Acute Care/Hospitalization

Estrogen levels predict life or death in critically ill patients

After a severe trauma, the body responds with a cascade of reactions that trigger the immune and inflammatory systems. Lesly A. Dossett, M.D., and colleagues at Vanderbilt University and the University of Virginia, looked at how one chemical in the cascade, estrogen, predicts whether a critically injured patient will survive. The team studied levels of estradiol, the most active form of estrogen in the human body, to determine its ability to foretell a patient's future. The team studied blood samples from 991 trauma patients admitted to intensive care units who survived for 48 hours or more at the 2 university medical centers.

Of the 133 (13.4 percent) patients who died, their median estradiol levels were 35 pg/mL. Survivors' levels were less than half of that amount (16 pg/mL). When the researchers used a model that combined patient age, estradiol level, and a commonly used trauma score, they were best able to predict patient outcome.

Serum estradiol was determined to be a marker of both how severely injured a patient was and a predictor of death. Whether or not estrogen plays a role in life or death or serves simply as an indicator remains to be explored. However, the researchers suggest that controlling estrogen levels could be part of a therapy to improve outcomes in critically injured patients. This study was funded in part by the Agency for Healthcare Research and Quality (HS13833).

See "High levels of endogenous estrogens are associated with death in the critically injured adult," by Dr. Dossett, Brian R. Swenson, M.D., M.S., Daithi Heffernan, M.D., and others in the March 2008 Journal of Trauma 64(3), pp. 580-585.

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