Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock. (September 2020)

• Record Type: Journal Article
• Authors: Coleman, Patrick J.; Nissen, Alexander P.; Kim, Daniel E.; Ainsworth, Craig R.; McCurdy, Michael T.; Mazzeffi, Michael A.; Chow, Jonathan H.
• Is Part Of: Seminars in cardiothoracic and vascular anesthesia. Volume 24:Number 3(2020)
• Page Start: 266
• Page End: 272
• Publication Date: 2020-09
• Subjects: vasodilatory shock -- angiotensin II -- liver failure -- end-stage liver disease -- decompensated cirrhosis -- sepsis -- septic shock; Cardiovascular system -- Surgery -- Methods -- Periodicals; Chest -- Surgery -- Methods -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Cardiovascular Surgical Procedures -- methods -- Periodicals; Thoracic Surgical Procedures -- methods -- Periodicals; 617.96
• DOI: 10.1177/1089253219877876
• Languages: English
• ISSNs: 1089-2532

Abstract

This case describes the first reported use of human-derived synthetic angiotensin II (Ang-2) in a patient with decompensated cirrhosis and septic shock. The patient presented in vasodilatory shock from Enterobacter cloacae bacteremia with a Sequential Organ Failure Assessment Score of 14 and a Model for End-Stage Liver Disease score of 36. This case is significant because liver failure was an exclusion criterion in the Angiotensin II for the Treatment of Vasodilatory Shock (ATHOS-3) trial, but the liver produces angiotensinogen, which is key precursor to Ang-2 in the renin-angiotensin-aldosterone system. Resuscitation with Ang-2 is a potentially beneficial medication when conventional vasopressors have failed to control mean arterial pressure in this population.