Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34095
Title: Exploring the norepinephrine to angiotensin II conversion ratio in patients with vasodilatory hypotension: A post-hoc analysis of the ARAMIS trial.
Austin Authors: See, Emily J ;Chaba, Anis;Spano, Sofia;Maeda, Akinori;Clapham, Caroline;Liu, Jasmine;Khasin, Monique;Liskaser, Grace;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Intensive Care
Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Issue Date: 25-Oct-2023
Date: 2023
Publication information: Journal of Critical Care 2023-10-25; 79
Abstract: Angiotensin II is approved for catecholamine-refractory vasodilatory shock but the conversion dose ratio from norepinephrine to angiotensin II remains unclear. We conducted a post-hoc analysis of the Acute Renal effects of Angiotensin II Management in Shock (ARAMIS) trial involving patients with vasodilatory hypotension. We determined the norepinephrine equivalent dose immediately prior to angiotensin II initiation and calculated the conversion dose ratio between norepinephrine and angiotensin II. We performed subgroup analyses based on recent exposure to angiotensin receptor blockers (ARBs) and renin levels at baseline. In 37 patients, the median conversion dose ratio between norepinephrine equivalent and angiotensin II was to 10:1 for norepinephrine bitartrate (5:1 for norepinephrine base). The conversion ratio was not affected by the baseline renin, with a median ratio of 10 (7-21) in the high renin group versus 12 (5-22) in the low renin group. Finally, exposure to ARBs prior admission appeared to diminish the conversion ratio with a median ratio of 7 (4-13) in ARB patients vs. 12 (7-22) in non-ARB patients. The norepinephrine to angiotensin II conversion dose ratio is 10:1 in a vasodilatory hypotension population. These findings can guide clinicians and researchers in the use, dosing, and study of angiotensin II in critical care.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34095
DOI: 10.1016/j.jcrc.2023.154453
ORCID: 
Journal: Journal of Critical Care
Start page: 154453
PubMed URL: 37890357
ISSN: 1557-8615
Type: Journal Article
Subjects: Conversion dose ratio
Critical care
Norepinephrine
Vasodilatory shock
sepsis
Appears in Collections:Journal articles

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