Observational studyJournal of intensive care medicine2022
A Multicenter Observational Cohort Study of Angiotensin II in Shock.
Observational study in Journal of intensive care medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06539234 (Angiotensin II Stress Test. Renin Kinetics During Treatment of Vasoplegic Shock With Angiotensin II in Relation to Hemodynamic Response to Treatment With Angiotensin II.), which is not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Angiotensin II Stress Test. Renin Kinetics During Treatment of Vasoplegic Shock With Angiotensin II in Relation to Hemodynamic Response to Treatment With Angiotensin II.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- An overview of reviews of Angiotensin II in distributive shock.BMC anesthesiology · 2026Pooled it
- Initiating angiotensin II at lower vasopressor doses in vasodilatory shock: an exploratory post-hoc analysis of the ATHOS-3 clinical trial.Critical care (London, England) · 2023Trial
- Role of Angiotensin II as a Vasoactive Agent to Treat Distributive Shock With a Focus on Preliminary Data in Pediatric-Aged Patients.Paediatric anaesthesia · 2026Review
- Vasoactive Agents in Burn Patients: Perspectives on Angiotensin-II.Journal of burn care & research : official publication of the American Burn Association · 2025Review
- [What is confirmed in the treatment of sepsis? : An update].Innere Medizin (Heidelberg, Germany) · 2024Review
- Angiotensin II-Real-Life Use and Literature Review.Medicina (Kaunas, Lithuania) · 2024Review
- Clinical Outcomes of Angiotensin II Therapy in Vasoplegic Shock: A Systematic Review and Meta-Analysis.Life (Basel, Switzerland) · 2024Review
- Proposal for the use of angiotensin II in distributive shock after extracorporeal circulation - position paper of the Section of Intensive Care Medicine and the Section of Cardiothoracic Anaesthesiology of the Polish Society of Anaesthesiology and Intensive Therapy.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2024Review
- Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review.Journal of anesthesia, analgesia and critical care · 2024Review
- Adoption of a Novel Vasopressor Agent in Critically Ill Adults.Annals of the American Thoracic Society · 2023Article
- Management of Sepsis and Septic Shock: What Have We Learned in the Last Two Decades?Microorganisms · 2023Review
- Utilization of Synthetic Human Angiotensin II for Catecholamine-Resistant Vasodilatory Shock in Critically Ill Children: A Single-Center Retrospective Case Series.Critical care explorations · 2023Article
- How Effective is Angiotensin II in Decreasing Mortality of Vasodilatory Shock? A Systematic Review.Open access emergency medicine : OAEM · 2023Review
- Timing of vasoactive agents and corticosteroid initiation in septic shock.Annals of intensive care · 2022Review
- Effects of Ziyin Qianyang Formula on Renal Fibrosis through the TGF-Evidence-based complementary and alternative medicine : eCAM · 2022Article
- Effectiveness of Angiotensin II for Catecholamine Refractory Septic or Distributive Shock on Mortality: A Propensity Score Weighted Analysis of Real-World Experience in the Medical ICU.Critical care explorations · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
introductionAngiotensin II (Ang-2) is a non-catecholamine vasopressor that targets the renin-angiotensin-aldosterone system by agonism of the angiotensin type 1 receptor. Its utility as a vasopressor and a catecholamine-sparing agent was demonstrated in the pivotal ATHOS-3 trial, and numerous post-hoc analyses have shown reduced mortality in certain subsets of the population.
methodsConsecutive adult patients at 5 centers who received Ang-2 from 2017-2020 were included in this multicenter, retrospective observational cohort study. Patient demographics, hemodynamics, and adverse events were collected. The primary outcomes of the study were the mean difference in MAP and norepinephrine (NEpi)-equivalent dose at hours 0 and 3 following initiation of Ang-2 therapy.
resultsOne hundred and sixty-two patients were included in this study. The primary outcomes of an increase in MAP (mean difference 9.3 mmHg, 95% CI 6.4-12.1, p < 0.001) and a reduction in NEpi equivalent dose (mean difference 0.16 µg/kg/min, 95% CI 0.10-0.22, p < 0.001) between hours 0 and 3 were statistically significant. The median time to reach a MAP ≥65 was 16 minutes (IQR 5-60 min). After stratifying patients by the NED dose and number of vasopressors administered prior to the initiation of Ang-2, those with a NED dose < 0.2 µg/kg/min, NED dose < 0.3 µg/kg/min, or those on ≤ 3 vasopressors had a significantly greater reduction in NED by hour 3 than those patients above these thresholds.
conclusionAng-2 is an effective vasopressor and reduces catecholamine dose significantly. Its effect is rapid, with target MAP obtained within 30 minutes in most patients. Given the critical importance of adequate blood pressure to organ perfusion, Ang-2 should be considered when target MAP cannot be achieved with conventional vasopressors. Ang-2 should be utilized early in the course of shock, before the NED dose exceeds 0.2-0.3 µg/kg/min and before the initiation of the fourth-line vasopressor.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.