Are Male Children with Cancer More Prone to Severe Sepsis?.

Sexual hormones are potent regulators of various immune functions. Although androgens are immunosuppressive, estrogens protect against septic challenges in animal model. In human sepsis studies post surgery, post trauma in adults have shown survival advantage for female sex with sepsis. Other reality is that in a developing country like India with a population of 1 billion, sex ratio has been gradually falling in the general population. In year 1901 females per 1000 males were 972 and in 2001 females per 1000 males are 933. Neglect of female child and unwillingness on the part of parents to spend money for treatment of girl child is one of the main reason for less number of girls getting treatment for cancer as compared to males. This study was done to find gender difference in incidence of severe sepsis in children with cancer in a single centre in Delhi, India. It was a retrospective analysis of children with and without cancer admitted to the Pediatric Intensive care Unit (PICU) at Sir Ganga Ram Hospital from January 2003 to January 2006, who met the following criteria: 1) severe sepsis by American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria and 2) receipt of fluid boluses of >30 mL/kg or receipt of a dopamine infusion of >5 ug/kg/min. Data evaluated were demographic variables, oncologic diagnosis and time from diagnosis to PICU admission, Pediatric Risk of Mortality I (PRISM I) score, neutropenia, use of inotropes, use of mechanical ventilation, culture results, survival to PICU discharge, and 6-month survival. Total admissions in PICU were 1450 out of which 977 were males (M) and 473 females (F) with M:F =2:1.Total number of children admitted with sepsis in PICU were 517 out of which males were 342 and females 175 with M:F= 2:1. Total number of pediatric oncology admissions in hospital (PICU and Ward) were 420 out of which males were 294 and females 126 with M:F = 2.3:1. Total number of pediatric oncology patients admitted in PICU were 60 out of which 44 were males and 16 were females with M:F = 2.8:1. Total number of consecutive pediatric oncology patients admitted to PICU with severe sepsis were 20 out of which 18 were males and 2 females with M:F =9:1. Overall mortality was 40 % at PICU discharge and 50% at 6 months follow up. 6 /18 (33%) males died as compared to 2/2 (100%) deaths in females. Mean PRISM I score was 11.9 among survivors and 19.4 among non-survivors. Mean Prism score for females was 16 as compared to 14.8 in males. We looked at gender distribution of 35 consecutive pediatric oncology patients with febrile neutropenia in the hospital. 28 were males and 7 females (Ratio M:F = 4:1) We looked at 30 consecutive non-oncology patients admitted with severe sepsis in PICU which showed 25 males and 5 females with a ratio of M:F = 5:1.In conclusion, m ale children with cancer have increased incidence of severe sepsis. This small study may reflect a bias of parents not electing to admit female patients with severe sepsis in hospital but as compared to ratio in total admission in PICU and admissions of oncology patients in ward and PICU the ratio is markedly increased to 9:1 which may indicate gender difference due to genetic basis.