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One possible mechanism is differential immunological and neuroendocrine responses to traumatic stress exposure. In the current prospective study, we aimed to identify whether sex is indirectly associated with the probability of developing nonremitting PTSD through pro-inflammatory markers and whether steroid hormone concentrations influence this effect. Female (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009179) and male (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009197) trauma survivors were recruited from an emergency department and completed clinical assessment within 24\u2005h and blood samples within \u223cthree hours of trauma exposure. Pro-inflammatory cytokines (IL-6, IL-1\n                    <jats:inline-formula>\n                      <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                        <mml:mi>\u03b2<\/mml:mi>\n                      <\/mml:math>\n                    <\/jats:inline-formula>\n                    , TNF, IFN\u03b3), and steroid hormone (estradiol, testosterone, progesterone, cortisol) concentrations were quantified in plasma. Compared to men, women had a higher probability of developing nonremitting PTSD after trauma (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.04), had lower pro-inflammatory cytokines and testosterone (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2019\n                    <jats:italic toggle=\"yes\">s<\/jats:italic>\n                    &lt;0.001), and had higher cortisol and progesterone (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2019\n                    <jats:italic toggle=\"yes\">s<\/jats:italic>\n                    &lt;0.001) concentrations. Estradiol concentrations were not different between the sexes (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.24). Pro-inflammatory cytokines were a significant mediator in the relationship between sex and probability of developing nonremitting PTSD (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05), such that men had higher concentrations of pro-inflammatory cytokines which were associated with lower risk of nonremitting PTSD development. This effect was significantly moderated by estradiol (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05), as higher estradiol levels in men were associated with higher pro-inflammatory cytokine concentrations and lower risk for developing nonremitting PTSD. The current results suggest that sex differences in the pro-inflammatory cytokine response to trauma exposure partially mediate the probability of developing nonremitting PTSD, and that the protective ability to mount an pro-inflammatory cytokine response in men may depend on higher estradiol levels in the aftermath of trauma exposure.\n                  <\/jats:p>","DOI":"10.1177\/24705470211032208","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T09:29:26Z","timestamp":1632389366000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":28,"title":["Sex Differences in Peritraumatic Inflammatory Cytokines and Steroid Hormones Contribute to Prospective Risk for Nonremitting Posttraumatic Stress Disorder"],"prefix":"10.1177","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6775-3299","authenticated-orcid":false,"given":"Chloe S.","family":"Lalonde","sequence":"first","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Mekawi","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly F.","family":"Ethun","sequence":"additional","affiliation":[{"name":"Yerkes National Primate Research Center, Atlanta, Georgia, USA"},{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonore","family":"Beurel","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine"},{"name":"University of Miami Miller School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Gould","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firdaus S.","family":"Dhabhar","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine"},{"name":"University of Miami Miller School of Medicine"},{"name":"Department of Psychology, University of Miami, Coral Gables, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Schultebraucks","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Galatzer-Levy","sequence":"additional","affiliation":[{"name":"New York University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Maples-Keller","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara O.","family":"Rothbaum","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry J.","family":"Ressler","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"},{"name":"Mclean Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-1160","authenticated-orcid":false,"given":"Charles B.","family":"Nemeroff","sequence":"additional","affiliation":[{"name":"University of Texas at Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2531-923X","authenticated-orcid":false,"given":"Vasiliki","family":"Michopoulos","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine"},{"name":"Yerkes National Primate Research Center, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1612499"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3402\/ejpt.v6.26068"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1995.03950240066012"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.129.1.52"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/nri.2016.90"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.130.4.601"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.08.013"},{"issue":"1","key":"e_1_3_3_9_2","first-page":"1","article-title":"Gender differences in trauma, shock and sepsis","volume":"5","author":"B\u00f6sch F","year":"2018","unstructured":"B\u00f6sch F, Angele MK, Chaudry IH. 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