COVID-19 and the RAAS—a potential role for angiotensin II?

Busse, Laurence W.; Chow, Jonathan H.; McCurdy, Michael T.; Khanna, Ashish K.

doi:10.1186/s13054-020-02862-1

Cited by 94 publications

(103 citation statements)

References 16 publications

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“…Our ndings con rm this effect on oxygenation. ANGII has been previously shown to increase blood pressure in catecholamine refractory vasodilatory shock in a randomized placebo-controlled trial [6,7]. Our ndings con rm this effect on blood pressure.…”

Section: Relationship With Previous Studiessupporting

confidence: 78%

“…Angiotensin II (ANGII) is an FDA and EMA approved vasopressor for the treatment of catecholamine resistant vasodilatory shock [6] and a substrate for ACE2. In a phase III double blind randomized trial, ANG II as rescue vasopressor improved blood pressure in such vasodilatory shock [6], increased survival in patients with a high angiotensin I/II ratio [7] and in those with a high renin level . [8].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Angiotensin II Infusion on Markers of Organ Function in Invasively Ventilated COVID-19 Patients

Zangrillo

Colombo

Scandroglio

et al. 2020

Preprint

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Background: The use of angiotensin II (ANGII) in invasively ventilated COVID-19 patients is controversial. Its effect on markers of organ function is unknown.Methods: We used ANGII either as rescue vasopressor agent or as low dose vasopressor support. Patients treated before ANGII availability or in an adjacent COVID-19 ICU served as controls. For data analysis, we applied Bayesian modelling as appropriate. We assessed the effects of ANG on markers of organ function.Results: We compared 46 ANGII patients with 53 controls. Compared with controls, ANGII increased MAP (median difference, 9.05 mmHg [95% confidence interval, 1.87 to 16.22]; p = 0.013) and PaO2/FiO2 ratio (median difference, 23.17 [95% confidence interval, 3.46 to 42.88]; p = 0.021). ANGII had no effect on lactate, urinary output, serum creatinine, C-Reactive protein, platelet count, or thromboembolic complications. However, it significantly decreased the odd ratio of liver dysfunction (odds ratio: 0.32; 0.09 to 0.94) and, on Bayesian modelling, in patients with abnormal baseline serum creatinine, ANGII carried a 95.7% probability of decreasing renal replacement therapy use. Conclusions: In ventilated COVID-19 patients, ANGII therapy was associated with increased blood pressure and PaO2/FiO2 ratios, decreased odds ratio of liver dysfunction, and a high probability of decreasing renal replacement therapy use in patients with abnormal baseline serum creatinine.

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Section: Relationship With Previous Studiessupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

The Effect of Angiotensin II Infusion on Markers of Organ Function in Invasively Ventilated COVID-19 Patients

Zangrillo

Colombo

Scandroglio

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…ANGII may be logical in this setting. It specifically assists patients recently exposed to angiotensin-converting enzyme inhibitors [2,3] and increases the internalization and downregulation of angiotensinconverting enzyme 2 [4], the receptor for COVID-19. Its use may also inform the debate about the risks and benefits of angiotensin receptor blockers in COVID-19-infected patients [5].…”

mentioning

confidence: 99%

Angiotensin II infusion in COVID-19-associated vasodilatory shock: a case series

et al. 2020

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“…Angiotensin II is not yet available for use commercially, but due to the number of critically ill patients, and the promising outcome of the drug, it has been made available for compassionate use in Italy, Germany and UK. 61 Angiotensin (1-7). Another focus area is the use of angiotensin (1-7) as a novel treatment for COVID-19.…”

Section: Potential Covid-19 Treatment Involving Ace2 Systemmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) and the renin-angiotensin system: A closer look at angiotensin-converting enzyme 2 (ACE2)

Zemlin

Wiese

2020

Ann Clin Biochem

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Since the first cases of atypical pneumonia linked to the Huanan Seafood Wholesale Market in Wuhan, China, were described in late December 2019, the global landscape has changed radically. In March 2020, the World Health Organization declared COVID-19 a global pandemic, and at the time of writing this review, just over three million individuals have been infected with more than 200,000 deaths globally. Numerous countries are in 'lockdown', social distancing is the new norm, even the most advanced healthcare systems are under pressure, and a global economic recession seems inevitable. A novel coronavirus (SARS-CoV-2) was identified as the aetiological agent. From experience with previous coronavirus epidemics, namely the severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) in 2004 and 2012 respectively, it was postulated that the angiotensin-converting enzyme-2 (ACE2) receptor is a possible port of cell entry. ACE2 is part of the renin-angiotensin system and is also associated with lung and cardiovascular disorders and inflammation. Recent studies have confirmed that ACE2 is the port of entry for SARS-CoV-2. Male sex, advanced age and a number of associated comorbidities have been identified as risk factors for infection with COVID-19. Many high-risk COVID-19 patients with comorbidities are on ACE inhibitors and angiotensin receptor blockers, and this has sparked debate about whether to continue these treatment regimes. Attention has also shifted to ACE2 being a target for future therapies or vaccines against COVID-19. In this review, we discuss COVID-19 and its complex relationship with ACE2.

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COVID-19 and the RAAS—a potential role for angiotensin II?

Cited by 94 publications

References 16 publications

The Effect of Angiotensin II Infusion on Markers of Organ Function in Invasively Ventilated COVID-19 Patients

The Effect of Angiotensin II Infusion on Markers of Organ Function in Invasively Ventilated COVID-19 Patients

Angiotensin II infusion in COVID-19-associated vasodilatory shock: a case series

Coronavirus disease 2019 (COVID-19) and the renin-angiotensin system: A closer look at angiotensin-converting enzyme 2 (ACE2)

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