Key result
Levosimendan reduces mortality and improves LVEF and cardiac input vs dobutamine in severe sepsis.
Why the study?
Organ dysfunction in sepsis causes significant mortality in myocardial dysfunction, prompting examination of levosimendan's efficacy in severe sepsis complicated with septic cardiomyopathy.
Does levosimendan improve hemodynamics and reduce mortality in adult patients with severe sepsis complicated with septic cardiomyopathy compared to dobutamine?
Meta-Analysis
Does levosimendan improve hemodynamics and reduce mortality in adult patients with severe sepsis complicated with septic cardiomyopathy compared to dobutamine?
p-value: p=<0.001
Levosimendan improves hemodynamics and reduces mortality in patients with severe sepsis complicated by septic cardiomyopathy compared to dobutamine.
Supports levosimendan over dobutamine in septic cardiomyopathy; extends trial data with pooled hemodynamic and mortality benefits.
INTRODUCTION: Sepsis is a medical condition characterized by acute organ dysfunction and uncontrolled inflammation. Organ dysfunction in sepsis is the primary cause of mortality in patients with myocardial dysfunction. Levosimendan is a vasodilating and inotropic agent used in patients with acute heart failure and has resulted in decreased morbidity and mortality in these patients. Our main objective is to examine levosimendan's efficacy in treating severe sepsis complicated with septic cardiomyopathy. METHODS: We systematically searched five databases, PubMed, Web of Science, Embase, Cochrane Library and BioMed Central, for articles and publications from their inception to 2023. Our study adopted the PICOS approach in identifying suitable publications during the systematic search. Inclusion criteria included randomized, controlled trials utilizing levosimendan in adult patients diagnosed with septic shock or severe sepsis. We excluded non-English publications and non-randomized controlled trials. The Newcastle-Ottawa scale (NOS) scale was used to assess the methodological quality, while the risk of bias was assessed through the Cochrane Risk of bias tool. All statistical analyses were performed using RevMan version 5.4. RESULTS: Eight studies met the eligibility criteria and were included in the analysis. There was a statistically significant positive effect on cardiac input in patients treated with levosimendan compared to those treated with dobutamine (p < 0.001). Similarly, there were positive effects on left ventricular ejection fraction (LVEF) (p < 0.001) and left ventricular stroke work index (LVSWI) (p < 0.001). We observed a significant reduction in mortality (p < 0.01) and serum levels of lactic acid (p < 0.01). DISCUSSION: Levosimendan is a calcium sensitizer associated with an influx of calcium ions and activation of ATP-dependent potassium channels that increases myocardial contractility contractions, enhances vasodilation and improves oxygen supply to the cells and tissues. CONCLUSION: Levosimendan is highly efficacious and safe in the management of sepsis and sepsis-induced cardiomyopathy.
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Guan et al. (2023) conducted a meta-analysis in Severe sepsis complicated with septic cardiomyopathy. Levosimendan vs. Dobutamine was evaluated on Cardiac input (p=<0.001). Levosimendan significantly improved cardiac input (P<0.001), LVEF (P<0.001), and reduced mortality (P<0.01) compared to dobutamine in patients with severe sepsis.
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