomic response, innate immunity, organ dysfunction, and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock

Lopez

Efron

Ozrazgat‐Baslanti

et al. 2016

Journal of Trauma and Acute Care Surgery

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Introduction The effect of gender on post-traumatic pathophysiology and outcomes after severe traumatic injury remains debated. We sought to determine the relationship of gender to the genomic and inflammatory responses, and clinical outcomes after hemorrhagic shock. Methods We analyzed blunt trauma patients in hemorrhagic shock from a prospective, multi-institutional cohort study to assess for gender based differences in the genomic response and clinical outcomes. Serially drawn blood samples were analyzed to evaluate peripheral leukocyte genome-wide expression and circulating inflammatory mediators at intervals between 0.5 and 28 days after injury. Multivariate logistic regression models were developed to assess the effect of gender on outcomes after controlling for age, injury and shock severity, blood transfusion, and comorbidities. Results The cohort consisted of 1,285 (67%) male and 643 (33%) female blunt trauma patients. Injury and shock severity were similar between the two groups. There were small but statistically significant differences between males and females regarding their age, BMI, and 12 hour blood and crystalloid administration. Organ failure was more severe in males, with slower recovery (9.0 vs. 6.5 days) in males compared to females (p<0.01). However, there were no differences between males and females in plasma levels of IL-6, IL-8, IL-10, IL-1β, TNF-α and MCP-1. Multivariate analysis revealed that gender was not a significant independent risk factor for complicated recovery or 28-day mortality. Transcriptomic analysis revealed 333 genes with significant differential expression patterns between males and females (FDR<0.001), including genes associated with general inflammation, innate immunity, cell adhesion and cell signaling. None of the former genes were directly associated with sex hormones or X/Y chromosomes. Conclusion There are gender-specific differences in the leukocyte genomic response to severe injury that are associated with more robust and longer duration organ dysfunction. However, these expression patterns do not appear to be associated with sex-linked genes or circulating cytokine level differences, and do not translate to worsened gender-specific organ failure outcomes or inpatient mortality.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Sex-based differences in the genomic response, innate immunity, organ dysfunction, and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock

Lopez

Efron

Ozrazgat‐Baslanti

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…They have also been hypothesized to tolerate shock to a greater extent and have a lower susceptibility to sepsis [55]. Seven studies in the systematic review independently identified males as having statistically elevated rates of mortality after spine surgery and similar results are apparent in other disciplines such as trauma surgery [56]. These facts, combined with the reduced between-study heterogeneity and absence of publication bias for the works included in our analysis, lend further support to our findings.…”

Section: Discussionsupporting

confidence: 75%

“…The pooled OR estimate in the meta-analysis maintained a 63% increase in postoperative odds of death for males compared with females. This may be reflective of underlying physiologic differences between the sexes as well as variation in the number and severity of medical comorbidities [45,46,56,58]. Females are known to have lower rates of coronary artery disease, peripheral vascular disease, and renal dysfunction [58].…”

Section: Discussionmentioning

confidence: 99%

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Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Schoenfeld

Reamer

Wynkoop

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue. Questions/purposes We performed a systematic review to address two questions: (1) Does sex (male versus female) influence mortality after spine surgery? (2) Does sex impact the development of postoperative complications after spine surgery?Methods This systematic review was performed through a query of PubMed using a structured search algorithm. Additional queries of Embase, SCOPUS, Web of Science, and the tables of contents of orthopaedic and neurosurgical journals were also conducted using search terms such as ''sex factors'', ''male or female'', ''risk factors'', and ''spine surgery''. Selected papers were independently abstracted by three of the authors (AJS, ENR, EIW) and pooling was performed. Our literature search returned 720 studies, of which 99 underwent full review. Of these, 50 were selected for final abstraction. The Cochrane Q test was used to assess study heterogeneity; significant study heterogeneity was present and so a random-effects model was used. A Harbord test was used to evaluate for the presence of publication bias; this analysis found no statistically significant evidence of publication bias. Results Males were at increased odds of mortality after spine surgery (odds ratio [OR], 1.63; 95% confidence interval [CI], p \ 0.001). No differences between the sexes were identified for the odds of complications (OR, 1.04; 95% CI, 0.95-1.13; p = 0.42). Conclusions Our results determined that males were at elevated odds of mortality but not of complications after spine surgery. These results should be used to inform preoperative discussion and decision-making at the time of surgical consent. Future work should be directed at determining the underlying factors responsible for increased

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Sex dimorphisms in coagulation: Implications in trauma‐induced coagulopathy and trauma resuscitation

Coleman,

Gumina,

Hund

et al. 2024

American J Hematol

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Trauma‐induced coagulopathy (TIC) is one of the leading causes of preventable death in injured patients. Consequently, it is imperative to understand the mechanisms underlying TIC and how to mitigate this mortality. An opportunity for advancement stems from the awareness that coagulation demonstrates a strong sex‐dependent effect. Females exhibit a relative hypercoagulability compared to males, which persists after injury and confers improved outcomes. The mechanisms underlying sex dimorphisms in coagulation and its protective effect after injury have yet to be elucidated. This review explores sex dimorphisms in enzymatic hemostasis, fibrinogen, platelets, and fibrinolysis, with implications for resuscitation of patients with TIC.

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The Role of Biological Sex in Severely Traumatized Patients on Outcomes

Cited by 41 publications

References 52 publications

Sex-based differences in the genomic response, innate immunity, organ dysfunction, and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock

Sex-based differences in the genomic response, innate immunity, organ dysfunction, and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock

Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Sex dimorphisms in coagulation: Implications in trauma‐induced coagulopathy and trauma resuscitation

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