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Sex Differences in Inflammatory Response and Acid-Base Balance in Prepubertal Children with Severe Sepsis
Nicolas Lefèvre1, Benjamin Noyon, Dominique Biarent
1*Department of Pulmonology, Allergology and Cystic Fibrosis, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium †Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium ‡Department of Emergency Medicine, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium §Department of Critical Care Medicine, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium ||Laboratory of Pediatrics, Free University of Brussels, Brussels, Belgium.
Insights
Prepubertal girls with severe sepsis show higher neutrophilic inflammation and longer fever duration, potentially aiding pathogen clearance. Further research is needed to explore the link between acidosis and immune response modulation in pediatric sepsis.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Genetics
Background:
- Sex differences exist in the severity and prognosis of acute inflammatory conditions like sepsis.
- Hormonal and genetic factors are implicated in these sex-based variations.
- Understanding these differences is crucial for tailored treatment strategies in pediatric intensive care.
Purpose of the Study:
- To investigate potential genetic influences on sex differences in severe sepsis among prepubertal children.
- To analyze clinical signs and biological inflammatory markers in relation to sex.
Main Methods:
- A cohort of 142 prepubertal children (66 girls, 76 boys) with severe sepsis admitted to the pediatric intensive care unit (PICU) was studied.
- Clinical data including white blood cell count, neutrophil count, C-reactive protein levels, fever duration, pH, base excess, and bicarbonate levels were analyzed.
- Survival rates were also compared between sexes.
Main Results:
- Girls exhibited significantly higher maximum white blood cell counts, neutrophil counts, and C-reactive protein levels compared to boys.
- Female patients experienced significantly longer fever duration and presented with lower pH, base excess, and bicarbonate levels on admission.
- A trend towards a higher survival rate was observed in girls, though not statistically significant (P=0.14).
Conclusions:
- Prepubertal girls with severe sepsis demonstrate heightened neutrophilic inflammation and prolonged fever, which may enhance pathogen clearance.
- Lower pH on admission in girls suggests a different metabolic response to sepsis.
- Further investigation is warranted to elucidate the relationship between acidosis and immune response modulation in pediatric sepsis.
Purpose And Methods:
The severity and prognosis of various acute inflammatory conditions, such as sepsis, differ between males and females. The mechanisms underlying these sex differences probably involve both hormonal and genetic factors. In order to evaluate a possible genetic influence, we reviewed clinical signs and biological inflammatory markers of prepubertal children with severe sepsis admitted to the pediatric intensive care unit (PICU).
Findings:
A total of 142 prepubertal children, 66 girls and 76 boys, suffering from severe sepsis and admitted to the PICU were included. The survival rate demonstrated a tendency to be higher in females (P = 0.14). Maximum white blood cell count (23,800 cells/μL [15,110-34,600] in girls vs. 19,025 cells/μL [12,358-26,098] in boys, P = 0.02), neutrophil count (16,944 cells/μL [10,620-27,540] vs. 13,756 cells/μL [8410-20,110], P = 0.03), and C-reactive protein level (26.2 mg/dL [15.7-33.6] vs. 18.8 mg/dL [11.1-30.0], P = 0.04) were all significantly higher in girls. Girls also exhibited significantly longer fever duration (2 days [1-6] vs. 1 day [1-3] for the boys, P <0.01), lower pH on admission (7.32 [7.25-7.39] vs. 7.37 [7.31-7.43] P = 0.03), and lower base excess (-6 mEq/L [-10.7 to -0.8] vs. -2.3 mEq/L [-6.6 to -2.6], P <0.01), as well as lower bicarbonate levels (19.1 mEq/l [15.9-24.0] vs. 21.15 mEq/l [18.3-26.68], P = 0.04), when compared with the boys.
Conclusions:
Our study revealed higher neutrophilic inflammation, as well as lower pH on admission, in girls with severe sepsis; associated with longer fever duration, which could contribute to better pathogen clearance. However, further studies are needed to demonstrate the link between acidosis and modulation of the immune response.
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