Clinical Response to Third-Line Angiotensin-II vs Epinephrine in Septic Shock: A Propensity-Matched Cohort Study.

Autor:	Blankenship CR; Department of Pharmacy Practice, Barnes-Jewish Hospital, St. Louis, MO, USA., Betthauser KD; Department of Pharmacy Practice, Barnes-Jewish Hospital, St. Louis, MO, USA., Hencken LN; Department of Pharmacy Practice, Barnes-Jewish Hospital, St. Louis, MO, USA., Maamari JA; Department of Pharmacy Practice, Barnes-Jewish Hospital, St. Louis, MO, USA., Goetz J; Department of Pharmacy Practice, Barnes-Jewish Hospital, St. Louis, MO, USA., Giacomino BD; Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA., Gibson GA; Department of Pharmacy Practice, Barnes-Jewish Hospital, St. Louis, MO, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2024 Oct; Vol. 58 (10), pp. 1003-1012. Date of Electronic Publication: 2024 Feb 01.
DOI:	10.1177/10600280231226132
Abstrakt:	Background: The appropriate third-line vasopressor in septic shock patients receiving norepinephrine and vasopressin is unknown. Angiotensin-II (AT-II) offers a unique mechanism of action to traditionally used vasopressors in septic shock. Objective: The objective of this study was to compare the clinical efficacy and safety of third-line AT-II to epinephrine in patients with septic shock. Methods: A single-center, retrospective cohort study of critically ill patients was performed between April 1, 2019 and July 31, 2022. Propensity-matched (2:1) analysis compared adults with septic shock who received third-line AT-II to controls who received epinephrine following norepinephrine and vasopressin. The primary outcome was clinical response 24 hours after third-line vasopressor initiation. Additional efficacy and safety outcomes were investigated. Results: Twenty-three AT-II patients were compared with 46 epinephrine patients. 47.8% of AT-II patients observed a clinical response at hour 24 compared with 28.3% of epinephrine patients ( P = 0.12). In-hospital mortality (65.2% vs 73.9%, P = 0.45), cardiac arrhythmias (26.1% vs 26.1%, P = 0.21), and thromboembolism (4.3% vs 2.2%, P = 0.61) were not observed to be statistically different between groups. Conclusions and Relevance: Administration of AT-II as a third-line vasopressor agent in septic shock patients was not associated with significantly improved clinical response at hour 24 compared with epinephrine. Although underpowered to detect meaningful differences, the clinical observations of this study warrant consideration and further investigation of AT-II as a third-line vasopressor in septic shock. Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KDB discloses being a member of La Jolla Pharmaceutical Company’s speakers bureau at the time this work was completed. KDB is a current employee of Innoviva Specialty Therapeutics. GAG discloses being a member of the speakers bureau for AstraZeneca. All other authors have no relevant disclosures.
Databáze:	MEDLINE
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