. 2021 Apr 1;49(4):e412-e422.

doi: 10.1097/CCM.0000000000004872.

Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial

Julien Demiselle¹, Valérie Seegers², Marie Lemerle¹, Ferhat Meziani^{3

4}, Fabien Grelon⁵, Bruno Megarbane⁶, Nadia Anguel⁷, Jean-Paul Mira⁸, Pierre-François Dequin⁹, Soizic Gergaud¹⁰, Nicolas Weiss¹¹, François Legay¹², Yves Le Tulzo¹³, Marie Conrad¹⁴, René Robert¹⁵, Frédéric Gonzalez¹⁶, Christophe Guitton¹⁷, Fabienne Tamion¹⁸, Jean-Marie Tonnelier¹⁹, Jean-Pierre Bédos²⁰, Thierry Van Der Linden²¹, Antoine Vieillard-Baron^{22

23}, Eric Mariotte²⁴, Gaël Pradel²⁵, Olivier Lesieur²⁶, Jean-Damien Ricard²⁷, Fabien Hervé²⁸, Damien du Cheyron²⁹, Claude Guerin³⁰, Jean-Louis Teboul⁷, Julie Helms^{3

31}, Peter Radermacher³², Pierre Asfar¹

Affiliations

¹ Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
² Service de Biométrie, Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France.
³ Department of Medical Intensive Care, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
⁴ INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
⁵ Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
⁶ Department of Medical and Toxicological Intensive Care, Lariboisière University Hospital, University of Paris, INSERM UMRS-1144, Paris, France.
⁷ Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France.
⁸ Department of Medical Intensive Care, Cochin University Hospital, Paris, France.
⁹ Department of Medical Intensive Care, Tours University Hospital, Tours, France.
¹⁰ Department of Surgical Intensive Care, University Hospital of Angers, Angers, France.
¹¹ Department of Medical Intensive Care, Georges Pompidou European Hospital, Paris, France.
¹² Department of Medical Intensive Care, Saint Brieuc Hospital, Saint Brieuc, France.
¹³ Department of Infectious Diseases and Medical Intensive Care, Rennes University Hospital, Rennes, France.
¹⁴ Department of Medical Intensive Care, Nancy University Hospital, Nancy, France.
¹⁵ Department of Medical Intensive Care, Université de Poitiers, CHU Poitiers, Poitiers, France.
¹⁶ Department of Medical and Surgical Intensive Care, Avicenne Teaching Hospital, Bobigny, France.
¹⁷ Department of Medical Intensive Care, Nantes University Hospital, Nantes, France.
¹⁸ Department of Medical Intensive Care, Rouen University Hospital, Rouen, France.
¹⁹ Department of Medical Intensive Care, Brest University Hospital, Brest, France.
²⁰ Department of Medical and Surgical Intensive Care, Versailles Hospital, Versailles, France.
²¹ Department of Intensive Care, Saint Philibert hospital, Catholic university of Lille, Lille, France.
²² Department of Medical and Surgical Intensive Care, Boulogne Billancourt University Hospital, Boulogne Billancourt, France.
²³ Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France.
²⁴ Department of Intensive Care, Saint Louis Hospital, Paris, France.
²⁵ Department of Intensive Care, Avignon Hospital, Avignon, France.
²⁶ Department of Medical and Surgical Intensive Care, La Rochelle Saint Louis Hospital, La Rochelle, France.
²⁷ Department of Medico-Surgical Intensive Care, Université de Paris, Assistance Publique - Hôpitaux de Paris, Louis Mourier Hospital, Colombes, France.
²⁸ Department of Medical and Surgical Intensive Care, Quimper Hospital, Quimper, France.
²⁹ Department of Medical Intensive Care, Caen University Hospital, Caen, France.
³⁰ Department of Medical Intensive Care, Edouard Herriot Hospital, Lyon, France.
³¹ ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France.
³² Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, Ulm, Germany.

PMID: 33591012
DOI: 10.1097/CCM.0000000000004872

Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial

Julien Demiselle et al. Crit Care Med. 2021.

. 2021 Apr 1;49(4):e412-e422.

doi: 10.1097/CCM.0000000000004872.

