Summary

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• This summary is based on the review of four systematic review(s)/meta-analysis(es). ^[1-4]
• Mean Arterial Pressure (MAP) Increases: Angiotensin II (ATII) significantly increased MAP in vasodilatory shock patients across multiple studies. The ATHOS-3 trial and other sources confirmed that ATII improved MAP comparably to catecholamine vasopressors (mean difference (MD) = -9.60; 95% CI, -9.71 to -9.49).
• Mortality Outcomes: Mortality outcomes were mixed, with no significant difference observed between ATII and standard therapy in overall in-hospital mortality (relative risk (RR) = 0.83; 95% confidence interval (CI), 0.68-1.02). However, patients with elevated renin levels showed improved mortality with ATII treatment in specific subgroups.
• Reduction in Vasopressor Requirements: ATII was associated with a reduction in norepinephrine or norepinephrine-equivalent dose within 3 hours of treatment initiation (MD = -0.06; 95% CI, -0.11 to -0.02), indicating a decrease in reliance on other vasopressors.
• Adverse Events: Angiotensin II (ATII) showed no significant differences in multi-organ failure (MOF) (RR = 1.01; 95% CI, 0.61-1.65) or atrial fibrillation (AF) (RR = 1.27; 95% CI, 0.38-4.23) compared to standard therapy. However, thromboembolism was noted as a safety concern with ATII.
• Specific Safety Concerns: Thromboembolism was a notable risk with ATII, while terlipressin and selepressin were associated with ischemia.
• Angiotensin II was primarily used in patients with catecholamine-refractory vasodilatory shock, demonstrating better mortality outcomes in those with elevated renin levels. Further research is required to assess its effects across other specific subgroups, including comparisons with drugs like terlipressin and selepressin.