Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/22560
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dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorWunderink, Richard G-
dc.contributor.authorSzerlip, Harold-
dc.contributor.authorEnglish, Shane W-
dc.contributor.authorBusse, Laurence W-
dc.contributor.authorDeane, Adam M-
dc.contributor.authorKhanna, Ashish K-
dc.contributor.authorMcCurdy, Michael T-
dc.contributor.authorOstermann, Marlies-
dc.contributor.authorYoung, Paul J-
dc.contributor.authorHandisides, Damian R-
dc.contributor.authorChawla, Lakhmir S-
dc.contributor.authorTidmarsh, George F-
dc.contributor.authorAlbertson, Timothy E-
dc.date2020-02-06-
dc.date.accessioned2020-02-11T01:18:14Z-
dc.date.available2020-02-11T01:18:14Z-
dc.date.issued2020-
dc.identifier.citationCritical Care 2020; 24(1): 43-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/22560-
dc.description.abstractIn patients with vasodilatory shock, plasma concentrations of angiotensin I (ANG I) and II (ANG II) and their ratio may reflect differences in the response to severe vasodilation, provide novel insights into its biology, and predict clinical outcomes. The objective of these protocol prespecified and subsequent post hoc analyses was to assess the epidemiology and outcome associations of plasma ANG I and ANG II levels and their ratio in patients with catecholamine-resistant vasodilatory shock (CRVS) enrolled in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. We measured ANG I and ANG II levels at baseline, calculated their ratio, and compared these results to values from healthy volunteers (controls). We dichotomized patients according to the median ANG I/II ratio (1.63) and compared demographics, clinical characteristics, and clinical outcomes. We constructed a Cox proportional hazards model to test the independent association of ANG I, ANG II, and their ratio with clinical outcomes. Median baseline ANG I level (253 pg/mL [interquartile range (IQR) 72.30-676.00 pg/mL] vs 42 pg/mL [IQR 30.46-87.34 pg/mL] in controls; P <  0.0001) and median ANG I/II ratio (1.63 [IQR 0.98-5.25] vs 0.4 [IQR 0.28-0.64] in controls; P <  0.0001) were elevated, whereas median ANG II levels were similar (84 pg/mL [IQR 23.85-299.50 pg/mL] vs 97 pg/mL [IQR 35.27-181.01 pg/mL] in controls; P = 0.9895). At baseline, patients with a ratio above the median (≥1.63) had higher ANG I levels (P <  0.0001), lower ANG II levels (P <  0.0001), higher albumin concentrations (P = 0.007), and greater incidence of recent (within 1 week) exposure to angiotensin-converting enzyme inhibitors (P <  0.00001), and they received a higher norepinephrine-equivalent dose (P = 0.003). In the placebo group, a baseline ANG I/II ratio <1.63 was associated with improved survival (hazard ratio 0.56; 95% confidence interval 0.36-0.88; P = 0.01) on unadjusted analyses. Patients with CRVS have elevated ANG I levels and ANG I/II ratios compared with healthy controls. In such patients, a high ANG I/II ratio is associated with greater norepinephrine requirements and is an independent predictor of mortality, thus providing a biological rationale for interventions aimed at its correction. ClinicalTrials.gov identifier NCT02338843. Registered 14 January 2015.-
dc.language.isoeng-
dc.subjectACE-
dc.subjectACE dysfunction-
dc.subjectAngiotensin I-
dc.subjectAngiotensin II-
dc.subjectSepsis-
dc.subjectVasodilatory shock-
dc.titleAngiotensin I and angiotensin II concentrations and their ratio in catecholamine-resistant vasodilatory shock.-
dc.typeJournal Article-
dc.identifier.journaltitleCritical Care-
dc.identifier.affiliationDepartment of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, Australiaen
dc.identifier.affiliationDepartment of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USAen
dc.identifier.affiliationClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canadaen
dc.identifier.affiliationDepartment of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canadaen
dc.identifier.affiliationSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canadaen
dc.identifier.affiliationOutcomes Research Consortium, Cleveland, OH, USAen
dc.identifier.affiliationDepartment of Veterans Affairs, Northern California Health System, Mather, CA, USAen
dc.identifier.affiliationDivision of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USAen
dc.identifier.affiliationDepartment of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USAen
dc.identifier.affiliationDepartment of Medicine, Division of Nephrology, Baylor University Medical Center, Dallas, TX, USAen
dc.identifier.affiliationStanford University School of Medicine, Palo Alto, CA, USAen
dc.identifier.affiliationDepartment of Medicine, Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USAen
dc.identifier.affiliationLa Jolla Pharmaceutical Company, San Diego, CA, USAen
dc.identifier.affiliationIntensive Care Unit, Wellington Hospital, Wellington, New Zealanden
dc.identifier.affiliationCentre for Integrated Critical Care, Department of Medicine & Radiology, The University of Melbourne, Melbourne, Australiaen
dc.identifier.affiliationAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australiaen
dc.identifier.affiliationDepartment of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USAen
dc.identifier.affiliationMedical Research Institute of New Zealand, Wellington, New Zealanden
dc.identifier.affiliationDepartment of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK-
dc.identifier.affiliationDepartment of Intensive Care, Austin Health, Heidelberg, Victoria, Australia-
dc.identifier.doi10.1186/s13054-020-2733-x-
dc.identifier.orcid0000-0002-1650-8939-
dc.identifier.pubmedid32028998-
dc.type.austinJournal Article-
local.name.researcherBellomo, Rinaldo
item.cerifentitytypePublications-
item.languageiso639-1en-
item.grantfulltextnone-
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
crisitem.author.deptIntensive Care-
crisitem.author.deptData Analytics Research and Evaluation (DARE) Centre-
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