Abstract | December 20, 2021

Influence of Female Sex Hormones on Burn Outcomes

Presenting Author: Kassandra Corona, BS, University of Texas Medical Branch|Galveston|Texas

Co-Authors: Kendall Wermine, BS|Medical Student/School of Medicine|University of Texas Medical Branch, Galveston, Texas Giovanna De La Tejera, BSA|Medical Student/School of Medicine|University of Texas Medical Branch, Galveston, Texas Sunny Gotewal, BS|Medical Student/School of Medicine|University of Texas Medical Branch, Galveston, Texas Shivan Chokshi, BBA|Medical Student/School of Medicine|University of Texas Medical Branch, Galveston, Texas Elvia Villarreal, BS|Medical Student/School of Medicine|University of Texas Medical Branch, Galveston, Texas Lyndon Huang, BA|Medical Student/School of Medicine|University of Texas Medical Branch, Galveston, Texas George Golovko, PhD|Assistant Professor/Pharmacology|University of Texas Medical Branch, Galveston, Texas Amina El Ayadi, PhD|Assistant Professor/Surgery|University of Texas Medical Branch, Galveston, Texas Juquan Song, MD|Assistant Professor/Surgery|University of Texas Medical Branch, Galveston, Texas Steven E. Wolf, MD|Professor and Chief/Surgery|University of Texas Medical Branch, Galveston, Texas

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to discuss the role of female hormones on post-burn outcomes, and to further examine the protective properties of exogenous hormone treatment on postmenopausal women with thermal injury.

Introduction:
The pathophysiological response to major trauma has shown a gender dimorphism in outcomes based on sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated that estrogen alleviates hyper-inflammation after burn. There are two objectives of this study: to investigate the role of female hormones on post-burn outcomes, and to further investigate the protective properties of exogenous hormone treatment on post-menopausal women with thermal injury.

Methods:
This study obtained data from TriNetX research network with electronic medical records of de-identified patients. Patients who suffered burns were included from 2002-2020. This population was then 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 ensure that the burned patients had started menopause which usually occurs at around age 45-55. Outcomes for mortality, sepsis, acute myocardial infarction, and acute kidney injury were measured within one day after burn injury to one month after burn injury. The statistical analysis for the measures of association used the z-test. Significance was p-value <0.05.

Results:
Compared to males, female burns 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%). Additionally, female burns over the age 45 had a 544% greater relative risk of death, sepsis (285%), acute kidney failure (769 %), and acute myocardial infarction (1,747%) when compared to younger females. All the above data was significant at p<0.0001. TriNetX identified 197,448 burn patients, of which 6,693 were on estrogen and progestin. The females over 45 on exogenous hormones had a 37% significant risk reduction in acute kidney failure when compared to the women over 45 not on estrogen or progestin (p<0.05).

Conclusion:
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.

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Posted in: Burn Medicine101
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