Cortisol levels and short term outcome in hiv infected patients with sepsis in Kenyatta Hospital

Abstract

Introduction Adrenal insufficiency occurs in Human immunodeficiency virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) and causes morbidity and mortality in HIV patients. Objective To determine cortisol levels and short term out come at 2 weeks in HIV infected and HIV uninfected patients admitted with sepsis in Kenyatta National hospital. Design This was a Cross Sectional Comparative study. Settings Medical wards, Intensive Care Unit, Renal Units Kenyatta National Hospital. Subjects Patients admitted with sepsis. Method Consecutive HIV infected admitted with sepsis as defined by a tool adopted from the consensus conference held 2008 were recruited. Male or female HIV infected patient’s aged more than 13 yrs and their age and sex matched comparative HIV negative patients were included. A baseline cortisol test was done. Synthetic cosyntrophin was given intravenously to stimulate the adrenal glands and serum cortisol levels at 30 and 60 minutes done following the stimulation. Patients were then followed until 2 weeks after admission to establish their outcome. Expected outcomes were either discharge from the hospital or death. P values of 0.005 were considered significant at confidence intervals of 95%. Adrenal insufficiency was defined as baseline cortisol levels < 130nmol/l and or failure to achieve cortisol levels of > 414nmol/l post stimulation. Results A total of 94 HIV infected and HIV uninfected patients were recruited in the study 47 patients in each group. The mean age was 36±12.2 in the HIV infected group and 37± 13.4 HIV uninfected group. There was no statistically significant difference in the proportions of patients with adrenal insufficiency in the two groups. The prevalence of primary adrenal insufficiency in the study and comparative groups was 19% and 25.5% respectively. There were more deaths in the comparative group 31.9% compared to the study group at 24%. Conclusion There was no significant difference of adrenal insufficiency in the study group and comparative group in the comparative group.