TNFα Variation During the Menstrual Cycle and Thereafter: A New Explanation for Gender-Based Disparities in ICU Admission Rates, Trauma Outcomes, and General Mortality.

BACKGROUND: Multiple studies have found gender-based disparities in intensive care unit (ICU) admission rates and in complications following trauma. Female gender was associated with lower mortality when comparing patients less than 50 years of age. These data suggest an important role for cycle rather than gender itself. Our previous results indicate a crucial role for tumor necrosis factor alpha (TNFα) in inducing nososocomial infections.

HYPOTHESIS: Cycle is important for TNF and other female hormone productions.

METHODS: Six older than 60 years old volunteers in both genders, 40 young female volunteers (no contraceptive drug, n = 18, contraceptive drug, n = 9, lactation, n = 9, pregnant, n = 4) were collected with following exclusion criteria, malignant disease, inflammation, infection, trauma and taking non-steroid anti-inflammatory drugs and antibiotics. Females were studied on days 1 and 14 of cycle. Serum TNFα was determined by HS TNF ELISA. Female hormones were also determined.

RESULTS: Serum TNFα, estradiol, and progesterone individual values in volunteers with cycle (no contraceptive drug) demonstrate marked interindividual differences on day 1 and day 14 of cycle. It can be seen beside interindividual differences the personal difference between TNFα, estradiol, and progesterone values on day 1 and day 14.Serum TNFα, estradiol, and progesterone individual values in volunteers with no cycle (contraceptive drug yes) demonstrate marked interindividual differences on day 1 and day 14 of cycle. It can be seen beside interindividual differences the personal difference between TNFα, estradiol, and progesterone values on day 1 and day 14; furthermore, seemingly lower estradiol values on day 1 and day 14 between groups can be seen. A significant decrease was demonstrated in serum progesterone values on day 14 of group with contraceptive drug compared with group with no contraceptive one.A significant negative correlation is demonstrated between serum progesterone and serum TNFα values on day 14.A marked significant difference in serum TNFα values between volunteers with cycle and with no cycle, like contraceptive, lactation pregnancy (trimesters P1, P2, P3), and climax.

CONCLUSION: For homogenous group of female patients not the gender and age are important but the cycle itself.