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Clinical Response to Third-Line Angiotensin-II vs Epinephrine in Septic Shock: A Propensity-Matched Cohort Study.
Blankenship, Caitlyn R; Betthauser, Kevin D; Hencken, Laura N; Maamari, Julie A; Goetz, Jenna; Giacomino, Bria D; Gibson, Gabrielle A.
Afiliación
  • 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.
Ann Pharmacother ; 58(10): 1003-1012, 2024 Oct.
Article en En | MEDLINE | ID: mdl-38303571
ABSTRACT

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 (21) 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Séptico / Vasoconstrictores / Angiotensina II / Epinefrina / Mortalidad Hospitalaria / Puntaje de Propensión Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Pharmacother Asunto de la revista: FARMACOLOGIA / TERAPIA POR MEDICAMENTOS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Séptico / Vasoconstrictores / Angiotensina II / Epinefrina / Mortalidad Hospitalaria / Puntaje de Propensión Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Pharmacother Asunto de la revista: FARMACOLOGIA / TERAPIA POR MEDICAMENTOS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos