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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
MacGowan JE, Barnes MW, Finland N (1975) Bacteremia at Boston City Hospital: occurrence and mortality during 12 selected years (1935–1972) with special reference to hospital-acquired cases. J Infect Dis 132:316–335
Schröder J, Kahlke V, Staubach KH, Zabel P, Stüber F (1998) Gender differences in human sepsis. Arch Surg 133:1200–1205
Wichmann MW, Inthorn D, Andress HJ, Schildberg FW (2000) Incidence and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome. Intensive Care Med 26:167–172
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky R (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
Tasker RC (2000) Gender differences and critical medical illness. Acta Paed Scand 89:621–622
Angele MK, Schwacha MG, Ayala A, Chaudry IH (2000) Effect of gender and sex hormones on immune responses following shock. Shock 14:81–90
Losonczy G, Kriston T, Szabo A, Muller V, Harvey J, Hamar P, Heemann U, Baylis C (2000) Male gender predisposes to development of endotoxic shock in the rat. Cardiovasc Res 47:183–91
Ikejima K, Enomoto N, Iimuro Y, Ikejima A, Fang D, Xu J, Forman DT, Brenner DA, Thurman RG (1998) Estrogen increases sensitivity of hepatic Kupffer cells to endotoxin. Am J Physiol 274:G669–76
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R, The Consensus Committee (1994) Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Intensive Care Med 20:225–232
European Parliament (1995) Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC (2003). The epidemiology of severe sepsis in newborns, infants, and children in the U.S. AJRCCM167:695–701
Levine M, Quint PA, Goldstein B, Barton P, Bradley JS, Shemie SD, Yeh T, Kim SS, Cafaro DP, Scannon PJ, Giroir BP (2000) Recombinant bactericidal/permeability-increasing protein (rBPI21) as adjunctive treatment for children with severe meningococcal sepsis: a randomised trial. Lancet 356:961–967
Geishofer G, Mannhalter C, Häring D, Triebl K, Endler G, Panzer S, Zenz W (2002) Der 4G/4G-Polymorphismus der Promotorregion des Plasminogen Aktivator Inhibitor 1 Gens korreliert mit der Prognose der Meningokokkensepsis. Abstract presented at the "Jahrestagung Österreichische Gesellschaft für Kinder- und Jugendheilkunde, Wien"
German Childhood Cancer Registry (2000) Annual Report 2000. IMBEI, Mainz, p34
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bindl, L., Buderus, S., Dahlem, P. et al. Gender-based differences in children with sepsis and ARDS: The ESPNIC ARDS Database Group. Intensive Care Med 29, 1770–1773 (2003). https://doi.org/10.1007/s00134-003-1948-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-003-1948-z