A Multicenter Observational Cohort Study of Angiotensin II in Shock

作者：Susan Smith, Andrea S. Newsome, Yanglin Guo, Jason Hecht, Michael T. McCurdy, Michael Mazzeffi, Jonathan H. Chow, Shravan Kethireddy · 发表于：Journal of Intensive Care Medicine · 年份：2020 · DOI：10.1177/0885066620972943 · 被引用次数：34 · 研究领域：Renin-Angiotensin System Studies、Heart Failure Treatment and Management、Blood Pressure and Hypertension Studies

INTRODUCTION: Angiotensin II (Ang-2) is a non-catecholamine vasopressor that targets the renin-angiotensin-aldosterone system by agonism of the angiotensin type 1 receptor. Its utility as a vasopressor and a catecholamine-sparing agent was demonstrated in the pivotal ATHOS-3 trial, and numerous post-hoc analyses have shown reduced mortality in certain subsets of the population. METHODS: Consecutive adult patients at 5 centers who received Ang-2 from 2017-2020 were included in this multicenter, retrospective observational cohort study. Patient demographics, hemodynamics, and adverse events were collected. The primary outcomes of the study were the mean difference in MAP and norepinephrine (NEpi)-equivalent dose at hours 0 and 3 following initiation of Ang-2 therapy. RESULTS: One hundred and sixty-two patients were included in this study. The primary outcomes of an increase in MAP (mean difference 9.3 mmHg, 95% CI 6.4-12.1, p < 0.001) and a reduction in NEpi equivalent dose (mean difference 0.16 µg/kg/min, 95% CI 0.10-0.22, p < 0.001) between hours 0 and 3 were statistically significant. The median time to reach a MAP ≥65 was 16 minutes (IQR 5-60 min). After stratifying patients by the NED dose and number of vasopressors administered prior to the initiation of Ang-2, those with a NED dose < 0.2 µg/kg/min, NED dose < 0.3 µg/kg/min, or those on ≤ 3 vasopressors had a significantly greater reduction in NED by hour 3 than those patients above these thresholds. CONCLUSION: Ang-2 is ...