Tedesco Diana Julia, Hutter Maria Fernanda, Khalaf Fadi, Pond Gregory R, Jeschke Marc G
Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada.
Crit Care Med. 2025 Jul 17. doi: 10.1097/CCM.0000000000006789.
Sex and its effects on outcomes after burn are controversially discussed. In particular, the impact of sex on physiologic responses post-burn remains largely unknown. To bridge this knowledge gap, this study aimed to explore outcomes and the underlying pathophysiological responses in males and females across different age groups.
Cohort study.
Tertiary burn center.
Adult burn patients (≥ 18 yr) admitted with an acute burn injury.
None.
We included all patients (≥ 18 yr) admitted with acute burn injuries between 2006 and 2021. Patients were stratified based on sex assigned at birth and age group: adult (< 60 yr) vs. older adult (≥ 60 yr). Clinical laboratory measures and inflammatory markers were compared throughout hospitalization between male and female burn patients within each age group. Outcomes included 30-day mortality, in-hospital complications, organ biomarkers, and inflammatory cytokine responses. A total of 2321 patients were included. Adult females experienced greater mortality (1% vs. 2%; p < 0.05) and increased skin graft loss (5% vs. 9%; p < 0.05) compared with their male counterparts. Furthermore, among adults, female sex was an independent predictor of mortality in a multivariate model (odds ratio, 3.6; 95% CI, 1.3-9.6; p < 0.05). Adult females showed acute decreases in pro-inflammatory cytokines (interferon-γ, interleukin [IL]-6, IL-1β, tumor necrosis factor-α; p < 0.05). Interestingly, no differences in mortality or complications were observed between older adult males and females. Older adult males and females also showed similar inflammatory responses and limited differences in organ function.
In this large cohort study, we observed that adult females show increased mortality compared with their male counterparts. Differences in inflammatory responses underlie this observation, contributing to the observed poor outcomes. Importantly, sex differences in post-burn responses appear to diminish with age, highlighting the importance of deepening our understanding of the underlying physiologic mechanisms to optimize patient care.
关于性别及其对烧伤后结局的影响存在争议。特别是，性别对烧伤后生理反应的影响在很大程度上仍不清楚。为了填补这一知识空白，本研究旨在探讨不同年龄组男性和女性的结局及潜在的病理生理反应。
队列研究。
三级烧伤中心。
因急性烧伤入院的成年烧伤患者（≥18岁）。
无。
我们纳入了2006年至2021年间因急性烧伤入院的所有患者（≥18岁）。患者根据出生时的性别和年龄组进行分层：成年人（<60岁）与老年人（≥60岁）。在每个年龄组内，比较了男性和女性烧伤患者住院期间的临床实验室指标和炎症标志物。结局包括30天死亡率、住院并发症、器官生物标志物和炎症细胞因子反应。共纳入2321例患者。与成年男性相比，成年女性的死亡率更高（1%对2%；p<0.05），皮肤移植失败率更高（5%对9%；p<0.05）。此外，在成年人中，在多变量模型中女性是死亡率的独立预测因素（比值比，3.6；95%CI，1.3 - 9.6；p<0.05）。成年女性的促炎细胞因子（干扰素-γ、白细胞介素[IL]-6、IL-1β、肿瘤坏死因子-α）急性下降（p<0.05）。有趣的是，老年男性和女性在死亡率或并发症方面未观察到差异。老年男性和女性也表现出相似的炎症反应，器官功能差异有限。
在这项大型队列研究中，我们观察到成年女性与成年男性相比死亡率增加。炎症反应的差异是这一观察结果的基础，导致了观察到的不良结局。重要的是，烧伤后反应的性别差异似乎随着年龄的增长而减小，这突出了加深我们对潜在生理机制的理解以优化患者护理的重要性。
Zotero 插件