Gender based differences in the genomic response, innate immunity, organ dysfunction and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock.

Introduction: The effect of gender on post-traumatic pathophysiology and outcomes after severe traumatic injury remains debated. We sought to determine the relationship of gender to the genomic and inflammatory responses, and clinical outcomes after hemorrhagic shock. Methods: We analyzed blunt trauma patients in hemorrhagic shock from a prospective, multi-institutional cohort study to assess for gender based differences in the genomic response and clinical outcomes. Serially drawn blood samples were analyzed to evaluate peripheral leukocyte genome-wide expression and circulating inflammatory mediators at intervals between 0.5 and 28 days after injury. Multivariate logistic regression models were developed to assess the effect of gender on outcomes after controlling for age, injury and shock severity, blood transfusion, and comorbidities. Results: The cohort consisted of 1,285 (67%) male and 643 (33%) female blunt trauma patients. Injury and shock severity were similar between the two groups. There were small but statistically significant differences between males and females regarding their age, BMI, and 12 hour blood and crystalloid administration. Organ failure was more severe in males, with slower recovery (9.0 vs. 6.5 days) in males compared to females (p

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