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258Y262, 2010
INTRODUCTION
Copyright @ 2010 by the Shock Society. Unauthorized reproduction of this article is prohibited.
GENDER DIFFERENCES
IN INFLAMMATORY
MARKERS
IN
CHILDREN
259
33.5 (1Y96)
P (Mann-Whitney)
0.53
ESR, mm/h
39.5 (2Y104)
24 (1Y104)
0.005
CRP, mg/dL
5.45 (0.2Y36)
2.6 (0.3Y37.3)
0.0001
Body temperature, -C
38.3 (35.5Y40.8)
38.3 (35.6Y40.8)
0.98
1 (0Y240)*
1 (0Y80)*
0.06
14,040 (2,940Y35,210)
13,110 (2,820Y43,470)
0.73
8,796 (328Y27,647)
6,774 (600Y38,688)
0.02
3,100 (511Y12,758)
Platelets, cells/2L
334,000 (32,000Y952,000)
No. subjects
241
3,072 (563Y12,728)
316,500 (32,000Y833,000)
0.56
0.66
241
Neutrophil counts
Neutrophil counts were estimated using the reader from Bayer, Technicon
H2 (Dublin, Ireland) and Advia 120 hematology analyzer (Siemens Healthcare Diagnostic, Brussels, Belgium).
Body temperature
To establish central body temperatures, intrarectal measurements were
made using a mercury thermometer. Fever was defined for central body
temperature values greater than 37.5-C.
Statistical analysis
For discrete variable, Fisher exact test was used, and for nonparametric
variables, Mann-Whitney test. Multiple regression analysis was used to
determine related variables, and the Kruskal-Wallis test to analyze relationship
between multiple nonparametric variables.
RESULTS
The study population comprised 482 children, age- and
sex-matched, who had had different infectious conditions.
Copyright @ 2010 by the Shock Society. Unauthorized reproduction of this article is prohibited.
260
CASIMIR
ET AL.
Percentile plots of CRP concentrations, ESR, and neutrophil counts (Figs. 2Y4) clearly showed separate distributions
for boys (below) and girls (above). Figures 2 and 3 show separate curves above a threshold of CRP 2.5 mg/dL and ESR 20
mm/h up to CRP 25 mg/dL and ESR 80 mm/h. The same was
true for neutrophil count (Fig. 4), with two distinct distributions observed for values between 7,500 and 20,000 cells/2L.
The trend was the same when patients were classified according to their specific infectious condition (results not shown). In
the case of bronchiolitis, separate curves were already visible
for neutrophil counts greater than 2,000 cells/2L. Further
analyses were made with respect to the specific infectious
disease.
PyelonephritisBody temperature at admission was not
significantly different for both sexes. However, significant
differences were observed between girls and boys with respect
to CRP concentration (P = 0.02) and both white blood cell and
neutrophil counts (P = 0.04 and 0.03, respectively) (Table 2).
Copyright @ 2010 by the Shock Society. Unauthorized reproduction of this article is prohibited.
GENDER DIFFERENCES
IN INFLAMMATORY
MARKERS
IN
CHILDREN
261
26.5 (2Y104)
ESR, mm/h
19 (1Y116)
53 (13Y75)
CRP, mg/dL
36.5 (3Y82)
9.8 (1.7Y34.9)
Body temperature, -C
39 (36.7Y40.5)
35 (1Y96)
0.47
0.14
7.5 (0.5Y20.4)
P (Mann-Whitney)
38.2 (36.9Y40.5)
24 (1Y80)
0.02
0.2
0.27
WBC, cells/2L
18,490 (5,440Y30,780)
13,700 (5,800Y28,489)
0.04
Neutrophils, cells/2L
11,440 (2,263Y23,055)
7,700 (600Y17,608)
0.03
Lymphocytes, cells/2L
3,898 (1,008Y10,680)
Platelets, cells/2L
3,024 (1,127Y7,955)
289,500 (208,000Y606,000)
303,000 (172,000Y525,000)
20
19
No. subjects
DISCUSSION
Our retrospective study presents some weaknesses, because
it focused only on three markers of the inflammatory response
while key cytokines or other upstream mediators (e.g., IL-6,
IL-2, IL-12, TNF, and NO) were not measured. However,
using usual biological markers (CRP, ESR, and neutrophil
count), these data show that marked differences exist between
boys and girls younger than 10 years. Possible differences in
immune reactivity due to age were excluded because male and
female subjects were age matched. Longer periods of hospitalization in girls, for example, with bronchiolitis, and
longer duration of fever after antibiotic therapy, also in girls,
generally suggest that sex can modulate the clinical expression of certain symptoms and perhaps the severity of disease.
However, new prospective studies are needed to evaluate
whether sexual differences in inflammatory markers are
associated with clear quantitative and/or qualitative clinical
0.46
0.59
38 (1Y121)
CRP, mg/dL
5.5 (0.2Y36)
ESR, mm/h
44.5 (2Y104)
WBC, cells/2L
P Mann-Whitney
0.27
0.001
0.01
13,730 (2,940Y35,210)
12,925 (2,820Y43,470)
0.83
Neutrophils, cells/2L
8,794 (328Y27,645)
7,785 (875Y38,688)
0.77
Lymphocytes, cells/2L
3,052 (511Y12,758)
3,097 (563Y12,728)
1 (0Y240)
1 (0Y64)
78
72
19
15
33
39 (36.2Y40.8)
192
0.81
0.11
29
39 (36Y40)
192
Copyright @ 2010 by the Shock Society. Unauthorized reproduction of this article is prohibited.
0.74
262
CASIMIR
ET AL.
5 (1Y12)
P (Mann-Whitney)
0.20
CRP, mg/dL
0.5 (0.5Y8.1)
0.55 (0.5Y8)
0.61
ESR, mm/h
8.5 (2Y67)
10.5 (1Y60)
0.84
WBC, cells/2L
Neutrophils, cells/2L
Hospitalization, d
No. subjects
14,000 (4,890Y23,760)
5,267 (1,433Y14,921)
15 (9Y42)
29
11,900 (3,300Y23,260)
0.35
3,385 (921Y14,002)
0.02
0.0007
10 (3Y24)
30
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Copyright @ 2010 by the Shock Society. Unauthorized reproduction of this article is prohibited.