Angiotensin II for the treatment of vasodilatory shock

Khanna, Ashish, English, Shane W., Wang, Xueyuan S., Ham, Kealy, Tumlin, James, Szerlip, Harold, Busse, Laurence W., Altaweel, Laith, Albertson, Timothy E., Mackey, Caleb, McCurdy, Michael T., Boldt, David W., Chock, Stefan, Young, Paul J., Krell, Kenneth, Wunderink, Richard G., Ostermann, Marlies, Murugan, Raghavan, Gong, Michelle N., Panwar, Rakshit, Hastbacka, Johanna, Favory, Raphael, Venkatesh, Balasubramanian, Thompson, B. Taylor, Bellomo, Rinaldo, Jensen, Jeffrey, Kroll, Stew, Chawla, Lakhmir S., Tidmarsh, George F. and Deane, Adam M. (2017) Angiotensin II for the treatment of vasodilatory shock. New England Journal of Medicine, 377 5: 419-430. doi:10.1056/NEJMoa1704154

Author Khanna, Ashish
English, Shane W.
Wang, Xueyuan S.
Ham, Kealy
Tumlin, James
Szerlip, Harold
Busse, Laurence W.
Altaweel, Laith
Albertson, Timothy E.
Mackey, Caleb
McCurdy, Michael T.
Boldt, David W.
Chock, Stefan
Young, Paul J.
Krell, Kenneth
Wunderink, Richard G.
Ostermann, Marlies
Murugan, Raghavan
Gong, Michelle N.
Panwar, Rakshit
Hastbacka, Johanna
Favory, Raphael
Venkatesh, Balasubramanian
Thompson, B. Taylor
Bellomo, Rinaldo
Jensen, Jeffrey
Kroll, Stew
Chawla, Lakhmir S.
Tidmarsh, George F.
Deane, Adam M.
Title Angiotensin II for the treatment of vasodilatory shock
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 1533-4406
Publication date 2017-08-01
Year available 2017
Sub-type Article (original research)
DOI 10.1056/NEJMoa1704154
Open Access Status Not yet assessed
Volume 377
Issue 5
Start page 419
End page 430
Total pages 12
Place of publication Waltham, MA, United States
Publisher Massachussetts Medical Society
Language eng
Subject 2700 Medicine
Abstract BACKGROUND Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated the effectiveness of angiotensin II for the treatment of patients with this condition. METHODS We randomly assigned patients with vasodilatory shock who were receiving more than 0.2 μg of norepinephrine per kilogram of body weight per minute or the equivalent dose of another vasopressor to receive infusions of either angiotensin II or placebo. The primary end point was a response with respect to mean arterial pressure at hour 3 after the start of infusion, with response defined as an increase from baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, without an increase in the dose of background vasopressors. RESULTS A total of 344 patients were assigned to one of the two regimens; 321 received a study intervention (163 received angiotensin II, and 158 received placebo) and were included in the analysis. The primary end point was reached by more patients in the angiotensin II group (114 of 163 patients, 69.9%) than in the placebo group (37 of 158 patients, 23.4%) (odds ratio, 7.95; 95% confidence interval [CI], 4.76 to 13.3; P<0.001). At 48 hours, the mean improvement in the cardiovascular Sequential Organ Failure Assessment (SOFA) score (scores range from 0 to 4, with higher scores indicating more severe dysfunction) was greater in the angiotensin II group than in the placebo group (-1.75 vs. -1.28, P = 0.01). Serious adverse events were reported in 60.7% of the patients in the angiotensin II group and in 67.1% in the placebo group. Death by day 28 occurred in 75 of 163 patients (46%) in the angiotensin II group and in 85 of 158 patients (54%) in the placebo group (hazard ratio, 0.78; 95% CI, 0.57 to 1.07; P = 0.12). CONCLUSIONS Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors.
Keyword Refractory Septic Shock
Severe Sepsis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Faculty of Medicine
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