TY - JOUR
T1 - Levosimendan reduces mortality in patients with severe sepsis and septic shock
T2 - A meta-analysis of randomized trials
AU - Zangrillo, Alberto
AU - Putzu, Alessandro
AU - Monaco, Fabrizio
AU - Oriani, Alessandro
AU - Frau, Giovanna
AU - De Luca, Monica
AU - Di Tomasso, Nora
AU - Bignami, Elena
AU - Lomivorotov, Vladimir
AU - Likhvantsev, Valery
AU - Landoni, Giovanni
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Purpose: There is controversy about the use of inotropes in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate if levosimendan, as compared with standard inotropic therapy (eg, dobutamine), reduces mortality in septic patients. Materials and Methods: BioMedCentral, PubMed, EMBASE, and the Cochrane Central Register were searched for pertinent studies, up to 1st May 2015. Randomized trials on the use of levosimendan in patients with severe sepsis and septic shock were included if reporting mortality data. The primary outcome was mortality, whereas secondary outcomes were blood lactate, cardiac index, total fluid infused, norepinephrine dosage, and mean arterial pressure. Results: Seven studies for a total of 246 patients were included in the analysis. Levosimendan was associated with significantly reduced mortality compared with standard inotropic therapy (59/125 [47%] in the levosimendan group and 74/121 [61%] in the control group; risk difference = -0.14, risk ratio = 0.79 [0.63-0.98], P for effect = .03, I2 = 0%, numbers needed to treat = 7). Blood lactate was significantly reduced in the levosimendan group, whereas cardiac index and total fluid infused were significantly higher in the levosimendan group. No difference in mean arterial pressure and norepinephrine usage was noted. Conclusions: In patients with severe sepsis and septic shock, levosimendan is associated with a significant reduction in mortality compared with standard inotropic therapy. A large ongoing multicenter randomized trial will have to confirm these findings.
AB - Purpose: There is controversy about the use of inotropes in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate if levosimendan, as compared with standard inotropic therapy (eg, dobutamine), reduces mortality in septic patients. Materials and Methods: BioMedCentral, PubMed, EMBASE, and the Cochrane Central Register were searched for pertinent studies, up to 1st May 2015. Randomized trials on the use of levosimendan in patients with severe sepsis and septic shock were included if reporting mortality data. The primary outcome was mortality, whereas secondary outcomes were blood lactate, cardiac index, total fluid infused, norepinephrine dosage, and mean arterial pressure. Results: Seven studies for a total of 246 patients were included in the analysis. Levosimendan was associated with significantly reduced mortality compared with standard inotropic therapy (59/125 [47%] in the levosimendan group and 74/121 [61%] in the control group; risk difference = -0.14, risk ratio = 0.79 [0.63-0.98], P for effect = .03, I2 = 0%, numbers needed to treat = 7). Blood lactate was significantly reduced in the levosimendan group, whereas cardiac index and total fluid infused were significantly higher in the levosimendan group. No difference in mean arterial pressure and norepinephrine usage was noted. Conclusions: In patients with severe sepsis and septic shock, levosimendan is associated with a significant reduction in mortality compared with standard inotropic therapy. A large ongoing multicenter randomized trial will have to confirm these findings.
KW - Anesthesia
KW - Dobutamine
KW - Intensive care
KW - Levosimendan
KW - Septic shock
KW - Severe sepsis
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U2 - 10.1016/j.jcrc.2015.05.017
DO - 10.1016/j.jcrc.2015.05.017
M3 - Article
AN - SCOPUS:84941316178
VL - 30
SP - 908
EP - 913
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
IS - 5
ER -