EFFICACY OF NOVEL SYNTHETIC ANGIOTENSIN II IN SEPTIC SHOCK

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Septic shock is a form of distributive shock characterized by decreased organ perfusion secondary to a dysregulated host response to infection. Septic shock has been associated with life-threatening multiple organ dysfunction and staggering mortality, with some studies estimating mortality greater than 50%. One of the cornerstones of improving outcomes has been maintaining adequate mean arterial pressure with vasopressors. Preliminary trials have shown that synthetic angiotensin II, a novel category of vasopressors which acts directly on the renin-angiotensin-aldosterone system, has significant vasopressor effect with no significant difference in serious adverse effects. Our study examined the effects of synthetic angiotensin II as a third-line agent in septic shock, comparing the change in MAP three hours after initiation, lactate clearance three hours after initiation, length of ICU stay, and cost. METHODS: We conducted a retrospective cohort study examining patients with septic shock on two vasopressors, with catecholamine-resistant shock (total catecholamine dose requirement >0.2 mcg/kg/min), requiring the initiation of a third agent. We compared patients who received synthetic angiotensin II versus a control group of any other appropriate third-line vasopressor. The protocol was approved by the IRB at Orange Regional Medical Center and data was obtained from the charts of ICU patients at the same hospital. RESULTS: There was a statistically significant increase in MAP at three hours in the angiotensin II group compared to the control group (16.3 mmHg vs. 4.3 mmHg; p = 0.0304). Overall, lactic acid clearance at 3 hours in the angiotensin II group was better than in the control group (13.39% vs. -57.2%), but was not statistically significant (p = 0.1338). Length of ICU stay did not statistically differ between the groups (433.6 hours vs 402.9 hours; p = 0.8370). Cost was significantly higher in the angiotensin II group versus the control group ($5717.84 vs. $1267.21; p < 0.0001). CONCLUSIONS: In our study of patients with catecholamine-resistant septic shock, initiation of synthetic angiotensin II as a third-line agent showed a significant improvement in MAP at 3 hours compared to other traditional third-line agents, without improvement in lactate clearance or ICU length of stay and at significantly higher cost. While showing promise as a potent vasopressor, given that angiotensin II has not yet demonstrated significant reductions in length of ICU stay, duration of mechanical ventilation, or mortality, the cost effectiveness of its use should also be taken into consideration. CLINICAL IMPLICATIONS: In the setting of catecholamine-resistant septic shock, our data shows that synthetic angiotensin II is associated with significant improvement in MAP at three hours compared to traditional third-line vasopressors and may play an important role in patients with catecholamine-resistant shock. DISCLOSURES: No relevant relationships by Maria Chaudhry, source=Web Response No relevant relationships by Murali Krishna, source=Web Response No relevant relationships by Karthika Linga, source=Web Response No relevant relationships by Isaac Pak, source=Web Response No relevant relationships by Lauren Stuczynski, source=Web Response