Levosimendan at 0.2 mcg/kg/min reduced 28-day mortality (RR 0.73) and improved cardiac index compared to dobutamine in patients with sepsis-induced myocardial dysfunction.
Meta-Analysis (n=296)
Does levosimendan reduce mortality and improve cardiac function in patients with sepsis-induced myocardial dysfunction compared to dobutamine?
In a network meta-analysis, levosimendan at 0.2 mcg/kg/min was superior to dobutamine in reducing 28-day mortality and improving hemodynamic parameters in patients with sepsis-induced myocardial dysfunction.
Effect estimate: RR 0.73
Introduction: Sepsis-induced myocardial dysfunction (SIMD) is a severe complication that needs inotropic support. This study hypothesizes that varying doses of levosimendan, a calcium sensitizer, can improve cardiac function and reduce mortality in SIMD patients compared to dobutamine. Methods: We performed a Bayesian network meta-analysis of 8 randomized controlled trials (RCTs) involving 296 patients, comparing levosimendan at doses of 0.05, 0.1, and 0.2 mcg/kg/min to dobutamine at 5 mcg/kg/min. Outcomes measured included 28-day mortality (relative risk RR with 95% credible interval CrI), and changes in cardiac index (CI), lactic acid levels, left ventricular ejection fraction (LVEF), heart rate, and stroke volume index (SVI) reported as mean differences (MD) with 95% CrI. A random-effects model addressed variability, and the surface under the cumulative ranking curve (SUCRA) was used to rank interventions. Results: Among the analyzed 8 RCTs, levosimendan at 0.2 mcg/kg/min showed the best results for reducing 28-day mortality (RR 0.73, SUCRA 69.28), followed by 0.05 mcg/kg/min (RR 0.75, SUCRA 65.09) and 0.1 mcg/kg/min (RR 0.87, SUCRA 45.58), with dobutamine having the lowest ranking (SUCRA 20.05). For cardiac index, levosimendan at 0.2 mcg/kg/min (MD 0.40, SUCRA 74.81) and 0.1 mcg/kg/min (MD 0.39, SUCRA 69.39) outperformed dobutamine (SUCRA 5.80). It also significantly reduced lactic acid levels (MD -1.09, SUCRA 99.29) and increased SVI (MD 4.88, SUCRA 98.44). LVEF improved the most with levosimendan at 0.2 mcg/kg/min (MD 4.22, SUCRA 86.22), with dobutamine having a SUCRA of 19.51. Heart rate decreased significantly with levosimendan at 0.2 mcg/kg/min (MD -2.09, SUCRA 84.91) compared to dobutamine (SUCRA 15.09). Conclusions: Levosimendan at 0.2 mcg/kg/min reduces mortality, lactic acid levels, and heart rate while improving cardiac index, LVEF, and stroke volume index in SIMD patients compared to dobutamine. These results suggest levosimendan is a superior inotropic agent, though more large-scale trials are needed to confirm these findings.
Khalil et al. (Sun,) conducted a meta-analysis in Sepsis-induced myocardial dysfunction (SIMD) (n=296). Levosimendan vs. Dobutamine at 5 mcg/kg/min was evaluated on 28-day mortality (RR 0.73). Levosimendan at 0.2 mcg/kg/min reduced 28-day mortality (RR 0.73) and improved cardiac index compared to dobutamine in patients with sepsis-induced myocardial dysfunction.