Real-world Experience of Angiotensin II and Renin Usage in Patients With Distributive Shock:A Single-center Descriptive Study

Objective: To evaluate real-life use of angiotensin II, a novel vasopressor, and renin, which can be used as a marker of endogenous angiotensin II deficiency and disease severity. Design: A retrospective observational single-center cohort study. Setting: Four intensive care units in one university hospital. Participants: Adult patients with distributive shock, no limitations of active care, and with ongoing use of vasoconstrictors (norepinephrine base ≥0.3 mcg/kg/min plus vasopressin), who were admitted between August 2022 and August 2023. Interventions: None. Measurements and Main Results: Septic shock (38/42, 90.5%) and post-cardiopulmonary bypass vasoplegia (4/42, 9.5%) were the causes of distributive shock. After the initiation of angiotensin II, a decrease in the norepinephrine base dose at 4, 24, and 48 hours (0.40 ± 0.25 mcg/kg/min, 0.21 ± 0.11 mcg/kg/min, and 0.13 ± 0.06 mcg/kg/min, respectively), and a decrease in vasopressin dose were observed. Renin concentration decreased after initiation of angiotensin II from 376.90 ± 168.50 mU/L to 188.24 ± 167.47 mU/L (p < 0.01). Control renin was lower in survivors to hospital discharge compared with nonsurvivors (78.06 ± 121.14 mU/L in survivors, v 259.07 ± 163.4 mU/L in nonsurvivors, p < 0.01). Conclusions: Angiotensin II can be used to decrease the doses of non-angiotensin II vasopressors, and renin concentration may potentially aid in the prognostication of patients with distributive shock.