Cargando…

12 The Influence of Female Sex Hormones on Outcomes After Burn Injury

INTRODUCTION: The pathophysiological response to major trauma has gender dimorphism in outcomes associated with sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated exogenous estrogen alleviates hyper-inflammation...

Descripción completa

Detalles Bibliográficos
Autores principales: Corona, Kassandra K, Song, Juquan, De La Tejera, Giovanna, Huang, Lyndon G, Wermine, Kendall, Gotewal, Sunny, Efejuku, Tsola A, Joglar, Alejandro A, Keys, Phillip H, Villarreal, Elvia L, Chokshi, Shivan N, Chaij, Jasmine M, Palackic, Alen, El Ayadi, Amina, Golovko, George, Wolf, Steven E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8945956/
http://dx.doi.org/10.1093/jbcr/irac012.016
_version_ 1784674078055989248
author Corona, Kassandra K
Song, Juquan
De La Tejera, Giovanna
Huang, Lyndon G
Wermine, Kendall
Gotewal, Sunny
Efejuku, Tsola A
Joglar, Alejandro A
Keys, Phillip H
Villarreal, Elvia L
Chokshi, Shivan N
Chaij, Jasmine M
Palackic, Alen
El Ayadi, Amina
Golovko, George
Wolf, Steven E
author_facet Corona, Kassandra K
Song, Juquan
De La Tejera, Giovanna
Huang, Lyndon G
Wermine, Kendall
Gotewal, Sunny
Efejuku, Tsola A
Joglar, Alejandro A
Keys, Phillip H
Villarreal, Elvia L
Chokshi, Shivan N
Chaij, Jasmine M
Palackic, Alen
El Ayadi, Amina
Golovko, George
Wolf, Steven E
author_sort Corona, Kassandra K
collection PubMed
description INTRODUCTION: The pathophysiological response to major trauma has gender dimorphism in outcomes associated with sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated exogenous estrogen alleviates hyper-inflammation after burn. We thus posit that female patients have fewer comorbidities depending on female hormone levels. We had two objectives: to investigate the role of female hormones on outcomes after burn and to investigate potential protective properties of exogenous hormone treatment on burned post-menopausal women. METHODS: This study obtained data from the TriNetX research network with electronic medical records of de-identified patients. Both male and female patients who suffered burns were included from 2002-2020. The population was stratified to only include women over 45 on estrogen or progestin hormones taken within 6 months prior to injury and 1 month after injury to assure a menopausal state which occurs at age 45-55. Outcomes for mortality, sepsis, acute myocardial infarction, and acute kidney injury were measured within one day of injury to one month following injury. Odds ratios, risk difference, and risk ratios were calculated for outcome analysis after propensity-matched for race and ethnicity. A z-test for risk difference was performed. Statistical significance was defined at p < 0.05. RESULTS: Compared to males, females grossly had a 28% risk reduction of 30-day mortality and a relative risk reduction for sepsis (26%), acute kidney failure (30), and myocardial infarction (29%) (p< .05). Additionally, female burns younger than the age 45 had risk reductions for mortality 5.4-fold within 3 months, 2.9-fold lower for sepsis, 17.5-fold lower for myocardial infarction, and 7.7-fold lower for acute kidney injury (p< .001). TriNetX identified 169,566 female burn patients, of which 2,683 were on estrogen and progestin and above 45 years old. Women over 45 on exogenous hormones had a 37% significant risk reduction in acute kidney failure when compared to the women over 45 not prescribed estrogen or progestin (p< .05). CONCLUSIONS: Female burn patients had better outcomes, while women over 45 had worse outcomes indicating the role of female sex hormone correlated to burn patient progress. The administration of estrogen and progestins for females above age 45 resulted in reduced risks for acute kidney failure after burn injury.
format Online
Article
Text
id pubmed-8945956
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-89459562022-03-28 12 The Influence of Female Sex Hormones on Outcomes After Burn Injury Corona, Kassandra K Song, Juquan De La Tejera, Giovanna Huang, Lyndon G Wermine, Kendall Gotewal, Sunny Efejuku, Tsola A Joglar, Alejandro A Keys, Phillip H Villarreal, Elvia L Chokshi, Shivan N Chaij, Jasmine M Palackic, Alen El Ayadi, Amina Golovko, George Wolf, Steven E J Burn Care Res Correlative II: Prevention/Epidemiology/Public Health 1 INTRODUCTION: The pathophysiological response to major trauma has gender dimorphism in outcomes associated with sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated exogenous estrogen alleviates hyper-inflammation after burn. We thus