Gender-based differences in children with sepsis and ARDS: the ESPNIC ARDS Database Group.
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.
Bindl
Lutz
L
University Childrens Hospital, Adenauerallee 119, 53113 Bonn, Germany. bindl@mailer.ukb.uni-bonn.de
Buderus
Stephan
S
Dahlem
Peter
P
Demirakca
Sueha
S
Goldner
Martin
M
Huth
Ralf
R
Kohl
Martina
M
Krause
Martin
M
Kühl
Peter
P
Lasch
Peter
P
Lewandowski
Klaus
K
Merz
Ulrich
U
Moeller
Jens
J
Mohamad
Yehya
Y
Peters
Mark
M
Porz
Wolfgang
W
Vierzig
Anne
A
Rüchard
Jochen
J
Scharf
Jochem
J
Varnholt
Verena
V
D002648:Child; D002675:Child, Preschool; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007223:Infant; D008297:Male; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D018805:Sepsis / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012727:Sex Characteristics; D017678:Sex Distribution
D012739:Gonadal Steroid Hormones