Authors

Affiliations

¹ Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
² Service de Biométrie, Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France.
³ Department of Medical Intensive Care, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
⁴ INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
⁵ Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
⁶ Department of Medical and Toxicological Intensive Care, Lariboisière University Hospital, University of Paris, INSERM UMRS-1144, Paris, France.
⁷ Department of Medical Intensive Care, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France.
⁸ Department of Medical Intensive Care, Cochin University Hospital, Paris, France.
⁹ Department of Medical Intensive Care, Tours University Hospital, Tours, France.
¹⁰ Department of Surgical Intensive Care, University Hospital of Angers, Angers, France.
¹¹ Department of Medical Intensive Care, Georges Pompidou European Hospital, Paris, France.
¹² Department of Medical Intensive Care, Saint Brieuc Hospital, Saint Brieuc, France.
¹³ Department of Infectious Diseases and Medical Intensive Care, Rennes University Hospital, Rennes, France.
¹⁴ Department of Medical Intensive Care, Nancy University Hospital, Nancy, France.
¹⁵ Department of Medical Intensive Care, Université de Poitiers, CHU Poitiers, Poitiers, France.
¹⁶ Department of Medical and Surgical Intensive Care, Avicenne Teaching Hospital, Bobigny, France.
¹⁷ Department of Medical Intensive Care, Nantes University Hospital, Nantes, France.
¹⁸ Department of Medical Intensive Care, Rouen University Hospital, Rouen, France.
¹⁹ Department of Medical Intensive Care, Brest University Hospital, Brest, France.
²⁰ Department of Medical and Surgical Intensive Care, Versailles Hospital, Versailles, France.
²¹ Department of Intensive Care, Saint Philibert hospital, Catholic university of Lille, Lille, France.
²² Department of Medical and Surgical Intensive Care, Boulogne Billancourt University Hospital, Boulogne Billancourt, France.
²³ Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France.
²⁴ Department of Intensive Care, Saint Louis Hospital, Paris, France.
²⁵ Department of Intensive Care, Avignon Hospital, Avignon, France.
²⁶ Department of Medical and Surgical Intensive Care, La Rochelle Saint Louis Hospital, La Rochelle, France.
²⁷ Department of Medico-Surgical Intensive Care, Université de Paris, Assistance Publique - Hôpitaux de Paris, Louis Mourier Hospital, Colombes, France.
²⁸ Department of Medical and Surgical Intensive Care, Quimper Hospital, Quimper, France.
²⁹ Department of Medical Intensive Care, Caen University Hospital, Caen, France.
³⁰ Department of Medical Intensive Care, Edouard Herriot Hospital, Lyon, France.
³¹ ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France.
³² Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Helmholtzstrasse 8-1, Ulm, Germany.

PMID: 33591012
DOI: 10.1097/CCM.0000000000004872

Abstract

Objectives: Individualizing a target mean arterial pressure is challenging during the initial resuscitation of patients with septic shock. The Sepsis and Mean Arterial Pressure (SEPSISPAM) trial suggested that targeting high mean arterial pressure might reduce the occurrence of acute kidney injury among those included patients with a past history of chronic hypertension. We investigated whether the class of antihypertensive medications used before the ICU stay in chronic hypertensive patients was associated with the severity of acute kidney injury occurring after inclusion, according to mean arterial pressure target.

Design: Post hoc analysis of the SEPSISPAM trial.

Setting: The primary outcome was the occurrence of severe acute kidney injury during the ICU stay defined as kidney disease improving global outcome stage 2 or higher. Secondary outcomes were mortality at day 28 and mortality at day 90.

Patients: All patients with chronic hypertension included in SEPSISPAM with available antihypertensive medications data in the hospitalization report were included.

Measurements and main results: We analyzed 297 patients. Severe acute kidney injury occurred in 184 patients, without difference according to pre-ICU exposure to antihypertensive medications. Patients with pre-ICU exposure to angiotensin II receptor blockers had significantly less severe acute kidney injury in the high mean arterial pressure target group (adjusted odd ratio 0.24 with 95% CI [0.09-0.66]; p = 0.006). No statistically significant association was found after adjustment for pre-ICU exposure to antihypertensive medications and survival.

Conclusions: Our results suggest that patients with septic shock and chronic hypertension treated with angiotensin II receptor blocker may benefit from a high mean arterial pressure target to reduce the risk of acute kidney injury occurrence.

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Conflict of interest statement

Dr. Dequin’s institution received funding from Angers University Hospital, the French Ministry of Health, Abionic, Atox Bio, Sphingotec GMBH, Adrenomed, Medspace, Aridis, Merck, Combioxin, GSK, Med-Immune, Genentech INH, Rev-Immune, Faron, Kenta, and Tigenix, and he received support for article research from the French Ministry of Health. Dr. Gonzalez disclosed work for hire. Dr. Teboul received funding from Getinge/Pulsion. Dr. Radermacher’s institution received funding from Deutsche Forschungsgemeinschaft and the German Ministry of Defense. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

Initial Arterial Blood Pressure Targets in Patients With Septic Shock: One Size Fits All or Made to Measure?
Jörres A. Jörres A. Crit Care Med. 2021 Apr 1;49(4):719-721. doi: 10.1097/CCM.0000000000004900. Crit Care Med. 2021. PMID: 33731615 No abstract available.

References

1. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43:304–377
1. De Backer D, Cecconi M, Lipman J, et al. Challenges in the management of septic shock: A narrative review. Intensive Care Med. 2019; 45:420–433
1. Asfar P, Meziani F, Hamel JF, et al. SEPSISPAM InvestigatorsHigh versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014; 370:1583–1593
1. Macchia A, Romero M, Comignani PD, et al. Previous prescription of β-blockers is associated with reduced mortality among patients hospitalized in intensive care units for sepsis. Crit Care Med. 2012; 40:2768–2772
1. Kim J, Kim YA, Hwangbo B, et al. Effect of antihypertensive medications on sepsis-related outcomes: A population-based cohort study. Crit Care Med. 2019; 47:e386–e393

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Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial

Affiliations

Prior Exposure to Angiotensin II Receptor Blockers in Patients With Septic Shock to Individualize Mean Arterial Pressure Target? A Post Hoc Analysis of the Sepsis and Mean Arterial Pressure (SEPSISPAM) Trial

Authors

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Abstract

Conflict of interest statement

Comment in

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