posit that female patients have fewer comorbidities depending on female hormone levels. We had two objectives: to investigate the role of female hormones on outcomes after burn and to investigate potential protective properties of exogenous hormone treatment on burned post-menopausal women. METHODS: This study obtained data from the TriNetX research network with electronic medical records of de-identified patients. Both male and female patients who suffered burns were included from 2002-2020. The population was stratified to only include women over 45 on estrogen or progestin hormones taken within 6 months prior to injury and 1 month after injury to assure a menopausal state which occurs at age 45-55. Outcomes for mortality, sepsis, acute myocardial infarction, and acute kidney injury were measured within one day of injury to one month following injury. Odds ratios, risk difference, and risk ratios were calculated for outcome analysis after propensity-matched for race and ethnicity. A z-test for risk difference was performed. Statistical significance was defined at p < 0.05. RESULTS: Compared to males, females grossly had a 28% risk reduction of 30-day mortality and a relative risk reduction for sepsis (26%), acute kidney failure (30), and myocardial infarction (29%) (p< .05). Additionally, female burns younger than the age 45 had risk reductions for mortality 5.4-fold within 3 months, 2.9-fold lower for sepsis, 17.5-fold lower for myocardial infarction, and 7.7-fold lower for acute kidney injury (p< .001). TriNetX identified 169,566 female burn patients, of which 2,683 were on estrogen and progestin and above 45 years old. Women over 45 on exogenous hormones had a 37% significant risk reduction in acute kidney failure when compared to the women over 45 not prescribed estrogen or progestin (p< .05). CONCLUSIONS: Female burn patients had better outcomes, while women over 45 had worse outcomes indicating the role of female sex hormone correlated to burn patient progress. The administration of estrogen and progestins for females above age 45 resulted in reduced risks for acute kidney failure after burn injury. Oxford University Press 2022-03-23 /pmc/articles/PMC8945956/ http://dx.doi.org/10.1093/jbcr/irac012.016 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the American Burn Association. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Correlative II: Prevention/Epidemiology/Public Health 1
Corona, Kassandra K
Song, Juquan
De La Tejera, Giovanna
Huang, Lyndon G
Wermine, Kendall
Gotewal, Sunny
Efejuku, Tsola A
Joglar, Alejandro A
Keys, Phillip H
Villarreal, Elvia L
Chokshi, Shivan N
Chaij, Jasmine M
Palackic, Alen
El Ayadi, Amina
Golovko, George
Wolf, Steven E
12 The Influence of Female Sex Hormones on Outcomes After Burn Injury
title 12 The Influence of Female Sex Hormones on Outcomes After Burn Injury
title_full 12 The Influence of Female Sex Hormones on Outcomes After Burn Injury
title_fullStr 12 The Influence of Female Sex Hormones on Outcomes After Burn Injury
title_full_unstemmed 12 The Influence of Female Sex Hormones on Outcomes After Burn Injury
title_short 12 The Influence of Female Sex Hormones on Outcomes After Burn Injury
title_sort 12 the influence of female sex hormones on outcomes after burn injury
topic Correlative II: Prevention/Epidemiology/Public Health 1
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8945956/
http://dx.doi.org/10.1093/jbcr/irac012.016
work_keys_str_mv AT coronakassandrak 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT songjuquan 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT delatejeragiovanna 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT huanglyndong 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT werminekendall 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT gotewalsunny 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT efejukutsolaa 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT joglaralejandroa 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT keysphilliph 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT villarrealelvial 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT chokshishivann 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT chaijjasminem 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT palackicalen 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT elayadiamina 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT golovkogeorge 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury
AT wolfstevene 12theinfluenceoffemalesexhormonesonoutcomesafterburninjury