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Gender-based differences in children with sepsis and ARDS: the ESPNIC ARDS Database Group
Lutz Bindl1, Stephan Buderus, Peter Dahlem
1University Childrens Hospital, Adenauerallee 119, 53113 Bonn, Germany. bindl@mailer.ukb.uni-bonn.de
Insights
Male children are more prone to severe sepsis, even before puberty. This study found a higher male-to-female ratio in sepsis patients, suggesting factors beyond testosterone influence this gender disparity in severe sepsis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Male gender is a known risk factor for severe sepsis and septic shock, often attributed to higher testosterone levels.
- This predisposition is typically observed in adults, but its presence in prepubertal children, with low sex hormone levels, remained unclear.
Purpose of the Study:
- To investigate if a male preponderance exists in prepubertal patients with severe sepsis, similar to adults.
- To explore potential factors contributing to gender differences in sepsis severity in young children.
Main Methods:
- Retrospective analysis of the ESPNIC ARDS database for patients aged up to 8 years with sepsis.
- Comparison of male/female ratios in septic patients versus non-septic ARDS patients.
- Subgroup analysis based on age and causative bacteria (Neisseria meningitidis vs. others).
Main Results:
- A significant male preponderance (M/F ratio 1.7) was observed in prepubertal sepsis patients, comparable to adult sepsis data.
- The male preponderance was highest in infants (1-12 months) with a M/F ratio of 2.8.
- No male preponderance was found in patients with meningococcal septic shock, and the overall M/F ratio for severe sepsis (excluding meningococcal) was 2.1.
Conclusions:
- Prepubertal children with sepsis exhibit an increased frequency of males, similar to adult populations.
- The male preponderance in severe sepsis among young children is likely due to factors other than testosterone.
- Further research is needed to identify non-hormonal factors contributing to gender disparities in pediatric sepsis.
Abstract:
Male gender predisposes to severe sepsis and septic shock. This effect has been ascribed to higher levels of testosterone. The ESPNIC ARDS database was searched, to determine if there was evidence of a similar male preponderance in severe sepsis in prepubertal patients in spite of low levels of male sex hormones at this age. A total of 72 patients beyond neonatal age up to 8 years of age with sepsis were identified. The male/female (M/F) ratio was 1.7 (1.0;2.7) and differed significantly from non-septic ARDS patients in this age group [n = 209; M/F = 1.0 (0.8;1.3)]. The highest M/F-ratio was observed in the first year of life. The gender-ratio was the same as reported in adult patients with sepsis. In infants between 1 month and 12 months of age, the ratio was 2.8 (1.2;6.1) (Chi2= 5.6; P< 0.01), in children from 1 year to 8 years of age it was 1.2 (0.7;2.2) (n.s.). In a subgroup of patients with severe sepsis or septic shock, caused by other bacteria than Neisseria meningitidis, the M/F-ratio was 2.1 (1.2;3.6) (Chi2= 4.9; P<0.05), while in patients with meningococcal sepsis (n=20) the M/F-ratio was 1.0 (0.4;2.3). In prepubertal ARDS patients with sepsis an increased frequency of male patients is found, comparable to adults. No male preponderance exists in patients with ARDS due to meningococcal septic shock. Since levels of testosterone and other sex hormones are extremely low at this age, we conclude that factors others than testosterone are involved in the male preponderance in severe sepsis.