The results of this study confirm the importance of IL-31 in AD pathophysiology. Serum IL-31 level is an objective reliable marker of AD severity in children. It may represent a novel target for antipruritic drug development.
Objectives:
To assess the early physiologic response to angiotensin-II treatment in patients with coronavirus disease 2019–induced respiratory failure and distributive shock.
Design:
Retrospective consecutive-sample cohort study.
Setting:
Three medical ICUs in New York during the coronavirus disease 2019 outbreak.
Patients:
All patients were admitted to the ICU with respiratory failure and were receiving norepinephrine for distributive shock.
Interventions:
The treatment groups were patients who received greater than or equal to 1 hour of angiotensin-II treatment. Time-zero was the time of angiotensin-II initiation. Controls were identified using a 2:1 hierarchical process that matched for 1) date and unit of admission; 2) specific organ support modalities; 3) age; 4) chronic lung, cardiovascular, and kidney disease; and 5) sex. Time-zero in the control group was 21 hours post vasopressor initiation, the mean duration of vasopressor therapy prior to angiotensin-II initiation in the treated group.
Measurements and Main Results:
Main outcomes were trajectories of vasopressor requirements (in norepinephrine-equivalent dose) and mean arterial pressure. Additionally assessed trajectories were respiratory (Pa
o
2
/F
io
2
, Pa
co
2
), metabolic (pH, creatinine), and coagulation (
d
-dimer) dysfunction indices after time-zero. We also recorded adverse events and clinical outcomes. Trajectories were analyzed using mixed-effects models for immediate (first 6 hr), early (48 hr), and sustained (7 d) responses. Twenty-nine patients (
n
= 10 treated,
n
= 19 control) were identified. Despite matching, angiotensin-II–treated patients had markedly greater vasopressor requirements (mean: 0.489 vs 0.097 µg/kg/min), oxygenation impairment, and acidosis at time-zero. Nonetheless, angiotensin-II treatment was associated with an immediate and sustained reduction in norepinephrine-equivalent dose (6 hr model: β = –0.036 µg/kg/min/hr; 95% CI: –0.054 to –0.018 µg/kg/min/hr,
p
interaction
=0.0002) (7 d model: β = –0.04 µg/kg/min/d, 95% CI: –0.05 to –0.03 µg/kg/min/d;
p
interaction
= 0.0002). Compared with controls, angiotensin-II–treated patients had significantly faster improvement in mean arterial pressure, hypercapnia, acidosis, baseline-corrected creatinine, and
d
-dimer. Three thrombotic events occurred, all in control patients.
Conclusions:
Angiotensin-II treatment for coronavirus disease 2019–induced distributive shock was associated with rapid improvement in multiple physiologic indices. Angiotensin-II in coronavirus disease 2019–indu...
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