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Erschienen in: Journal of Gastroenterology 3/2013

01.03.2013 | Original Article—Liver, Pancreas, and Biliary Tract

Increased admission serum estradiol level is correlated with high mortality in patients with severe acute pancreatitis

verfasst von: Chih-Wei Lu, Liang-Chih Liu, Ya-Ching Hsieh, Li-Heng Yang, Ray-Jade Chen, Chi-Hsun Hsieh

Erschienen in: Journal of Gastroenterology | Ausgabe 3/2013

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Abstract

Background

Sexual dimorphism in critical diseases has been documented. Severe acute pancreatitis is a disease with high mortality. We hypothesized that admission sex hormone levels may be used as an early predictor of outcome in these patients.

Methods

A prospective cohort of patients with severe acute pancreatitis admitted to the intensive care unit for at least 48 h were enrolled (n = 62). Serum levels of estradiol, progesterone, and testosterone were determined on admission. The association of sex hormone levels and various disease severity scoring systems with patient outcome was analyzed.

Results

There was no difference in overall mortality between the sexes. However, estradiol was significantly elevated in nonsurvivors (39 vs. 206 pg/mL, p < 0.001). The estradiol level was the best single-variable predictor of mortality (area under the curve 0.97), followed by the sequential organ failure assessment score, the multiple organ dysfunction score, and the Acute Physiology and Chronic Health Care Evaluation II (APACHE II) score. A serum estradiol level of 102 pg/mL was both sensitive and specific to predict mortality. There were no differences between survivors and non-survivors in terms of age, body mass index, or progesterone and testosterone levels.

Conclusions

Admission serum estradiol level is a good marker of disease severity and predictor of death in patients with severe acute pancreatitis.
Literatur
1.
2.
Zurück zum Zitat Soran A, Chelluri L, Lee KK, Tisherman SA. Outcome and quality of life of patients with acute pancreatitis requiring intensive care. J Surg Res. 2000;91(1):89–94.PubMedCrossRef Soran A, Chelluri L, Lee KK, Tisherman SA. Outcome and quality of life of patients with acute pancreatitis requiring intensive care. J Surg Res. 2000;91(1):89–94.PubMedCrossRef
3.
4.
5.
Zurück zum Zitat George RL, McGwin G Jr, Metzger J, Chaudry IH, Rue LW III. The association between gender and mortality among trauma patients as modified by age. J Trauma. 2003;54(3):464–71.PubMedCrossRef George RL, McGwin G Jr, Metzger J, Chaudry IH, Rue LW III. The association between gender and mortality among trauma patients as modified by age. J Trauma. 2003;54(3):464–71.PubMedCrossRef
6.
Zurück zum Zitat Knoferl MW, Angele MK, Diodato MD, Schwacha MG, Ayala A, Cioffi WG, et al. Female sex hormones regulate macrophage function after trauma-hemorrhage and prevent increased death rate from subsequent sepsis. Ann Surg. 2002;235(1):105–12.PubMedCrossRef Knoferl MW, Angele MK, Diodato MD, Schwacha MG, Ayala A, Cioffi WG, et al. Female sex hormones regulate macrophage function after trauma-hemorrhage and prevent increased death rate from subsequent sepsis. Ann Surg. 2002;235(1):105–12.PubMedCrossRef
7.
Zurück zum Zitat May AK, Dossett LA, Norris PR, Hansen EN, Dorsett RC, Popovsky KA, et al. Estradiol is associated with mortality in critically ill trauma and surgical patients. Crit Care Med. 2008;36(1):62–8.PubMedCrossRef May AK, Dossett LA, Norris PR, Hansen EN, Dorsett RC, Popovsky KA, et al. Estradiol is associated with mortality in critically ill trauma and surgical patients. Crit Care Med. 2008;36(1):62–8.PubMedCrossRef
8.
Zurück zum Zitat Dossett LA, Swenson BR, Heffernan D, Bonatti H, Metzger R, Sawyer RG, et al. High levels of endogenous estrogens are associated with death in the critically injured adult. J Trauma. 2008;64(3):580–5.PubMedCrossRef Dossett LA, Swenson BR, Heffernan D, Bonatti H, Metzger R, Sawyer RG, et al. High levels of endogenous estrogens are associated with death in the critically injured adult. J Trauma. 2008;64(3):580–5.PubMedCrossRef
9.
Zurück zum Zitat Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586–90.PubMedCrossRef Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586–90.PubMedCrossRef
10.
Zurück zum Zitat Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.PubMedCrossRef Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.PubMedCrossRef
11.
Zurück zum Zitat Heinrich S, Schafer M, Rousson V, Clavien PA. Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg. 2006;243(2):154–68.PubMedCrossRef Heinrich S, Schafer M, Rousson V, Clavien PA. Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg. 2006;243(2):154–68.PubMedCrossRef
12.
Zurück zum Zitat Rau BM, Kemppainen EA, Gumbs AA, Buchler MW, Wegscheider K, Bassi C, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg. 2007;245(5):745–54.PubMedCrossRef Rau BM, Kemppainen EA, Gumbs AA, Buchler MW, Wegscheider K, Bassi C, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg. 2007;245(5):745–54.PubMedCrossRef
13.
Zurück zum Zitat Sato N, Endo S, Kasai T, Inoue Y, Fujino Y, Onodera M, et al. Relationship of the serum procalcitonin level with the severity of acute pancreatitis. Res Commun Mol Pathol Pharmacol. 2004;115–116:243–9.PubMed Sato N, Endo S, Kasai T, Inoue Y, Fujino Y, Onodera M, et al. Relationship of the serum procalcitonin level with the severity of acute pancreatitis. Res Commun Mol Pathol Pharmacol. 2004;115–116:243–9.PubMed
14.
Zurück zum Zitat Ranson JH, Rifkind KM, Turner JW. Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surg Gynecol Obstet. 1976;143(2):209–19.PubMed Ranson JH, Rifkind KM, Turner JW. Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surg Gynecol Obstet. 1976;143(2):209–19.PubMed
15.
Zurück zum Zitat Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.PubMedCrossRef Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.PubMedCrossRef
16.
Zurück zum Zitat Vincent JL, Moreno R, Takala J, Willatts S, De MA, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.PubMedCrossRef Vincent JL, Moreno R, Takala J, Willatts S, De MA, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.PubMedCrossRef
17.
Zurück zum Zitat Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603–13.PubMedCrossRef Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603–13.PubMedCrossRef
