IDENTIFYING CANDIDATES FOR ANGIOTENSIN II VASOPRESSOR THERAPY BY TRIAL AND REAL WORLD CRITERIA Spencer Livengood, April Miller Quidley, Lauren Chambers Vidant Medical Center - Greenville, NC
Background/Purpose: Angiotensin II is a new vasopressor with an unclear role in shock treatment, including mortality benefit and risk of thrombosis. The study purpose is to assess the number of patients potentially eligible to receive angiotensin II at an academic medical center and their outcomes relative to ATHOS-3 trial criteria.
Methodology: This is an IRB approved, single center, retrospective cohort study of medical record reports. Patients receiving norepinephrine between 7/1/17 and 6/30/18 were identified for analysis and included if > 18 years of age, with diagnosis codes for septic shock, and catecholamine-resistant hypotension. Excluded patients had acute coronary occlusion; liver failure; ECMO; bleeding; neutropenia; mannitol allergy; received > 500mg hydrocortisone or equivalent/day; or were pregnant. The primary endpoint is the number of patients who were candidates for angiotensin II therapy. The secondary endpoints are mortality, limb ischemia, and patients receiving vasopressin greater than or equal to 0.03U/min.
Results: There were 1666 patients screened as candidates for angiotensin II; 556 patients met specified inclusion criteria; and 156 patients met exclusions. This indicates that 400 patients met the primary outcome of being candidates for angiotensin II therapy. Secondary outcomes showed 7-day mortality of 31%, 28-day mortality of 42%, 3.3% rate of thrombus or limb ischemia, and 289 (72%) patients also receiving vasopressin.
Conclusions: There were a modest number of patients within one year identified as candidates to receive angiotensin II with lower mortality and a higher rate of thrombotic events than evidenced in initial angiotensin II trials. These results suggest the need for close evaluation of potential candidates for angiotensin II therapy and monitoring of patients receiving therapy for thrombotic events.
Presentation Objective: Quantify patients eligible to receive angiotensin II vasopressor therapy in a year_x0019_s time based on trial criteria.
Self-Assessment: How often could angiotensin II be used when incorporated into practice?
