Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock

Document Type

Journal Article

Publication Date

9-1-2020

Journal

Seminars in Cardiothoracic and Vascular Anesthesia

Volume

24

Issue

3

DOI

10.1177/1089253219877876

Keywords

angiotensin II; decompensated cirrhosis; end-stage liver disease; liver failure; sepsis; septic shock; vasodilatory shock

Abstract

© The Author(s) 2019. 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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