18.
Zurück zum Zitat Dossett LA, Swenson BR, Evans HL, Bonatti H, Sawyer RG, May AK. Serum estradiol concentration as a predictor of death in critically ill and injured adults. Surg Infect (Larchmt). 2008;9(1):41–8.CrossRef Dossett LA, Swenson BR, Evans HL, Bonatti H, Sawyer RG, May AK. Serum estradiol concentration as a predictor of death in critically ill and injured adults. Surg Infect (Larchmt). 2008;9(1):41–8.CrossRef
19.
Zurück zum Zitat Gee AC, Sawai RS, Differding J, Muller P, Underwood S, Schreiber MA. The influence of sex hormones on coagulation and inflammation in the trauma patient. Shock. 2008;29(3):334–41.PubMed Gee AC, Sawai RS, Differding J, Muller P, Underwood S, Schreiber MA. The influence of sex hormones on coagulation and inflammation in the trauma patient. Shock. 2008;29(3):334–41.PubMed
20.
Zurück zum Zitat Angstwurm MW, Gaertner R, Schopohl J. Outcome in elderly patients with severe infection is influenced by sex hormones but not gender. Crit Care Med. 2005;33(12):2786–93.PubMedCrossRef Angstwurm MW, Gaertner R, Schopohl J. Outcome in elderly patients with severe infection is influenced by sex hormones but not gender. Crit Care Med. 2005;33(12):2786–93.PubMedCrossRef
21.
Zurück zum Zitat Zhang XP, Zhang J, Ma ML, Cai Y, Xu RJ, Xie Q, et al. Pathological changes at early stage of multiple organ injury in a rat model of severe acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2010;9(1):83–7.PubMed Zhang XP, Zhang J, Ma ML, Cai Y, Xu RJ, Xie Q, et al. Pathological changes at early stage of multiple organ injury in a rat model of severe acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2010;9(1):83–7.PubMed
22.
Zurück zum Zitat Kylanpaa ML, Repo H, Puolakkainen PA. Inflammation and immunosuppression in severe acute pancreatitis. World J Gastroenterol. 2010;16(23):2867–72.PubMedCrossRef Kylanpaa ML, Repo H, Puolakkainen PA. Inflammation and immunosuppression in severe acute pancreatitis. World J Gastroenterol. 2010;16(23):2867–72.PubMedCrossRef
23.
Zurück zum Zitat Spratt DI, Morton JR, Kramer RS, Mayo SW, Longcope C, Vary CP. Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization. Am J Physiol Endocrinol Metab. 2006;291(3):E631–8.PubMedCrossRef Spratt DI, Morton JR, Kramer RS, Mayo SW, Longcope C, Vary CP. Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization. Am J Physiol Endocrinol Metab. 2006;291(3):E631–8.PubMedCrossRef
24.
Zurück zum Zitat Samy TS, Zheng R, Matsutani T, Rue LW III, Bland KI, Chaudry IH. Mechanism for normal splenic T lymphocyte functions in proestrus females after trauma: enhanced local synthesis of 17beta-estradiol. Am J Physiol Cell Physiol. 2003;285(1):C139–49.PubMed Samy TS, Zheng R, Matsutani T, Rue LW III, Bland KI, Chaudry IH. Mechanism for normal splenic T lymphocyte functions in proestrus females after trauma: enhanced local synthesis of 17beta-estradiol. Am J Physiol Cell Physiol. 2003;285(1):C139–49.PubMed
25.
Zurück zum Zitat Schneider CP, Nickel EA, Samy TS, Schwacha MG, Cioffi WG, Bland KI, et al. The aromatase inhibitor, 4-hydroxyandrostenedione, restores immune responses following trauma-hemorrhage in males and decreases mortality from subsequent sepsis. Shock. 2000;14(3):347–53.PubMedCrossRef Schneider CP, Nickel EA, Samy TS, Schwacha MG, Cioffi WG, Bland KI, et al. The aromatase inhibitor, 4-hydroxyandrostenedione, restores immune responses following trauma-hemorrhage in males and decreases mortality from subsequent sepsis. Shock. 2000;14(3):347–53.PubMedCrossRef
26.
Zurück zum Zitat Mizushima Y, Wang P, Jarrar D, Cioffi WG, Bland KI, Chaudry IH. Estradiol administration after trauma-hemorrhage improves cardiovascular and hepatocellular functions in male animals. Ann Surg. 2000;232(5):673–9.PubMedCrossRef Mizushima Y, Wang P, Jarrar D, Cioffi WG, Bland KI, Chaudry IH. Estradiol administration after trauma-hemorrhage improves cardiovascular and hepatocellular functions in male animals. Ann Surg. 2000;232(5):673–9.PubMedCrossRef
27.
Zurück zum Zitat Gatson JW, Maass DL, Simpkins JW, Idris AH, Minei JP, Wigginton JG. Estrogen treatment following severe burn injury reduces brain inflammation and apoptotic signaling. J Neuroinflamm. 2009;6:30.CrossRef Gatson JW, Maass DL, Simpkins JW, Idris AH, Minei JP, Wigginton JG. Estrogen treatment following severe burn injury reduces brain inflammation and apoptotic signaling. J Neuroinflamm. 2009;6:30.CrossRef
28.
