Angiotensin II infusion in COVID‐19: An international, multicenter, registry‐based study

Abstract

To expand our understanding of the role of angiotensin II (ANGII) in coronavirus infectious disease 2019 (COVID‐19), we conducted an international, multicenter registry study to assess the use of ANGII in patients with COVID‐19 compared to patients not receiving ANGII. Critically ill adult patients who were diagnosed with COVID‐19 and received ANGII were matched with COVID‐19 patients not receiving ANGII according to age, respiratory support, history of hypertension, use of angiotensin‐converting enzyme inhibitors and/or ANGII receptor blocker, and date of admission. All outcomes were exploratory in nature and included improvement in oxygenation, duration of organ support, and mortality. In one year, 132 patients were included (65 in the ANGII group and 67 in the control group), and patients were comparable in baseline characteristics. During the first 12 h of infusion, patients in the ANGII had a faster decrease in FiO2 and maintained similar mean arterial pressure levels. Hospital mortality was not statistically significantly different between the groups (53.8% vs. 40.3%; p = 0.226). Within the limitations of such a study design, our findings confirm previous observations of a potentially positive effect of ANGII on blood pressure and FiO2 but no effect on patient‐centered outcomes.

Association of vasopressors with mortality in critically ill patients with COVID-19: A systematic review and meta-analysis

“…The studies originated from multiple countries, with 13 of coming from institutions located in the USA [20,21,23,32-35,38,42,43,45,48,51]. Nineteen studies included only patients admitted in the ICU [20,22,24,25,27,30-32,35-39,43-47,52], five studies included patients admitted in a COVID-19-dedicated HDU [28,29,33,34,42], eight studies included patients who were admitted in both HDU and ICU [21,23,26,40,41,48,49,51], and one study included Emergency Department patients who were later admitted either in the HDU of ICU [50]. Thirty studies included data about patients who received vs .…”

“…patients who did not receive vasopressors [20-37,39-48,50,52]. Moreover, three studies included patients who received angiotensin-II [38,49,51] and, out of those, two compared the use of angiotensin-II with other vasopressors [49,51] (Appendix C2). Table 1 summarizes the main characteristics of the included studies.…”

“…Four studies provided data on mortality based on the specific vasopressor(s) administered [38,43,49,51]. The highest mortality rate was observed in patients treated with vasopressin or epinephrine (78% and 76%, respectively) [43].…”

“…The highest mortality rate was observed in patients treated with vasopressin or epinephrine (78% and 76%, respectively) [43]. Three of those studies investigated the role of angiotensin-II as a sole or second-line vasopressor agent [38,49,51]. These studies showed the lowest mortality rate.…”

“…Another intriguing finding is the low mortality rate in patients receiving angiotensin-II as a sole or second-line vasopressor agent. Serpa Neto et al showed a potentially positive effect of angiotensin-II on blood pressure and fraction of inspired oxygen in COVID-19 patients, but they did not collect data regarding treatment with steroids or other drugs, which may have affected their results [49]. Leisman et al and Ofosu-Barko et al reported that angiotensin-II treatment was associated with rapid improvement in multiple physiologic indices [38,51].…”