Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial
Exogenous angiotensin II increases mean arterial pressure in patients with catecholamine-resistant vasodilatory shock (CRVS). We hypothesized that renin concentrations may identify patients most likely to benefit from such therapy. To test the kinetic changes in renin concentrations and their progno...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2020-11, Vol.202 (9), p.1253-1261 |
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| creator | Bellomo, Rinaldo Forni, Lui G Busse, Laurence W McCurdy, Michael T Ham, Kealy R Boldt, David W Hästbacka, Johanna Khanna, Ashish K Albertson, Timothy E Tumlin, James Storey, Kristine Handisides, Damian Tidmarsh, George F Chawla, Lakhmir S Ostermann, Marlies |
| description | Exogenous angiotensin II increases mean arterial pressure in patients with catecholamine-resistant vasodilatory shock (CRVS). We hypothesized that renin concentrations may identify patients most likely to benefit from such therapy.
To test the kinetic changes in renin concentrations and their prognostic value in patients with CRVS.
We analyzed serum samples from patients enrolled in the ATHOS-3 (Angiotensin II for the Treatment of High-Output Shock) trial for renin, angiotensin I, and angiotensin II concentrations before the start of administration of angiotensin II or placebo and after 3 hours.
Baseline serum renin concentration (normal range, 2.13-58.78 pg/ml) was above the upper limits of normal in 194 of 255 (76%) study patients with a median renin concentration of 172.7 pg/ml (interquartile range [IQR], 60.7 to 440.6 pg/ml), approximately threefold higher than the upper limit of normal. Renin concentrations correlated positively with angiotensin I/II ratios (
= 0.39;
|
| doi_str_mv | 10.1164/rccm.201911-2172OC |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7605187</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2457701319</sourcerecordid><originalsourceid>FETCH-LOGICAL-c430t-52439a3ad3e5298d4c2112fdb377d0e2de5a4cee8edcbb5296bbbfcfdb58969b3</originalsourceid><addsrcrecordid>eNpVkU1PJCEQhslGs7q6f2APGxLPPVJAN83FZNJRdxITjV_xRmiadnB7QIGZxH8vZtTsnoDUU28VeRD6BWQG0PDjaMxqRglIgIqCoJfdN7QPNasrLgXZKXciWMW5fNhDP1J6IgRoC-Q72mO0IZIA7KN8bb3zWPsB36zjxm30hMv7SmdnfU743G2sx3P_6EK2PpXSYoHHEHGnszXLMOmV87a6tsmlrH3G9zqFwU06h_iKb5bB_J3hOe4m550p2bfR6ekQ7Y56Svbnx3mA7s5Ob7s_1cXl-aKbX1SGM5KrmnImNdMDszWV7cANBaDj0DMhBmLpYGvNjbWtHUzfF6Tp-340Bahb2cieHaCTbe7zul8VqPwo6kk9R7fS8VUF7dT_Fe-W6jFslGhIDa0oAUcfATG8rG3K6imsoy87K8prIQgwkIWiW8rEkFK049cEIOrdlHo3pbam1NZUafr9725fLZ9q2BsE2ZMQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2457701319</pqid></control><display><type>article</type><title>Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>American Thoracic Society (ATS) Journals Online</source><source>Alma/SFX Local Collection</source><creator>Bellomo, Rinaldo ; Forni, Lui G ; Busse, Laurence W ; McCurdy, Michael T ; Ham, Kealy R ; Boldt, David W ; Hästbacka, Johanna ; Khanna, Ashish K ; Albertson, Timothy E ; Tumlin, James ; Storey, Kristine ; Handisides, Damian ; Tidmarsh, George F ; Chawla, Lakhmir S ; Ostermann, Marlies</creator><creatorcontrib>Bellomo, Rinaldo ; Forni, Lui G ; Busse, Laurence W ; McCurdy, Michael T ; Ham, Kealy R ; Boldt, David W ; Hästbacka, Johanna ; Khanna, Ashish K ; Albertson, Timothy E ; Tumlin, James ; Storey, Kristine ; Handisides, Damian ; Tidmarsh, George F ; Chawla, Lakhmir S ; Ostermann, Marlies</creatorcontrib><description>Exogenous angiotensin II increases mean arterial pressure in patients with catecholamine-resistant vasodilatory shock (CRVS). We hypothesized that renin concentrations may identify patients most likely to benefit from such therapy.