Zurück zum Zitat Florian M, Lu Y, Angle M, Magder S. Estrogen induced changes in Akt-dependent activation of endothelial nitric oxide synthase and vasodilation. Steroids. 2004;69(10):637–45.PubMedCrossRef Florian M, Lu Y, Angle M, Magder S. Estrogen induced changes in Akt-dependent activation of endothelial nitric oxide synthase and vasodilation. Steroids. 2004;69(10):637–45.PubMedCrossRef
29.
Zurück zum Zitat Raju R, Bland KI, Chaudry IH. Estrogen: a novel therapeutic adjunct for the treatment of trauma-hemorrhage-induced immunological alterations. Mol Med. 2008;14(3–4):213–21.PubMed Raju R, Bland KI, Chaudry IH. Estrogen: a novel therapeutic adjunct for the treatment of trauma-hemorrhage-induced immunological alterations. Mol Med. 2008;14(3–4):213–21.PubMed
30.
Zurück zum Zitat Raju R, Chaudry IH. Sex steroids/receptor antagonist: their use as adjuncts after trauma-hemorrhage for improving immune/cardiovascular responses and for decreasing mortality from subsequent sepsis. Anesth Analg. 2008;107(1):159–66.PubMedCrossRef Raju R, Chaudry IH. Sex steroids/receptor antagonist: their use as adjuncts after trauma-hemorrhage for improving immune/cardiovascular responses and for decreasing mortality from subsequent sepsis. Anesth Analg. 2008;107(1):159–66.PubMedCrossRef
31.
Zurück zum Zitat Hsieh YC, Frink M, Choudhry MA, Bland KI, Chaudry IH. Metabolic modulators following trauma sepsis: sex hormones. Crit Care Med. 2007;35(9 Suppl):S621–9.PubMedCrossRef Hsieh YC, Frink M, Choudhry MA, Bland KI, Chaudry IH. Metabolic modulators following trauma sepsis: sex hormones. Crit Care Med. 2007;35(9 Suppl):S621–9.PubMedCrossRef
32.
Zurück zum Zitat Yu HP, Hsieh YC, Suzuki T, Choudhry MA, Schwacha MG, Bland KI, et al. Mechanism of the nongenomic effects of estrogen on intestinal myeloperoxidase activity following trauma-hemorrhage: up-regulation of the PI-3K/Akt pathway. J Leukoc Biol. 2007;82(3):774–80.PubMedCrossRef Yu HP, Hsieh YC, Suzuki T, Choudhry MA, Schwacha MG, Bland KI, et al. Mechanism of the nongenomic effects of estrogen on intestinal myeloperoxidase activity following trauma-hemorrhage: up-regulation of the PI-3K/Akt pathway. J Leukoc Biol. 2007;82(3):774–80.PubMedCrossRef
33.
Zurück zum Zitat Calippe B, Douin-Echinard V, Delpy L, Laffargue M, Lelu K, Krust A, et al. 17Beta-estradiol promotes TLR4-triggered proinflammatory mediator production through direct estrogen receptor alpha signaling in macrophages in vivo. J Immunol. 2010;185(2):1169–76.PubMedCrossRef Calippe B, Douin-Echinard V, Delpy L, Laffargue M, Lelu K, Krust A, et al. 17Beta-estradiol promotes TLR4-triggered proinflammatory mediator production through direct estrogen receptor alpha signaling in macrophages in vivo. J Immunol. 2010;185(2):1169–76.PubMedCrossRef
34.
Zurück zum Zitat Bruce-Keller AJ, Dimayuga FO, Reed JL, Wang C, Angers R, Wilson ME, et al. Gender and estrogen manipulation do not affect traumatic brain injury in mice. J Neurotrauma. 2007;24(1):203–15.PubMedCrossRef Bruce-Keller AJ, Dimayuga FO, Reed JL, Wang C, Angers R, Wilson ME, et al. Gender and estrogen manipulation do not affect traumatic brain injury in mice. J Neurotrauma. 2007;24(1):203–15.PubMedCrossRef
35.
Zurück zum Zitat Angele MK, Schwacha MG, Ayala A, Chaudry IH. Effect of gender and sex hormones on immune responses following shock. Shock. 2000;14(2):81–90.PubMedCrossRef Angele MK, Schwacha MG, Ayala A, Chaudry IH. Effect of gender and sex hormones on immune responses following shock. Shock. 2000;14(2):81–90.PubMedCrossRef
36.
Zurück zum Zitat Choudhry MA, Bland KI, Chaudry IH. Trauma and immune response—effect of gender differences. Injury. 2007;38(12):1382–91.PubMedCrossRef Choudhry MA, Bland KI, Chaudry IH. Trauma and immune response—effect of gender differences. Injury. 2007;38(12):1382–91.PubMedCrossRef
37.
Zurück zum Zitat Gannon CJ, Napolitano LM, Pasquale M, Tracy JK, McCarter RJ. A statewide population-based study of gender differences in trauma: validation of a prior single-institution study. J Am Coll Surg. 2002;195(1):11–8.PubMedCrossRef Gannon CJ, Napolitano LM, Pasquale M, Tracy JK, McCarter RJ. A statewide population-based study of gender differences in trauma: validation of a prior single-institution study. J Am Coll Surg. 2002;195(1):11–8.PubMedCrossRef
38.
Zurück zum Zitat Kauffmann RM, Norris PR, Jenkins JM, Dupont WD, Torres RE, Blume JD, et al. Trends in estradiol during critical illness are associated with mortality independent of admission estradiol. J Am Coll Surg. 2011;212(4):703–12.PubMedCrossRef Kauffmann RM, Norris PR, Jenkins JM, Dupont WD, Torres RE, Blume JD, et al. Trends in estradiol during critical illness are associated with mortality independent of admission estradiol. J Am Coll Surg. 2011;212(4):703–12.PubMedCrossRef
