Adrenal insufficiency and mortality in children aged 3 months to 12 years with sepsis and septic shock at Kenyatta National Hospital

Abstract

Background and objective: Children with sepsis and septic shock may have adrenal insufficiency or an exaggerated cortisol level rise and this factors increase the rate of mortality. We aimed to find out what the mortality rate is in children with adrenal insufficiency and in those with exaggerated cortisol rise. This information would provide a basis of adaptation of the Surviving Sepsis Guidelines to reduce progression of sepsis to septic shock, improve shock reversal and reduce stay in ICU thus improving survival and outcomes.
Methods: Hospital based cross sectional study done over three months among children aged 3 months and 12 years at the pediatric outpatient unit, acute rooms of pediatric wards, pediatric ICU and main ICU in Kenyatta National Hospital. Consecutive sampling was done and children who met the inclusion criteria were enrolled into the study. A standard questionnaire was used for data collection and a blood sample taken from each participant for cortisol assay.
Results: 80 participants were enrolled into the study. 35 died. Two (5.7%) participants who died had low cortisol, 7 (20%) had no rise in cortisol, 3 (8.6) had a normal response in cortisol rise while 23 (65.7%) had an exaggerated rise in cortisol. A significant association between the levels of cortisol and mortality (p= 0.027, Fishers exact test). Mortality was found to be higher in those found to have exaggerated levels of cortisol (p-value 0.007).
Conclusion: Mortality associated with exaggerated cortisol levels. Adrenal insufficiency had no impact on mortality rate.