Levosimendan vs. Dobutamine in Patients with Septic Shock: A Systematic Review and Meta-Analysis with Trial Sequential Analysis Article Swipe
Edith Elianna Rodríguez Aparicio
,
Gabriela de los Ángeles Criollo Jaramillo
,
L Cuéllar
,
Santiago Eduardo Pérez Herran
,
David René Rodríguez Lima
,
Antoine Herpain
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3390/jcm14155496
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.3390/jcm14155496
Introduction: Septic-induced cardiomyopathy (SICM) is a life-threatening condition in patients with septic shock. Persistent hypoperfusion despite adequate volume status and vasopressor use is associated with poor outcomes and is currently managed with inotropes. However, the superiority of available inotropic agents remains unclear. This meta-analysis aims to determine which inotropic agent may be more effective in this clinical scenario. Methods: A systematic review and meta-analysis were conducted, including data from randomized clinical trials (RCTs) comparing levosimendan and dobutamine in patients with septic shock and persistent hypoperfusion. Summary effect estimates, including odds ratios (ORs), standardized mean differences (SMDs), and 95% confidence intervals (CIs), were calculated using a random-effects model. Trial sequential analysis (TSA) was also performed. Results: Of 244 studies screened, 11 RCTs were included. Levosimendan was associated with a reduction in in-hospital mortality (OR 0.64; 95% CI: 0.47; 0.88) and ICU length of stay (SMD 5.87; 95% CI: –8.37; 20.11) compared with dobutamine. Treatment with levosimendan also resulted in significant reductions in BNP (SMD –1.87; 95% CI: –2.45; −1.2) and serum lactate levels (SMD –1.63; 95% CI: –3.13; −0.12). However, TSA indicated that the current evidence is insufficient to definitively confirm or exclude effects on in-hospital and 28-day mortality. Conclusions: Levosimendan may improve hemodynamics, tissue perfusion, and biomarkers, and may reduce in-hospital mortality and ICU length of stay in patients with SICM compared with dobutamine. However, TSA highlights the need for further studies to inform clinical practice and optimize inotrope selection.
Related Topics
Concepts
Levosimendan
Medicine
Dobutamine
Septic shock
Inotrope
Odds ratio
Randomized controlled trial
Internal medicine
Cardiology
Cardiogenic shock
Meta-analysis
Confidence interval
Shock (circulatory)
Acute decompensated heart failure
Anesthesia
Intensive care medicine
Sepsis
Heart failure
Hemodynamics
Myocardial infarction
Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.3390/jcm14155496
- https://www.mdpi.com/2077-0383/14/15/5496/pdf?version=1754366582
- OA Status
- gold
- References
- 53
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4412954259
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4412954259Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.3390/jcm14155496Digital Object Identifier
- Title
-
Levosimendan vs. Dobutamine in Patients with Septic Shock: A Systematic Review and Meta-Analysis with Trial Sequential AnalysisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-08-05Full publication date if available
- Authors
-
Edith Elianna Rodríguez Aparicio, Gabriela de los Ángeles Criollo Jaramillo, L Cuéllar, Santiago Eduardo Pérez Herran, David René Rodríguez Lima, Antoine HerpainList of authors in order
- Landing page
-
https://doi.org/10.3390/jcm14155496Publisher landing page
- PDF URL
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https://www.mdpi.com/2077-0383/14/15/5496/pdf?version=1754366582Direct link to full text PDF
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YesWhether a free full text is available
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-
goldOpen access status per OpenAlex
- OA URL
-
https://www.mdpi.com/2077-0383/14/15/5496/pdf?version=1754366582Direct OA link when available
- Concepts
-
Levosimendan, Medicine, Dobutamine, Septic shock, Inotrope, Odds ratio, Randomized controlled trial, Internal medicine, Cardiology, Cardiogenic shock, Meta-analysis, Confidence interval, Shock (circulatory), Acute decompensated heart failure, Anesthesia, Intensive care medicine, Sepsis, Heart failure, Hemodynamics, Myocardial infarctionTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
0Total citation count in OpenAlex
- References (count)
-
53Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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