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Gender Not a Predictor of Survival from Severe Injury

Study Reports at the Society of Critical Care Medicine's 32nd Critical Care Congress

(San Antonio, TX, January 30, 2003) - Despite previous research to the contrary, men and women have equal probability of surviving severe injury, according to a study released today at the 32nd Critical Care Congress of the Society of Critical Care Medicine.

"Our findings of a gender-neutral survival rate for severely injured trauma patients was a little surprising in light of earlier animal and clinical studies," says Amber A. Guth, MD, associate professor of surgery at New York University School of Medicine in New York City.

"We found that the most severely injured patients had the same survival rates regardless of gender; however, the women were more resistant to infection, tolerated shock better, had fewer episodes of multiple organ failure and had a much shorter hospital stay than the men," Dr. Guth explains.

Dr. Guth, lead author of the NYU School of Medicine study, "Post-traumatic Sepsis and Mortality: Does Gender Really Matter? An ICU-based Analysis," presented the findings today at Congress at the Henry B. Gonzalez Convention Center in San Antonio, TX.

Sepsis and multiple organ dysfunction syndromes are the main causes of death in the intensive care unit. Animal trials and experimental studies have identified gender as a prognostic indicator and have shown gender differences in immunological and hormonal responses to trauma; however, the clinical data have been inconclusive.

For this study, the researchers reviewed the trauma registry/surgical intensive care unit databank at Bellevue Hospital Center in New York City. Over a five-year period, they found 80 severely injured trauma patients who survived more than 24 hours and who met other criteria.

The researchers found that despite women having a trend toward a lower incidence of severe sepsis, systemic inflammatory response syndrome and multi-organ dysfunction syndrome, there was no difference in mortality. However, women had significantly shorter hospital stays than men-35 days for men vs. 15.4 days for women.

"The results of our study require further investigation into gender-specific therapies for critical care. We need to study the differences between men and women in hormonal and endocrine responses to severe injury on a much larger scale," comments Dr. Guth.

Dr. Guth recommends measuring testosterone and estrogen levels in injured patients as well as measuring cytokine levels. Estrogen is thought to promote protective immune responses while testosterone may depress cellular and organ function after trauma or hemorrhage. Additionally, low testosterone levels, a possible reaction to trauma, may slow recovery from multi-organ dysfunction.

Previous animal studies found that after injury, the females had a much more favorable cytokine profile than the males. Cytokines trigger inflammation and respond to infections.

This research offers a challenge for the critical care specialists who care for the severely injured. "The difference between the male and female response to severe injury brings up research questions for research and about therapy modalities," concludes Dr. Guth.

The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With over 10,000 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multidisciplinary, multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory care practitioners and other professionals with an interest in critical care, which may include physician assistants, social workers, dieticians, and members of the clergy.

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