Although salutary effects of female sex
steroids have been demonstrated not only in proestrus females but also in male animals treated with
estradiol in different models of
trauma, it remains unknown whether
sex hormones influence post-traumatic immune response in humans. We therefore investigated the effect of sex and age on organ dysfunction and
clinical course in patients with
multiple injuries. Polytraumatized patients (injury severity score>16) between 16 and 65 years old admitted to the Hannover Medical School Level 1 trauma center between January 1997 and December 2001 were included. Marshall Score for
multiple organ dysfunction syndrome (
MODS) was calculated for at least 14 days. The
length of stay in intensive care unit and the
ventilator days were recorded in addition to the number of transfusions the patient received. A total of 106 males and 37 females were included in the study. Patients with
MODS had increased plasma levels of
IL-6,
IL-8, and
IL-10. Furthermore, patients with organ dysfunction had more frequent
sepsis and higher mortality rates. In addition,
MODS was associated with extended
length of stay in the intensive care unit and increased
ventilator days. Females not older than 50 years with an injury severity score greater than 25 suffered significantly less
MODS and
sepsis compared with age-matched males. Moreover, they had significantly lower plasma
cytokines. Thus, in this prospective study, sex difference was confirmed in
MODS and
sepsis, with a benefit observed in females. Although the levels of sex
steroids were not measured, it seems that the protective effects may be due to
estrogen effects on plasma
cytokines. This suggestion is based on the fact that such salutary effects were apparent predominantly in premenopausal females.