High Levels of Endogenous Estrogens are Associated With Death in the Critically Injured Adult

Dossett, Lesly A.; Swenson, Brian R.; Heffernan, Daithi S.; Bonatti, Hugo; Metzger, Rosemarie; Sawyer, Robert G.; May, Addison K.

doi:10.1097/ta.0b013e31816543dd

Cited by 57 publications

(65 citation statements)

References 36 publications

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“…Others have noted that the presence of sex hormones (estrogens) in premenopausal people, lead to harm and worse outcomes in the setting of acute sepsis or pneumonia. 5,6,34 This appears an area for future investigation.…”

Section: Discussionmentioning

confidence: 93%

“…2,3 Sex hormones and sex-related gene polymorphisms could potentially enhance or suppress the immune system and affect outcomes in women. [4][5][6][7][8][9][10] Epidemiologic studies have produced conflicting results, 4,[11][12][13][14][15][16][17] , with some suggesting that in addition to gender, menopausal status may influence patient outcome. 4,13,[18][19][20] Clinical studies have suggested that male gender is associated with a greater incidence of nosocomial pneumonia in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Absence of Gender-Based Differences in Outcome of Patients with Hospital-Acquired Pneumonia

Cáceres

Welch

Kett

et al. 2013

Journal of Women's Health

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Absence of Gender-Based Differences in Outcome of Patients with Hospital-Acquired Pneumonia

Cáceres

Welch

Kett

et al. 2013

Journal of Women's Health

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“…30,31 In our study characterizing serum hormones acutely after TBI, elevated estradiol in particular was associated with mortality and poor outcomes 6 months postinjury. 10 These findings suggest that tissuespecific aromatase activity significantly influences the hormone profiles, and there are different mechanisms of hormone physiology at play in the CSF versus serum compartments.…”

Section: Garringer Et Almentioning

confidence: 99%

Impact of Aromatase Genetic Variation on Hormone Levels and Global Outcome after Severe TBI

Garringer

Niyonkuru

McCullough

et al. 2013

Journal of Neurotrauma

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Although experimental traumatic brain injury (TBI) studies support estradiol as a neuroprotectant and potent stimulator of neuroplasticity, clinical studies suggest a negative association between endogenous estradiol profiles and mortality/poor outcomes. However, no studies have evaluated associations with cerebral spinal fluid (CSF) hormone profiles and aromatase gene (cytochrome P450 [CYP]19A1) variability on clinical TBI outcomes. We evaluated 110 adults with severe TBI. Average and daily estradiol, testosterone, and estradiol/testosterone ratios (E2:T) were measured using CSF and serum samples and compared to healthy controls. Eighteen tagging and four functional single-nucleotide polymorphisms (SNPs) for CYP19A1 were genotyped and compared to hormones, acute mortality, and Glasgow Outcome Scale (GOS) scores 6 months post-TBI. TBI subjects had lower CSF estradiol over time versus controls. CSF testosterone was initially high, but declined over time. E2/T ratios were initially low, compared to controls, but rose over time. Higher mean E2/T ratio in bivariate analysis was associated with lower mortality ( p = 0.019) and better GOS-6 scores ( p = 0.030). rs2470152 influenced CSF E2/T ratio and also serum and CSF testosterone ( p £ 0.05 all comparisons). Multiple-risk SNPs rs2470152, rs4646, and rs2470144 were associated with worse GOS-6 scores ( p £ 0.05, all comparisons), and those with > 1 risk SNP variant had a higher risk for poor outcome, compared with those with £ 1 risk variant. TBI results in low CSF estradiol and dynamic CSF testosterone and E2/T ratio. In contrast to clinical serum hormone studies, higher CSF E2/T ratio was associated with better outcome. Further, genetic variation in CYP19A1 influences both hormone dynamics and outcome post-TBI.

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“…We showed high E 2 levels in female patients and a correlation between E 2 and disease severity. E 2 level increases in critically ill patients [22,23] and is reported to be associated with mortality [24]. Elevated aromatisation of adrenal androgens to E 2 mediated by cytokines is proven to result in increased serum E 2 levels [23,25].…”

Section: Discussionmentioning

confidence: 99%

The pıtuıtary-gonadal-thyroıd and lactotroph axes ın crıtıcally ıll patıents

Akbaş

Deyneli

Sönmez

et al. 2015

Endokrynologia Polska

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Introduction: The normal circadian rhythm of hormones in critical patients becomes chaotic causing some hormones to increase and others to decrease abnormally. The goal of this study is to evaluate hormonal changes in severely ill patients and to investigate the relationship between hormonal changes and mortality and morbidity. Material and methods: We enrolled 20 patients (10 F/10 M). Blood samples were collected on day 0, day 5, and day 10. If a patient was discharged before these defined days, a sample was drawn on that day. Twenty healthy controls were included. Results: Female patients had lower LH, FSH, and fT 3 and higher PRL and cortisol levels than controls on admission to the intensive care unit (ICU) (p LH = 0.021, p FSH :0.001, p fT3 = 0.021, p PRL = 0.042, p Cortisol < 0.001, respectively). Men had significantly low testosterone and fT 3 , and high PRL and cortisol levels on ICU admission (p T = 0.01, p fT3 = 0.043, p PRL = 0.005, p Cortisol < 0.001, respectively). The lowest levels of gonadotropins in both genders and testosterone in men were measured on day 5. Cortisol levels decreased in the patients discharged from the ICU (p = 0.01). FSH levels increased in recovered women (p FSH = 0.043). The mortality rate was 30%. There were correlations between admission TSH and NIMV duration (p = 0.006), fT 3 and APACHE II (p = 0.001), and PRL and mortality (p = 0.044). Positive correlations between E 2 and APACHE II (p = 0.003) in females, and PRL and APACHE II (p = 0.022) in males were also displayed.

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High Levels of Endogenous Estrogens are Associated With Death in the Critically Injured Adult

Cited by 57 publications

References 36 publications

Absence of Gender-Based Differences in Outcome of Patients with Hospital-Acquired Pneumonia

Absence of Gender-Based Differences in Outcome of Patients with Hospital-Acquired Pneumonia

Impact of Aromatase Genetic Variation on Hormone Levels and Global Outcome after Severe TBI

The pıtuıtary-gonadal-thyroıd and lactotroph axes ın crıtıcally ıll patıents

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