OTA 2006 Posters

Scientific Poster #1 Polytrauma

Influence of Gender on the Inflammatory Response and Outcome after Multiple Trauma
Frank Hildebrand, MD1 (n); Hans-Christoph Pape, MD2 (n); Christian Krettek, MD1 (n); Irshad Chaudry PhD3 (n);
1Trauma Department, Hannover Medical School, Germany;
2Department of Traumatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
3Center of Surgical Research, University of Alabama at Birmingham, Alabama, USA

Introduction: A gender-specific influence on the clinical course after elective surgery and systemic inflammation in patients and a gender-specific host response to experimental trauma hemorrhage have been demonstrated in numerous studies. However, the impact of gender on plasma cytokine concentrations and the incidence of clinical complications (sepsis, multiple organ distress syndrome [MODS]) in multiple trauma patients remain unclear.

Patients and Methods: In this retrospective study, data from multiple trauma patients submitted to the Trauma Department of Hannover Medical School between January 2001 and May 2004 were analyzed. Inclusion criteria included: age 16-65 years; ISS 16, survival 48 after trauma; and continuous determination of plasma concentrations of TNF-±, IL-1, IL-6, IL-8, and IL-10 during ICU stay. Patients were divided into groups according to gender and age (50 vs. >50 years) and injury severity (ISS 25 vs. >25). Statistics: ANOVA, Student t test, rank-sum-test. Values were considered significant at P<0.05.

Results: Demographic data, injury distribution, and injury severity were not significantly different between male and female patients. In male patients with an age 50 years and an ISS >25, a significantly higher incidence of MODS (35.1% vs. 7.1% in females) as well as sepsis (56.8% vs. 21.4%) were observed after multiple trauma. Furthermore, these male patients had significantly increased plasma concentrations of proinflammatory cytokines in the initial posttrauma period (IL-6 days 1-4; IL-8 days 1-2), as well as significantly higher systemic concentrations of the anti-inflammatory IL-10 (days 2-3 and 8-10) compared to female patients of comparable age and ISS. In patients with an age >50 years, no gender-specific differences were found for the incidence of posttraumatic complications and plasma concentrations of cytokines.

Discussion: Female patients before menopause appear to have a significantly reduced risk for the development of posttraumatic complications (sepsis und MODS) compared to male patients. A possible explanation for these findings might be differences of the hormonal milieu between males and females, which might be associated with a modulation of the posttraumatic inflammatory response. In future prospective studies, we hope to examine whether the interaction between the endocrine system and the immune response might be a therapeutic option for multiple trauma patients. However, other factors such as genetic predisposition may also influence the immune reactivity after multiple trauma.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.