The effect of hydrocortison requirement on angiotensin II and angiotensin receptors in patients suffering from septic shock: A prospective observational study

Aim: This study aims to evaluate the role of angiotensin II, AT1, and AT2 on catecholomine responsive and catecholomine resistant septic shock, and the effect of hydrocortisone traetment on catecholomine resistant septic shock and angiotensin II, AT1, and AT2. Material and Method: This study was enrolled 40 patients diagnosed with septic shock according to Sepsis 3 criteria. The patients with septic shock who needed a noradrenaline infusion rate of up to 0.5µg/kg/min to maintain MAP>65 mmHg were classified as control group (n=20) and the ones who required a noradrenaline infusion rate above 0.5µg/kg were classified as hydrocortisone group (n=20). Blood samples were taken for analysis of plasma angiotensin II, AT1, AT2 levels at the time of diagnosis, one hour after and on the 3rd day of the bundle and the hydrocortisone treatment. Hemodynamic parameters simultaneously obtained by continuous minimal invasive cardiac output measurement method were recorded. Results: It was observed that angiotensin II and AT1 levels in the hydrocortisone group were two times higher than the control group. In the hydrocortisone group after hydrocortisone treatment, angiotensin II and AT1 levels didn't differ, while AT2 level decreased significantly. Except for SVRI, all minimally invasive cardiac output measurement values were similar and within normal limits in both groups. SVRI value did not differ significantly from the physiological value in control group. In the hydrocortisone group while it was below the physiological value before the hydrocortisone treatment, it approached to the normal value after the hydrocortisone treatment. The 28-day mortality was seen in 70% of the patients in the hydrocortisone group and in 35% of the patients in the control group. Conclusion: Angiotensin II can be used as a biomarker of vasoplegia observed in refractory septic shock unresponsive to catecholamine. In these patients; therapeutic effect of hydrocortisone on hypotension was performed by decreasing AT 2 level, AT2 should be investigated as a therapeutic target in the treatment of vasoplegia-induced hypotension and SVRI measured by minimally invasive cardiac output method suggests that it can be used as a useful parameter in the diagnosis and follow-up of vasoplegia