Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock

Authors

Patrick J. Coleman, Brooke Army Military Medical Center
Alexander P. Nissen, Brooke Army Military Medical Center
Daniel E. Kim, U.S. Army Institute of Surgical Research
Craig R. Ainsworth, U.S. Army Institute of Surgical Research
Michael T. McCurdy, University of Maryland School of Medicine
Michael A. Mazzeffi, University of Maryland School of Medicine
Jonathan H. Chow, University of Maryland School of Medicine

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.

APA Citation

Coleman, P., Nissen, A., Kim, D., Ainsworth, C., McCurdy, M., Mazzeffi, M., & Chow, J. (2020). Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock. Seminars in Cardiothoracic and Vascular Anesthesia, 24 (3). http://dx.doi.org/10.1177/1089253219877876