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Hormonally Active Females Tolerate Shock Better Than Males: A Prospective Study of Over 4000 Trauma Patients
Edwin A Deitch, David H Livingston, Robert F Lavery*, Sean F Monaghan*, Advaith Bongu*, George W Macheido
UMDNJ-New Jersey Medical School, Newark, NJ

The notion that pre-menopausal females are more resistant to shock than males has been shown in numerous preclinical models, however human studies have been less clear due retrospective design or small numbers. We initiated a prospective study testing the hypothesis that females would be more resistant to metabolic stress as measured by lactate production than males during the initial post-trauma period.
METHODS: Prospective series of all patients at a Level I trauma center from 1/2000-12/2005. Study patients were required to have an arterial blood gas and lactate drawn within 30 minutes of arrival. Demographic data, injury severity score and lactate levels were recorded.
RESULTS: 5192 patients were evaluated and 4106 fulfilled the study requirement. Females in the hormonally active age ranges had lower lactates than males (Table). Data presented as mean (95% confidence intervals).
AgesN (M:F)All patientsFemalesMales
< 14 yrs118 (82:36)2.8 (2.3-3.4)2.8 (1.9-3.6)2.9 (2.2-3.5)
14-44 yrs2851 (2408:443)3.7 (3.6-3.8)2.4 (2.6-3.1)*3.5 (3.7-4.0)
45-54 yrs433 (344:89)3.5 (3.2-3.7)3.0 (2.5-3.6)*3.6 (3.3-3.9)
≥55 yrs704 (459:245)2.9 (2.7-3.1)2.7 (2.4-3.0)3.0 (2.8-3.3)

* p<0.0.0001 vs. males ANOVA and Tukey
There was no difference between the groups in terms of injury severity. Protective effects observed in premenopausal females vs males persisted in subgroups with major injury (ISS>25) or severe shock (>6units RBC in 24 hrs) (p<0.001).
CONCLUSIONS: The data firmly establishes a proof of principal that hormonally active human females have a lesser response to similar degrees of shock and trauma than their male counterparts. These data should be taken into account in designing studies evaluating the response to shock and subsequent organ failure.

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