Endothelial dysfunction is common in septic shock and has been shown to impair angiotensin converting enzyme and the renin-angiotensin-aldosterone system (RAAS). Dysregulation of this pathway, which can be measured with plasma renin activity (PRA), is important not only because RAAS dysfunction is associated with increased mortality but also because treatment with angiotensin II (Ang-2) has been shown to decrease mortality. In this case series of 2 patients, serial PRA levels identified septic shock patients with RAAS dysfunction. The patients were treated with Ang-2, an angiotensin type 1 receptor agonist, which resulted in significant improvements in hemodynamics and PRA levels during treatment.
ChawlaLSChenSBellomoRTidmarshGF. Angiotensin converting enzyme defects in shock: implications for future therapy. Crit Care. 2018;22:274.
6.
RiceCLKohlerJPCaseyLSzidonJPDaiseMMossGS. Angiotensin-converting enzyme (ACE) in sepsis. Circ Shock. 1983;11:59-63.
7.
BusseLWMcCurdyMTAliOHallAChenHOstermannM. The effect of angiotensin II on blood pressure in patients with circulatory shock: a structured review of the literature. Crit Care. 2017;21:324.
8.
MasonJWKleebergUDolanPColmanRW. Plasma kallikrein and Hageman factor in Gram-negative bacteremia. Ann Intern Med. 1970;73:545-551.
9.
SantosRAFerreiraAJVerano-BragaTBaderM. Angiotensin-converting enzyme 2, angiotensin-(1-7) and Mas: new players of the renin-angiotensin system. J Endocrinol. 2013;216:R1-R17.
10.
ChungKSSongJHJungWJ, et al. Implications of plasma renin activity and plasma aldosterone concentration in critically ill patients with septic shock. Korean J Crit Care Med. 2017;32:142-153.
11.
KhannaAEnglishSWWangXS, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377:419-430.
12.
SzerlipHBihoracAChangS, et al. Effect of disease severity on survival in patients receiving angiotensin II for vasodilatory shock. Crit Care Med. 2018;46:3.
13.
TumlinJAMuruganRDeaneAM, et al. Outcomes in patients with vasodilatory shock and renal replacement therapy treated with intravenous angiotensin II. Crit Care Med. 2018;46:949-957.
14.
BellomoRWunderinkRGSzerlipH, et al. Angiotensin I and angiotensin II concentrations and their ratio in catecholamine-resistant vasodilatory shock. Crit Care. 2020;24:43.
15.
HamKRBoldtDWMcCurdyMT, et al. Sensitivity to angiotensin II dose in patients with vasodilatory shock: a prespecified analysis of the ATHOS-3 trial. Ann Intensive Care. 2019;9:63.
16.
GordonACMasonAJThirunavukkarasuN, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA. 2016;316:509-518.
17.
LiuZMChenJKouQ, et al. Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre, randomised, double-blinded trial. Intensive Care Med. 2018;44:1816-1825.
18.
RussellJAWalleyKRSingerJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358:877-887.
19.
VasuTSCavallazziRHiraniAKaplanGLeibyBMarikPE. Norepinephrine or dopamine for septic shock: systematic review of randomized clinical trials. J Intensive Care Med. 2012;27:172-178.
20.
GleesonPJCrippaIAMongkolpunW, et al. Renin as a marker of tissue-perfusion and prognosis in critically ill patients. Crit Care Med. 2019;47:152-158.
21.
FernandoSMTranATaljaardMChengWPerryJJ. Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection. Ann Intern Med. 2018;169:264-265.
YerkeJRSachaGLScheragaRG, et al. Vasopressin plasma concentrations are not associated with hemodynamic response to exogenous vasopressin for septic shock. Pharmacotherapy. 2019;40:33-39.