To test the kinetic changes in renin concentrations and their prognostic value in patients with CRVS.
We analyzed serum samples from patients enrolled in the ATHOS-3 (Angiotensin II for the Treatment of High-Output Shock) trial for renin, angiotensin I, and angiotensin II concentrations before the start of administration of angiotensin II or placebo and after 3 hours.
Baseline serum renin concentration (normal range, 2.13-58.78 pg/ml) was above the upper limits of normal in 194 of 255 (76%) study patients with a median renin concentration of 172.7 pg/ml (interquartile range [IQR], 60.7 to 440.6 pg/ml), approximately threefold higher than the upper limit of normal. Renin concentrations correlated positively with angiotensin I/II ratios (
= 0.39;
< 0.001). At 3 hours after initiation of angiotensin II therapy, there was a 54.3% reduction (IQR, 37.9% to 66.5% reduction) in renin concentration compared with a 14.1% reduction (IQR, 37.6% reduction to 5.1% increase) with placebo (
< 0.0001). In patients with renin concentrations above the study population median, angiotensin II significantly reduced 28-day mortality to 28 of 55 (50.9%) patients compared with 51 of 73 patients (69.9%) treated with placebo (unstratified hazard ratio, 0.56; 95% confidence interval, 0.35 to 0.88;
= 0.012) (
= 0.048 for the interaction).
The serum renin concentration is markedly elevated in CRVS and may identify patients for whom treatment with angiotensin II has a beneficial effect on clinical outcomes.Clinical trial registered with www.clinicaltrials.gov (NCT02338843).</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201911-2172OC</identifier><identifier>PMID: 32609011</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Aged ; Angiotensin II - blood ; Biomarkers - blood ; Catecholamines - adverse effects ; Catecholamines - therapeutic use ; Clinical trials ; Female ; Humans ; Male ; Medical prognosis ; Middle Aged ; Original ; Predictive Value of Tests ; Renin - blood ; Shock (Circulatory) ; Shock - blood ; Shock - drug therapy ; Vasoconstrictor Agents - adverse effects ; Vasoconstrictor Agents - therapeutic use ; Vein & artery diseases</subject><ispartof>American journal of respiratory and critical care medicine, 2020-11, Vol.202 (9), p.1253-1261</ispartof><rights>Copyright American Thoracic Society Nov 1, 2020</rights><rights>Copyright © 2020 by the American Thoracic Society 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-52439a3ad3e5298d4c2112fdb377d0e2de5a4cee8edcbb5296bbbfcfdb58969b3</citedby><cites>FETCH-LOGICAL-c430t-52439a3ad3e5298d4c2112fdb377d0e2de5a4cee8edcbb5296bbbfcfdb58969b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,4025,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32609011$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Forni, Lui G</creatorcontrib><creatorcontrib>Busse, Laurence W</creatorcontrib><creatorcontrib>McCurdy, Michael T</creatorcontrib><creatorcontrib>Ham, Kealy R</creatorcontrib><creatorcontrib>Boldt, David W</creatorcontrib><creatorcontrib>Hästbacka, Johanna</creatorcontrib><creatorcontrib>Khanna, Ashish K</creatorcontrib><creatorcontrib>Albertson, Timothy E</creatorcontrib><creatorcontrib>Tumlin, James</creatorcontrib><creatorcontrib>Storey, Kristine</creatorcontrib><creatorcontrib>Handisides, Damian</creatorcontrib><creatorcontrib>Tidmarsh, George F</creatorcontrib><creatorcontrib>Chawla, Lakhmir S</creatorcontrib><creatorcontrib>Ostermann, Marlies</creatorcontrib><title>Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Exogenous angiotensin II increases mean arterial pressure in patients with catecholamine-resistant vasodilatory shock (CRVS). We hypothesized that renin concentrations may identify patients most likely to benefit from such therapy.
To test the kinetic changes in renin concentrations and their prognostic value in patients with CRVS.
We analyzed serum samples from patients enrolled in the ATHOS-3 (Angiotensin II for the Treatment of High-Output Shock) trial for renin, angiotensin I, and angiotensin II concentrations before the start of administration of angiotensin II or placebo and after 3 hours.
