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Sex Differences in Inflammatory Response and Acid–Base Balance in Prepubertal Children with Severe Sepsis

Lefèvre, Nicolas; Noyon, Benjamin; Biarent, Dominique; Corazza, Francis; Duchateau, Jean; Casimir, Georges

doi: 10.1097/SHK.0000000000000773
Clinical Aspects
Editor's Choice

Purpose and Methods: The severity and prognosis of various acute inflammatory conditions, such as sepsis, differ between males and females. The mechanisms underlying these sex differences probably involve both hormonal and genetic factors. In order to evaluate a possible genetic influence, we reviewed clinical signs and biological inflammatory markers of prepubertal children with severe sepsis admitted to the pediatric intensive care unit (PICU).

Findings: A total of 142 prepubertal children, 66 girls and 76 boys, suffering from severe sepsis and admitted to the PICU were included. The survival rate demonstrated a tendency to be higher in females (P = 0.14). Maximum white blood cell count (23,800 cells/μL [15,110–34,600] in girls vs. 19,025 cells/μL [12,358–26,098] in boys, P = 0.02), neutrophil count (16,944 cells/μL [10,620–27,540] vs. 13,756 cells/μL [8410–20,110], P = 0.03), and C-reactive protein level (26.2 mg/dL [15.7–33.6] vs. 18.8 mg/dL [11.1–30.0], P = 0.04) were all significantly higher in girls. Girls also exhibited significantly longer fever duration (2 days [1–6] vs. 1 day [1–3] for the boys, P <0.01), lower pH on admission (7.32 [7.25–7.39] vs. 7.37 [7.31–7.43] P = 0.03), and lower base excess (−6 mEq/L [−10.7 to −0.8] vs. −2.3 mEq/L [−6.6 to −2.6], P <0.01), as well as lower bicarbonate levels (19.1 mEq/l [15.9–24.0] vs. 21.15 mEq/l [18.3–26.68], P = 0.04), when compared with the boys.

Conclusions: Our study revealed higher neutrophilic inflammation, as well as lower pH on admission, in girls with severe sepsis; associated with longer fever duration, which could contribute to better pathogen clearance. However, further studies are needed to demonstrate the link between acidosis and modulation of the immune response.

*Department of Pulmonology, Allergology and Cystic Fibrosis, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium

Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium

Department of Emergency Medicine, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium

§Department of Critical Care Medicine, Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium

||Laboratory of Pediatrics, Free University of Brussels, Brussels, Belgium

Address reprint requests to Nicolas Lefèvre, MD, Department of Pulmonology, Allergology, and Cystic Fibrosis, Queen Fabiola Children's University Hospital, Free University of Brussels, Avenue J.J. Crocq 15, B-1020 Brussels, Belgium; E-mail: nicolas.lefevre@huderf.be

Received 6 June, 2016

Revised 29 June, 2016

Accepted 6 October, 2016

NL analyzed and interpreted the data, and drafted the manuscript. BN screened the patients, collected the data, and revised the manuscript. DB participated in the design of the study and helped to collect the data and revise the manuscript. FC participated in the design of the study and helped to draft the manuscript. JD performed the statistical analysis and helped to revise the manuscript. GC conceived of the study, and participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.

NL received a grant from “The Belgian Kid's Fund.”

The authors report no conflicts of interest.

© 2017 by the Shock Society