ABSTRACT
The renin angiotensin system may be involved in the cardiovascular response to septic shock. This chapter discusses the role of this system during endotoxemia and septic shock using a meta-analysis approach based on decision trees for the selection of the appropriate publications. The studies selected by this approach should provide answers to the three questions of the Koch-Dale criteria, criteria aimed to ascertain whether there exists a causal relationship between a given factor and a pathologic condition. The renin-angiotensin system is an enzymatic chain which leads to the generation of the potent vasoconstrictor angiotensin II. An increase in plasma renin activity (PRA) during endotoxemia has also been reported by Manson and Hess in the same canine model of septic shock. PRA, catecholamine, and vasopressin concentrations were significantly increased in rats 90 min after the administration of endotoxin, as compared to control animals. Reduction of renal blood flow is a common event during sepsis or endotoxemia as well as during the administration of angiotensin II.
