Clinical Response to Third-Line Angiotensin-II vs Epinephrine in Septic Shock: A Propensity-Matched Cohort Study

Area of Science:

• Critical Care Medicine
• Pharmacology
• Intensive Care

Background:

• Septic shock management requires effective vasopressors.
• The optimal third-line vasopressor after norepinephrine and vasopressin is undetermined.
• Angiotensin-II (AT-II) offers a novel mechanism for refractory septic shock.

Purpose of the Study:

• To compare the efficacy and safety of third-line Angiotensin-II (AT-II) versus epinephrine in septic shock patients.
• To evaluate clinical response and safety outcomes in patients receiving third-line vasopressors.

Main Methods:

• Retrospective cohort study (April 2019 - July 2022).
• Propensity-matched analysis (2:1) of septic shock patients receiving third-line AT-II versus epinephrine.
• Primary outcome: clinical response at 24 hours post-initiation.

Main Results:

• 47.8% of AT-II patients achieved clinical response versus 28.3% of epinephrine patients (P=0.12).
• No significant differences in in-hospital mortality, cardiac arrhythmias, or thromboembolism between groups.
• Study was underpowered to detect statistically significant differences.

Conclusions:

• Third-line AT-II was not associated with significantly improved 24-hour clinical response compared to epinephrine in septic shock.
• Clinical observations suggest further investigation of AT-II is warranted.
• Epinephrine remains a viable third-line option, but AT-II requires more study.