Baseline serum renin concentration (normal range, 2.13-58.78 pg/ml) was above the upper limits of normal in 194 of 255 (76%) study patients with a median renin concentration of 172.7 pg/ml (interquartile range [IQR], 60.7 to 440.6 pg/ml), approximately threefold higher than the upper limit of normal. Renin concentrations correlated positively with angiotensin I/II ratios (
= 0.39;
< 0.001). At 3 hours after initiation of angiotensin II therapy, there was a 54.3% reduction (IQR, 37.9% to 66.5% reduction) in renin concentration compared with a 14.1% reduction (IQR, 37.6% reduction to 5.1% increase) with placebo (
< 0.0001). In patients with renin concentrations above the study population median, angiotensin II significantly reduced 28-day mortality to 28 of 55 (50.9%) patients compared with 51 of 73 patients (69.9%) treated with placebo (unstratified hazard ratio, 0.56; 95% confidence interval, 0.35 to 0.88;
= 0.012) (
= 0.048 for the interaction).
The serum renin concentration is markedly elevated in CRVS and may identify patients for whom treatment with angiotensin II has a beneficial effect on clinical outcomes.Clinical trial registered with www.clinicaltrials.gov (NCT02338843).</description><subject>Aged</subject><subject>Angiotensin II - blood</subject><subject>Biomarkers - blood</subject><subject>Catecholamines - adverse effects</subject><subject>Catecholamines - therapeutic use</subject><subject>Clinical trials</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Predictive Value of Tests</subject><subject>Renin - blood</subject><subject>Shock (Circulatory)</subject><subject>Shock - blood</subject><subject>Shock - drug therapy</subject><subject>Vasoconstrictor Agents - adverse effects</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><subject>Vein & artery diseases</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1PJCEQhslGs7q6f2APGxLPPVJAN83FZNJRdxITjV_xRmiadnB7QIGZxH8vZtTsnoDUU28VeRD6BWQG0PDjaMxqRglIgIqCoJfdN7QPNasrLgXZKXciWMW5fNhDP1J6IgRoC-Q72mO0IZIA7KN8bb3zWPsB36zjxm30hMv7SmdnfU743G2sx3P_6EK2PpXSYoHHEHGnszXLMOmV87a6tsmlrH3G9zqFwU06h_iKb5bB_J3hOe4m550p2bfR6ekQ7Y56Svbnx3mA7s5Ob7s_1cXl-aKbX1SGM5KrmnImNdMDszWV7cANBaDj0DMhBmLpYGvNjbWtHUzfF6Tp-340Bahb2cieHaCTbe7zul8VqPwo6kk9R7fS8VUF7dT_Fe-W6jFslGhIDa0oAUcfATG8rG3K6imsoy87K8prIQgwkIWiW8rEkFK049cEIOrdlHo3pbam1NZUafr9725fLZ9q2BsE2ZMQ</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Bellomo, Rinaldo</creator><creator>Forni, Lui G</creator><creator>Busse, Laurence W</creator><creator>McCurdy, Michael T</creator><creator>Ham, Kealy R</creator><creator>Boldt, David W</creator><creator>Hästbacka, Johanna</creator><creator>Khanna, Ashish K</creator><creator>Albertson, Timothy E</creator><creator>Tumlin, James</creator><creator>Storey, Kristine</creator><creator>Handisides, Damian</creator><creator>Tidmarsh, George F</creator><creator>Chawla, Lakhmir S</creator><creator>Ostermann, Marlies</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope></search><sort><creationdate>20201101</creationdate><title>Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial</title><author>Bellomo, Rinaldo ; Forni, Lui G ; Busse, Laurence W ; McCurdy, Michael T ; Ham, Kealy R ; Boldt, David W ; Hästbacka, Johanna ; Khanna, Ashish K ; Albertson, Timothy E ; Tumlin, James ; Storey, Kristine ; Handisides, Damian ; Tidmarsh, George F ; Chawla, Lakhmir S ; Ostermann, Marlies</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-52439a3ad3e5298d4c2112fdb377d0e2de5a4cee8edcbb5296bbbfcfdb58969b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Angiotensin II - blood</topic><topic>Biomarkers - blood</topic><topic>Catecholamines - adverse effects</topic><topic>Catecholamines - therapeutic use</topic><topic>Clinical trials</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Predictive Value of Tests</topic><topic>Renin - blood</topic><topic>Shock (Circulatory)</topic><topic>Shock - blood</topic><topic>Shock - drug therapy</topic><topic>Vasoconstrictor Agents - adverse effects</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Forni, Lui