Gender Affects Recovery Course in Pediatric Burn Patients

Female pediatric burn patients exhibit a reduced inflammatory and hypermetabolic response compared to male patients, according to a study published in the July Annals of Surgery.

"Gender differences in the outcome of critically ill patients have been discussed in many studies and are the center of many ongoing studies," write Dr. Marc G. Jeschke and colleagues from University Texas Medical Branch in Galveston. "We have recently shown that female burned patients have an attenuated postburn response with associated increased endogenous anabolic hormone levels, decreased serum inflammatory markers, and decreased stay in the intensive care unit (ICU) when compared with males."

In the current study, the researchers compared hospital courses and physiological markers in 189 children (76 females) with burns over more than 40% of their total body surface area.

Males and females did not differ in demographics, burn size, nutritional intake, mortality or incidence of infections. Males did, however, have significantly longer ICU stays (35 days versus 26 days in females, p < 0.05). Furthermore, females had a significantly lower percent-predicted resting energy expenditure compared to males (p < 0.05) as well as a significantly attenuated loss in muscle protein net balance (p < 0.05). Between admission and discharge, females gained approximately 3% of their body weight, while males lost 1% of their body weight (p < 0.05).

Systemic inflammatory markers and stress hormone levels were significantly decreased in females compared to males (p < 0.05). In addition, cardiac and liver dysfunction were significantly attenuated in females (p < 0.05).

"These data strongly imply that there is a different response to a severe trauma such as a burn between males and females," Dr. Jeschke said in an interview. "By identifying now why this difference exists, e.g., genetically or hormone related, there may be new developments to improve the outcome."

Ann Surg 2008;248:126-136.

Reviewed by Ramaz Mitaishvili, MD

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