Trauma is a major cause of death and disability throughout the world. It is a leading cause of death with or without sepsis in about 50% of patients. Limited therapeutic options are available besides definitive care with a mortality benefit. Preclinical studies have demonstrated the mortality benefit of estrogen in trauma hemorrhagic shock (THS). Based on encouraging results from preclinical studies, we hypothesized that early administration of estrogen in male THS patients may reduce the inflammatory storm, prevent sepsis-associated problems, and subsequently reduce mortality. The authors studied the safety of early administration of estrogen as a therapeutic adjunct in the emergency department (ED) and its effects on the inflammatory storm, prevention of sepsis, and mortality during the intensive care unit stay. Forty THS patients were recruited. THS patients were divided into experimental and placebo control groups based on the estrogen administration in the ED. Serum levels of cytokines and immune cells were measured at different time points on days 0, 3, 7, and 14 in both groups of THS patients. The experimental group received intravenous estrogen (25 mg) at a single time point in the ED beside standard of care as per advanced trauma life support guidelines. Patients did not develop any major or minor adverse events and showed favorable clinical outcomes in the experimental group. The levels of T regulatory cells, monocytes, and systemic cytokines significantly reduced and showed a balanced inflammatory response in THS patients who received estrogen. In conclusion, this preliminary study showed that intravenous estrogen therapy is safe and reduced the inflammatory insult due to trauma hemorrhagic shock. It may protect THS patients from sepsis-associated complications. Future clinical trials are required to study the efficacy and mechanistic pathway.

Trauma is a major cause of morbidity and mortality throughout the world. Alarmingly the mortality rate, owing to multiple causes with or without sepsis, is now reported to cross the value of 50%. The preliminary study was conducted in humans to investigate the 1) safety of estrogen therapy following trauma hemorrhage 2) Does estrogen reduced the inflammatory storms caused due to trauma 3) Does estrogen affects the survival of THS patients and prevent the advancement of sepsis-associated problems. 40, THS patients and 20 healthy controls were recruited. THS patients were divided into experimental groups and placebo controls based on the estrogen administration in the ED. Serum level of cytokines and immune cells were measured at different time points on days 0, 3, 7, and 14 in both groups of THS patients. Patients receiving intravenous estrogen beside standard of care as per ATLS guidelines did not develop any major or minor adverse events and showed favorable clinical outcomes during their course of stay in the ED and ICU. The levels of T regulatory cells, monocytes, and systemic cytokines were significantly reduced in THS patients who received estrogen. Again, THS patients who received estrogen recovered early, do not have side effects and showed a balanced inflammatory response. In conclusion, this preliminary study showed that intravenous estrogen therapy is safe and overcame the problem of inflammatory insults caused due to trauma hemorrhagic shock. It may protect from sepsis-associated complications among THS patients.