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Published on: May 7, 2011
Sex Differences in Pediatric Sepsis Mortality: A Systematic Review and Meta-Analysis
Uchenna K Kennedy1, Juliette Moulin2, Lea Bührer3
1Children's Research Center, Division of Pediatric Urology, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Pediatric sepsis mortality is higher in boys than girls, according to a large systematic review. This finding highlights potential sex-based disparities in childhood sepsis outcomes, warranting further investigation.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Pediatric sepsis is a significant global cause of childhood mortality.
- Sex differences are known to influence disease risk, treatment, and outcomes.
- Adult studies indicate sex-specific responses to septic shock.
Purpose of the Study:
- To systematically review and meta-analyze the association between sex and outcomes in hospitalized children with sepsis.
- To investigate potential sex-based differences in pediatric sepsis mortality.
Main Methods:
- Searched Medline and Embase databases for studies published between January 2005 and March 2022.
- Included cohort studies and randomized controlled trials involving children (≥37-week-old postconception to 18 years) with sepsis, severe sepsis, or septic shock.
- Performed random-effects meta-analysis on extracted data, including patient demographics and illness severity.
Main Results:
- Analyzed 124 studies involving 426,163 pediatric patients (47% girls).
- Found moderate evidence of higher mortality in boys compared to girls with sepsis (Risk Difference: -0.005).
- The association between higher boy mortality and sepsis persisted when adjusting for country income level.
Conclusions:
- This systematic review and meta-analysis provides moderate evidence for increased sepsis mortality in boys compared to girls.
- The observed sex difference in pediatric sepsis mortality is robust and remains significant even after accounting for national income levels.
Objectives:
Pediatric sepsis remains a leading cause of childhood mortality worldwide. Sex differences have been shown to modify risk factors, treatment, and outcome of various diseases, and adult studies revealed sex differences in pathophysiological responses to septic shock. We aimed to perform a systematic review and meta-analysis on the association of sex with outcomes in hospitalized children with sepsis.
Data Sources:
Medline and Embase databases were searched for studies of children < 18 years with sepsis published between January 01, 2005, and March 31, 2022.
Study Selection:
We included cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years which included sepsis, severe sepsis or septic shock, and mortality as an outcome.
Data Extraction:
Study characteristics, patient demographics, and illness severity scores were extracted from eligible articles. Random-effects meta-analysis was performed.
Data Synthesis:
We screened 14,791 studies, with 912 full-text reviews and inclusion of 124 studies. The total population involved 426,163 patients, of which 47% (201,438) were girls. Meta-regression showed moderate evidence for a higher mortality in boys compared with girls. The estimated risk difference of mortality between boys and girls with all types of sepsis was -0.005 (95% CI, -0.0099 to -0.00001; p = 0.049), indicating slightly higher mortality for boys. When including the World Bank income level as a moderator, the effect was -0.008 (95% CI, -0.013 to -0.002; p = 0.005).
Conclusions:
This large systematic review and meta-analysis on sex differences in pediatric sepsis mortality showed moderate evidence for a higher sepsis mortality in boys compared with girls. The effect persisted when adjusting for country's income level.