39.
Zurück zum Zitat Piascik M, Rydzewska G, Milewski J, Olszewski S, Furmanek M, Walecki J, et al. The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study. Pancreas. 2010;39(6):863–7.PubMedCrossRef Piascik M, Rydzewska G, Milewski J, Olszewski S, Furmanek M, Walecki J, et al. The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study. Pancreas. 2010;39(6):863–7.PubMedCrossRef
40.
Zurück zum Zitat Imaizumi H, Kida M, Nishimaki H, Okuno J, Kataoka Y, Kida Y, et al. Efficacy of continuous regional arterial infusion of a protease inhibitor and antibiotic for severe acute pancreatitis in patients admitted to an intensive care unit. Pancreas. 2004;28(4):369–73.PubMedCrossRef Imaizumi H, Kida M, Nishimaki H, Okuno J, Kataoka Y, Kida Y, et al. Efficacy of continuous regional arterial infusion of a protease inhibitor and antibiotic for severe acute pancreatitis in patients admitted to an intensive care unit. Pancreas. 2004;28(4):369–73.PubMedCrossRef
41.
Zurück zum Zitat Yasuda T, Ueda T, Takeyama Y, Shinzeki M, Sawa H, Nakajima T, et al. Treatment strategy against infection: clinical outcome of continuous regional arterial infusion, enteral nutrition, and surgery in severe acute pancreatitis. J Gastroenterol. 2007;42(8):681–9.PubMedCrossRef Yasuda T, Ueda T, Takeyama Y, Shinzeki M, Sawa H, Nakajima T, et al. Treatment strategy against infection: clinical outcome of continuous regional arterial infusion, enteral nutrition, and surgery in severe acute pancreatitis. J Gastroenterol. 2007;42(8):681–9.PubMedCrossRef
42.
Zurück zum Zitat Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69–81.PubMed Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69–81.PubMed
43.
Zurück zum Zitat Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res. 1977;22(2):79–91.PubMedCrossRef Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res. 1977;22(2):79–91.PubMedCrossRef
44.
Zurück zum Zitat Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004;53(9):1340–4.PubMedCrossRef Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004;53(9):1340–4.PubMedCrossRef
45.
Zurück zum Zitat Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. 2010;139(3):813–20.PubMedCrossRef Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. 2010;139(3):813–20.PubMedCrossRef
46.
Zurück zum Zitat Malangoni MA, Martin AS. Outcome of severe acute pancreatitis. Am J Surg. 2005;189(3):273–7.PubMedCrossRef Malangoni MA, Martin AS. Outcome of severe acute pancreatitis. Am J Surg. 2005;189(3):273–7.PubMedCrossRef
47.
Zurück zum Zitat Maruyama Y, Adachi Y, Aoki N, Suzuki Y, Shinohara H, Yamamoto T. Mechanism of feminization in male patients with non-alcoholic liver cirrhosis: role of sex hormone-binding globulin. Gastroenterol Jpn. 1991;26(4):435–9.PubMed Maruyama Y, Adachi Y, Aoki N, Suzuki Y, Shinohara H, Yamamoto T. Mechanism of feminization in male patients with non-alcoholic liver cirrhosis: role of sex hormone-binding globulin. Gastroenterol Jpn. 1991;26(4):435–9.PubMed
48.
Zurück zum Zitat Guechot J, Peigney N, Ballet F, Vaubourdolle M, Giboudeau J, Poupon R. Sex hormone imbalance in male alcoholic cirrhotic patients with and without hepatocellular carcinoma. Cancer. 1988;62(4):760–2.PubMedCrossRef Guechot J, Peigney N, Ballet F, Vaubourdolle M, Giboudeau J, Poupon R. Sex hormone imbalance in male alcoholic cirrhotic patients with and without hepatocellular carcinoma. Cancer. 1988;62(4):760–2.PubMedCrossRef
49.
Zurück zum Zitat Angele MK, Wichmann MW, Ayala A, Cioffi WG, Chaudry IH. Testosterone receptor blockade after hemorrhage in males. Restoration of the depressed immune functions and improved survival following subsequent sepsis. Arch Surg. 1997;132(11):1207–14.PubMedCrossRef Angele MK, Wichmann MW, Ayala A, Cioffi WG, Chaudry IH. Testosterone receptor blockade after hemorrhage in males. Restoration of the depressed immune functions and improved survival following subsequent sepsis. Arch Surg. 1997;132(11):1207–14.PubMedCrossRef
Metadaten
Titel
Increased admission serum estradiol level is correlated with high mortality in patients with severe acute pancreatitis
verfasst von
Chih-Wei Lu
Liang-Chih Liu
Ya-Ching Hsieh
Li-Heng Yang
Ray-Jade Chen
Chi-Hsun Hsieh
Publikationsdatum
01.03.2013
Verlag
Springer Japan
Erschienen in
Journal of Gastroenterology / Ausgabe 3/2013
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-012-0636-6

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