G</creatorcontrib><creatorcontrib>Busse, Laurence W</creatorcontrib><creatorcontrib>McCurdy, Michael T</creatorcontrib><creatorcontrib>Ham, Kealy R</creatorcontrib><creatorcontrib>Boldt, David W</creatorcontrib><creatorcontrib>Hästbacka, Johanna</creatorcontrib><creatorcontrib>Khanna, Ashish K</creatorcontrib><creatorcontrib>Albertson, Timothy E</creatorcontrib><creatorcontrib>Tumlin, James</creatorcontrib><creatorcontrib>Storey, Kristine</creatorcontrib><creatorcontrib>Handisides, Damian</creatorcontrib><creatorcontrib>Tidmarsh, George F</creatorcontrib><creatorcontrib>Chawla, Lakhmir S</creatorcontrib><creatorcontrib>Ostermann, Marlies</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bellomo, Rinaldo</au><au>Forni, Lui G</au><au>Busse, Laurence W</au><au>McCurdy, Michael T</au><au>Ham, Kealy R</au><au>Boldt, David W</au><au>Hästbacka, Johanna</au><au>Khanna, Ashish K</au><au>Albertson, Timothy E</au><au>Tumlin, James</au><au>Storey, Kristine</au><au>Handisides, Damian</au><au>Tidmarsh, George F</au><au>Chawla, Lakhmir S</au><au>Ostermann, Marlies</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2020-11-01</date><risdate>2020</risdate><volume>202</volume><issue>9</issue><spage>1253</spage><epage>1261</epage><pages>1253-1261</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Exogenous angiotensin II increases mean arterial pressure in patients with catecholamine-resistant vasodilatory shock (CRVS). We hypothesized that renin concentrations may identify patients most likely to benefit from such therapy.
To test the kinetic changes in renin concentrations and their prognostic value in patients with CRVS.
We analyzed serum samples from patients enrolled in the ATHOS-3 (Angiotensin II for the Treatment of High-Output Shock) trial for renin, angiotensin I, and angiotensin II concentrations before the start of administration of angiotensin II or placebo and after 3 hours.
Baseline serum renin concentration (normal range, 2.13-58.78 pg/ml) was above the upper limits of normal in 194 of 255 (76%) study patients with a median renin concentration of 172.7 pg/ml (interquartile range [IQR], 60.7 to 440.6 pg/ml), approximately threefold higher than the upper limit of normal. Renin concentrations correlated positively with angiotensin I/II ratios (
= 0.39;
< 0.001). At 3 hours after initiation of angiotensin II therapy, there was a 54.3% reduction (IQR, 37.9% to 66.5% reduction) in renin concentration compared with a 14.1% reduction (IQR, 37.6% reduction to 5.1% increase) with placebo (
< 0.0001). In patients with renin concentrations above the study population median, angiotensin II significantly reduced 28-day mortality to 28 of 55 (50.9%) patients compared with 51 of 73 patients (69.9%) treated with placebo (unstratified hazard ratio, 0.56; 95% confidence interval, 0.35 to 0.88;
= 0.012) (
= 0.048 for the interaction).
The serum renin concentration is markedly elevated in CRVS and may identify patients for whom treatment with angiotensin II has a beneficial effect on clinical outcomes.Clinical trial registered with www.clinicaltrials.gov (NCT02338843).</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>32609011</pmid><doi>10.1164/rccm.201911-2172OC</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2020-11, Vol.202 (9), p.1253-1261 |
| issn | 1073-449X 1535-4970 |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; American Thoracic Society (ATS) Journals Online; Alma/SFX Local Collection |
| subjects | Aged Angiotensin II - blood Biomarkers - blood Catecholamines - adverse effects Catecholamines - therapeutic use Clinical trials Female Humans Male Medical prognosis Middle Aged Original Predictive Value of Tests Renin - blood Shock (Circulatory) Shock - blood Shock - drug therapy Vasoconstrictor Agents - adverse effects Vasoconstrictor Agents - therapeutic use Vein & artery diseases |
| title | Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial |
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