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

Abstract

abstract Introduction Adrenal insufficient occurs in Human immunodeficiency virus (HIV)/ Acquired Immunodeficienc) Syndrome (AIDS) and causes morbidity and mortalit} 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 w’ith sepsis as defined by a tool adopted from the consensus conference held 2008 wore 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 intravenous!} to stimulate the adrenal glands and serum cortisol levels at 30 and 60 minutes done following the stimulation. Patients wore 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 < I30nmol,'l and or failure to achieve cortisol levels of > 414nmol/l post stimulation. Results A total of 94 HIV infected and HIV uninfected patients wore 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 insufficienc} in the two groups. The pre\alence of primarx adrenal insufficiency in the stud\ and comparative groups was 19% and 25.5% respective! y. 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.