Real-world Experience of Angiotensin II and Renin Usage in Patients With Distributive Shock:A Single-center Descriptive Study.

OBJECTIVE

To evaluate real-life use of angiotensin II, a novel vasopressor, and renin, which can be used as a marker of endogenous angiotensin II deficiency and disease severity.

DESIGN

A retrospective observational single-center cohort study.

SETTING

Four intensive care units in one university hospital.

PARTICIPANTS

Adult patients with distributive shock, no limitations of active care, and with ongoing use of vasoconstrictors (norepinephrine base ≥0.3 mcg/kg/min plus vasopressin), who were admitted between August 2022 and August 2023.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Septic shock (38/42, 90.5%) and post-cardiopulmonary bypass vasoplegia (4/42, 9.5%) were the causes of distributive shock. After the initiation of angiotensin II, a decrease in the norepinephrine base dose at 4, 24, and 48 hours (0.40 ± 0.25 mcg/kg/min, 0.21 ± 0.11 mcg/kg/min, and 0.13 ± 0.06 mcg/kg/min, respectively), and a decrease in vasopressin dose were observed. Renin concentration decreased after initiation of angiotensin II from 376.90 ± 168.50 mU/L to 188.24 ± 167.47 mU/L (p < 0.01). Control renin was lower in survivors to hospital discharge compared with nonsurvivors (78.06 ± 121.14 mU/L in survivors, v 259.07 ± 163.4 mU/L in nonsurvivors, p < 0.01).

CONCLUSIONS

Angiotensin II can be used to decrease the doses of non-angiotensin II vasopressors, and renin concentration may potentially aid in the prognostication of patients with distributive shock.