Angiotensin II in Decompensated Cirrhosis Complicated by Septic Shock
Seminars in Cardiothoracic and Vascular Anesthesia
angiotensin II; decompensated cirrhosis; end-stage liver disease; liver failure; sepsis; septic shock; vasodilatory shock
© 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.
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