(1482) Efficacy and Safety of Angiotensin II for Vasodilatory Shock: A Real-World Analysis

Introduction: Angiotensin II (ATII) was FDA-approved in 2017 as a vasoactive agent used to increase mean arterial pressure (MAP) in vasodilatory shock. This novel agent works through a unique mechanism of action and may be a useful adjunct for blood pressure management in critically-ill patients. Unfortunately, there is limited data surrounding the real-world application and potential role in therapy of ATII.

Methods: A retrospective review of patients receiving ATII for vasodilatory shock at an academic medical center was performed. Patients were excluded if they were < 18 years of age, pregnant or incarcerated. The primary outcome of the study was ATII response, defined as any sustained (>60 min), decrease or discontinuation in background vasopressors after a stable dose of ATII was reached. Secondary outcomes included the incidence of fungal infections or venous thromboembolism (VTE), ICU length of stay (LOS) and in-hospital mortality.

Results: A total of 20 adult patients were included in the final analysis. The majority were female (55%) and 50% of patients were on renal replacement therapy when ATII was initiated. Eighteen (90%) patients were on two or more vasopressors at the start of ATII, with a median (IQR) baseline norepinephrine equivalent (NEE) dose of 0.67 (0.32-1.14) mcg/kg/min. ATII was started after a median (IQR) of 20 (7.4-31) hours of baseline vasopressor use and was continued for a median (IQR) of 14.7 (8.3-24.8) hours. Thirteen patients (65%) were considered ATII responders. ATII resulted in a non-significant reduction in median (IQR) NEE dose at 3h [0.6 (0.24-1.1) p=0.94], 12h [0.4 (0.22-0.6) p=0.43] and 24h [0.18 (0.17-0.38) p=0.16] compared to baseline. The average ICU LOS was 5.8 (1.9- 14.4) days, with an in-hospital mortality rate of 70%. Three patients (15%) had a documented fungal infection and 4 (20%) had a suspected or confirmed VTE event, despite all being on VTE prophylaxis.

Conclusions: A majority of patients in this study responded to ATII, with a decrease of background vasopressors at 3, 12 and 24 hours after ATII initiation. More studies are needed to effectively compare clinical outcomes of ATII with other vasopressors and further delineate its role in therapy.