Meta-Analysis of the Efficacy of Levosimendan in the Treatment of Severe Sepsis Complicated with Septic Cardiomyopathy.

IF 0.7 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Surgery Forum Pub Date : 2023-10-30 DOI:10.59958/hsf.6439

Qiongchan Guan, Chuang Zhang, Binbin Li, Daochao Huang, Aiming Li, Jie Qin, Xianhuan Zhang

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引用次数: 0

Abstract

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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左西孟丹治疗严重脓毒症并发脓毒症心肌病疗效的Meta分析。

简介：脓毒症是一种以急性器官功能障碍和炎症失控为特征的疾病。败血症的器官功能障碍是心肌功能障碍患者死亡的主要原因。左西孟丹是一种用于急性心力衰竭患者的血管舒张和变力剂，可降低这些患者的发病率和死亡率。我们的主要目的是检查左西孟丹治疗严重败血症并发败血症性心肌病的疗效。方法：我们系统地检索了PubMed、Web of Science、Embase、Cochrane Library和BioMed Central五个数据库，从它们成立到2023年的文章和出版物。我们的研究采用PICOS方法在系统搜索过程中确定合适的出版物。纳入标准包括在诊断为感染性休克或严重败血症的成年患者中使用左西孟丹的随机对照试验。我们排除了非英文出版物和非随机对照试验。纽卡斯尔-渥太华量表（NOS）用于评估方法质量，而偏倚风险通过Cochrane偏倚风险工具进行评估。所有统计分析均使用RevMan 5.4版进行。结果：8项研究符合资格标准并纳入分析。与多巴酚丁胺治疗的患者相比，左西孟旦治疗的患者对心脏输入有统计学意义的积极影响（p＜0.001），对左心室射血分数（LVEF）（p＜0.001）和左心室卒中功指数（LVSWI）（p＞0.001）有积极影响。我们观察到死亡率（p＜0.01）和血清乳酸水平（p＜0.05）显著降低增加心肌收缩性收缩、增强血管舒张并改善细胞和组织的氧气供应。结论：左西孟丹治疗脓毒症和脓毒症所致心肌病疗效确切，安全性高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart Surgery Forum 医学-外科

CiteScore

1.20

自引率

16.70%

发文量

130

审稿时长

6-12 weeks

期刊介绍： The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.