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] greater than or equal to 9 points) were studied. Males (n = 911) did not differ from females fn = 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 greater than or equal to 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. Conclusion: Sex influences posttraumatic morbidity in severely injured patients and supports the concept that females are immunologically better positioned toward a septic challenge.