Key result
Levosimendan treatment did not significantly reduce mortality compared to standard inotropic therapy in patients with septic shock (RR 0.96; 95% CI 0.81-1.12).
Why the study?
Does levosimendan reduce mortality in patients with septic shock?
Meta-Analysis (n=816)
Does levosimendan reduce mortality in patients with septic shock?
Relative Risk: 0.96 (95% CI 0.81–1.12)
In a meta-analysis of 816 patients with septic shock, levosimendan did not significantly reduce mortality compared to standard inotropic therapy.
Levosimendan offers no mortality advantage in septic shock; confirms standard inotropes remain appropriate without added benefit.
// Benji Wang 1 , Rujie Chen 1 , Xianyang Guo 1 , Wenwu Zhang 1 , Jianjian Hu 1 , Yuqiang Gong 1 and Bihuan Cheng 1 1 Department of Critical Care Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China Correspondence to: Bihuan Cheng, email: cbihuan@163.com Keywords: levosimendan, mortality, septic shock, meta-analysis, trial sequential analysis Received: May 24, 2017 Accepted: July 30, 2017 Published: August 10, 2017 ABSTRACT Object: Several studies have investigated a survival benefit for levosimendan treatment in patients with septic shock. However, data are conflicting. We conducted a meta-analysis to evaluate the effect of levosimendan treatment on mortality in patients with septic shock. Materials and Methods: We searched PubMed, EMBASE and Cochrane Library Databases up to March 27, 2017, without language restrictions. We searched for terms related to septic shock, levosimendan, randomized clinical trial. Randomized controlled trials reported the effect of levosimendan on mortality were included. Moreover, we constructed the trial sequential analysis (TSA) to determine the reliability of the outcomes. Furthermore, secondary outcomes were cardiac index(CI), mean arterial pressure (MAP), blood lactate, norepinephrine dose and length of ICU stay. Results: Ten studies with a total of 816 patients were included in this meta-analysis. There was no significant difference in the mortality between the levosimendan group and the standard inotropic therapy group [RR = 0.96, 95% CI (0.81–1.12), I 2 = 0]. However, methods adapted from formal interim monitoring boundaries applied to TSA indicated that the cumulative evidence was unreliable and inconclusive. Blood lactate was significantly reduced in the levosimendan group while there was no difference in MAP, CI, norepinephrine dose and length of ICU stay. Conclusions: Findings from this meta-analysis demonstrated that levosimendan treatment may not reduce mortality in patients with septic shock. The result remains inclusive and further randomized controlled trials were needed to confirm these conclusions.
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Wang et al. (2017) conducted a meta-analysis in septic shock (n=816). levosimendan vs. standard inotropic therapy was evaluated on mortality (RR 0.96, 95% CI 0.81-1.12). Levosimendan treatment did not significantly reduce mortality compared to standard inotropic therapy in patients with septic shock (RR 0.96; 95% CI 0.81-1.12).
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