title: Impact of gender on sepsis mortality and severity of illness for prepubertal and postpubertal children.
abstract: OBJECTIVE
  To investigate differences in sepsis mortality between prepubertal and postpubertal males and females.
  
  
  METHODS
  This was a retrospective review of the Virtual PICU Systems (VPS) database (including 74 pediatric intensive care units [PICUs]) for 2006-2008. We included prepubertal (aged 2-7 years) and postpubertal (aged 16-21 years) children with a primary diagnosis of sepsis admitted to a participating PICU.
  
  
  RESULTS
  Prepubertal females (n = 272; 9.9% mortality) and prepubertal males (n = 303; 10.9% mortality) had similar mortality and severity of illness (Pediatric Index of Mortality 2 risk of mortality [PIM 2 ROM]). Postpubertal females (n = 233; mortality, 5.6%) had lower mortality than postpubertal males (n = 212; mortality, 11.8%; P = .03). PIM 2 ROM was higher for postpubertal males than postpubertal females (P = .02). After controlling for hospital specific effects with multivariate modeling, in postpubertal children, female gender was independently associated with a lower initial severity of illness (PIM 2 ROM: OR, 0.77; 95% CI, 0.62-0.96; P = .02).
  
  
  CONCLUSIONS
  Sepsis mortality is similar in prepubertal males and females. However, postpubertal males have a higher sepsis mortality than postpubertal females, likely related to their greater severity of illness on PICU admission. These outcome differences in postpubertal children may reflect a hormonal influence on the response to infection or differences in underlying comorbidities, source of infection, or behavior.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Anoopindar K
authors.initials: AK
authors.lastname: Ghuman
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Newth
authors.forename: Robinder G
authors.initials: RG
authors.lastname: Khemani
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015278:Intensive Care Units, Pediatric; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011627:Puberty; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality*; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: AIC; Akaike information criterion; BIC; CARS; Compensatory anti-inflammatory response syndrome; LOS; Length of stay; PICU; PIM 2; Pediatric Index of Mortality 2; Pediatric intensive care unit; ROM; Risk of mortality; SIRS; Schwarz Bayes information criterion; Systemic inflammatory response syndrome; VPS; Virtual PICU Systems; ll; −2 log likelihood