Angiotensin II in Decompensated Cirrhosis Complicated by

Semin Cardiothorac Vasc Anesth · Sep 2020

Case Reports

Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock.

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.

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- Patrick J Coleman, Alexander P Nissen, Daniel E Kim, Craig R Ainsworth, Michael T McCurdy, Michael A Mazzeffi, and Jonathan H Chow.
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
- Semin Cardiothorac Vasc Anesth. 2020 Sep 1; 24 (3): 266-272.
AbstractThis 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.

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Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock.

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