Incidence of septic complications and multiple organ failure in severely injured patients is sex specific

Background: Sexual hormones are potent regulators of various immune functio ns. Although androgens are immunosuppressive, estrogens protect against sep tic challenges in animal models. This study correlates sexual dimorphism wi th the incidence of posttraumatic complications in severely injured patient s. Methods: From January of 1991 to February of 1996, 1,276 consecutive injure d 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 re gard to severity of injury (ISS) and injury pattern. Results: The incidence of posttraumatic sepsis (30.7%) and multiple organ d ysfunction syndrome (29.6%) was significantly increased in severely injured males with ISS greater than or equal to 25 points in comparison to the equ ivalent group of females (sepsis, 17.0%; multiple organ dysfunction syndrom e, 16.0%). No difference was found in patients with ISS < 25 points. Moreov er, plasma levels of procalcitonin and interleukin-6 were elevated (p < 0.0 5) in severely injured males compared with females. Conclusion: Sex influences posttraumatic morbidity in severely injured pati ents and supports the concept that females are immunologically better posit ioned toward a septic challenge.