Female sex protects from organ failure and sepsis after major trauma haemorrhage

Trentzsch, Heiko; Nienaber, Ulrike; Behnke, Martha; Lefering, Rolf; Piltz, Stefan

doi:10.1016/j.injury.2014.08.013

Cited by 69 publications

(83 citation statements)

References 64 publications

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“…[13][14][15] Of interest, gender differences have been described in other clinical settings. 16 The severity of thrombocytopenia was identified as a risk factor for bleeding. This analysis also investigated the burden or duration of severe thrombocytopenia, and patients with a lower platelet count on the previous day had a higher hazard of a grade 2 to 4 bleed.…”

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confidence: 99%

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

et al. 2015

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This study is a further analysis of the TOPPS trial data and assesses patients' baseline characteristics at enrolment, burden of thrombocytopenia, presence of fever and presence of minor hemorrhage as potential risk factors for WHO grade 2 to 4 bleeding. Recurrent event analyses have been used to allow assessment of bleeding over the 30-day trial period and to account for multiple bleeds per patient. MethodsDetails of the UK and Australian TOPPS randomized trial have been published previously .2,8,10 Six hundred patients were randomized to receive either prophylactic platelet transfusions if the platelet count was <10x10 9 /L (n=299), or no prophylaxis (n=301). The trial was approved by independent ethics committees. Although the median number of days with complete data was 30, bleeding data were not complete for all 30 days for all patients. The vast majority of bleeds were inpatient bleeds 8 and, as incomplete records often related to when the patient was at home, no bleeding was assumed on days for which no data were reported.Bleeding types were grouped to describe characteristics of bleeding: skin bruising included petechiae, purpura, and bruising; gastrointestinal bleeding included blood in the stool, melena and hematemesis; mouth bleeding included oral blood blisters and oropharyngeal bleeding; and other included musculoskeletal or deep tissue bleeding, eyes and visual impairment, pleural tap, and cerebral bleeds.For the modeling (Figure 1), patients were grouped by treatment plan [autologous hematopoietic stem cell transplant (HSCT) and chemotherapy (induction and consolidation)/allogeneic HSCT (myeloablative and reduced intensity)] and diagnosis [acute myeloid leukemia (AML), myeloma, lymphoma and other diagnoses]. In contrast to the TOPPS analysis, only the first day of consecutive bruising or petechiae was counted as a bleed, unless bleeding on the subsequent day was worse. Modeling analysisNegative binomial regression 11 was used to model baseline characteristics associated with the number of days of grade 2-4 bleeding (analysis 1). The risk factors considered are shown in Table 1. Previous HSCT (defined as any prior transplant) and relapsed disease were also considered.Recurrent event analysis 12 was used to model the hazard of a grade 2-4 bleed on any one day, accounting for previous bleeds (analyses 2a, 2b and 2c). Robust sandwich variance estimates 12 were used for the hazard confidence intervals. Analysis 2a was the main recurrent event analysis. Analysis 2b was performed on a subset of bleeding records in which the platelet count from all 3 previous days was reported. Analysis 2c was a further subset analysis in which patients' temperature from all 3 previous days Risk factors for bleeding and platelet transfusion haematologica | 2015; 100(6) 741 Figure 1. Shows the number of patients (Np) and number of bleeding records (Nr) included in each part of the analysis.Eight of the 600 patients in the TOPPS trial dataset were not included in the analyses described in this paper: two patients w...

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confidence: 99%

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

et al. 2015

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“…studied 7560 males and 2774 females to analyze sex differences in trauma-hemorrhage patient. [7] They found higher rates of multiple organ failure (24.4 vs. 21.3%, OR 1.19 (95% CI 1.07–1.33, P = 0.001) and sepsis (16.5 vs. 11.3%, OR 1.55 (95% CI 1.35–1.77), P < 0.001) in males when compared to females. Organ function of lung, cardiocirculatory system, liver, and kidney was better in females; however, there was no difference in mortality.…”

Section: Discussionmentioning

confidence: 99%

“…[7891011121314] Most of the studies on THS are from Caucasian population. The Indian population may differ from Caucasian population in immunological and constitutional aspects.…”

Section: Introductionmentioning

confidence: 99%

Gender-based assessment of survival in trauma-hemorrhagic shock: A retrospective analysis of Indian population

Verma

Bhoi

Baitha

et al. 2017

Indian Journal of Critical Care Medicine

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Introduction:Trauma-hemorrhagic shock (THS) is a leading cause of death. Female rats and women experience better outcomes in terms of survival after major trauma as compared to males. There are limited data in Indian population. Authors studied the gender-based outcome of patients with Class IV hemorrhagic shock due to blunt trauma and the distribution of factors among males and females which are known to affect outcome.Materials and Methods:It was a retrospective study with data of trauma victims between January 2008 and July 2013. Road traffic crash (RTC), fall, or assault of all ages with Class IV hemorrhagic shock on arrival was included in the study, and data were collected on demographic, clinical, and laboratory parameters. Drowning, burns, penetrating injuries, and septic, neurogenic, and cardiogenic shock were excluded from the study.Results:Seven hundred and eighty-one patients were analyzed under three groups: (i) overall group including all patients (n = 781), (ii) male group (n = 609), and (iii) female group (n = 172). After adjusting all variables, mortality was significantly lower in females as compared to males following THS (P < 0.05). Age, blood pressure, pulse, male gender, and fall and RTC as mode of injury (MOI) were independent predictors of mortality (P < 0.05) in overall group. Among males, age, pulse, and RTC as a MOI were significant (P < 0.05), while in females, only systolic blood pressure (SBP) was independent predictor of mortality.Conclusion:Females had better survival as compared to males following THS. SBP was an independent predictor of mortality in females with THS.

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“…In fact, among patients admitted to the hospital for trauma and relevant bleeding, higher rates of multiple organ failure and sepsis were observed in males. 27 Experimental studies on animal models showed that, after an endotoxic shock secondary to single injection of lipopolysaccharide (LPS), there were unremarkable differences between male and female rats. However, female rats may recover the inotropic cardiac function earlier than males.…”

Section: Discussionmentioning

confidence: 99%

Is Female Gender as Harmful as Bacteria? Analysis of Hospital Admissions for Urinary Tract Infections in Elderly Patients

Fabbian

Giorgi

López‐Soto

et al. 2015

Journal of Women's Health

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Female sex protects from organ failure and sepsis after major trauma haemorrhage

Cited by 69 publications

References 64 publications

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

Gender-based assessment of survival in trauma-hemorrhagic shock: A retrospective analysis of Indian population

Is Female Gender as Harmful as Bacteria? Analysis of Hospital Admissions for Urinary Tract Infections in Elderly Patients

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