title: Gender-based differences in children with sepsis and ARDS: the ESPNIC ARDS Database Group.
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.
authors.affiliation: University Childrens Hospital, Adenauerallee 119, 53113 Bonn, Germany. bindl@mailer.ukb.uni-bonn.de
authors.forename: Lutz
authors.initials: L
authors.lastname: Bindl
authors.forename: Stephan
authors.initials: S
authors.lastname: Buderus
authors.forename: Peter
authors.initials: P
authors.lastname: Dahlem
authors.forename: Sueha
authors.initials: S
authors.lastname: Demirakca
authors.forename: Martin
authors.initials: M
authors.lastname: Goldner
authors.forename: Ralf
authors.initials: R
authors.lastname: Huth
authors.forename: Martina
authors.initials: M
authors.lastname: Kohl
authors.forename: Martin
authors.initials: M
authors.lastname: Krause
authors.forename: Peter
authors.initials: P
authors.lastname: Kühl
authors.forename: Peter
authors.initials: P
authors.lastname: Lasch
authors.forename: Klaus
authors.initials: K
authors.lastname: Lewandowski
authors.forename: Ulrich
authors.initials: U
authors.lastname: Merz
authors.forename: Jens
authors.initials: J
authors.lastname: Moeller
authors.forename: Yehya
authors.initials: Y
authors.lastname: Mohamad
authors.forename: Mark
authors.initials: M
authors.lastname: Peters
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Porz
authors.forename: Anne
authors.initials: A
authors.lastname: Vierzig
authors.forename: Jochen
authors.initials: J
authors.lastname: Rüchard
authors.forename: Jochem
authors.initials: J
authors.lastname: Scharf
authors.forename: Verena
authors.initials: V
authors.lastname: Varnholt
mesh_terms: 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
chemical_list: D012739:Gonadal Steroid Hormones