SynthesisBMJ open2018
Effect of levosimendan on mortality in severe sepsis and septic shock: a meta-analysis of randomised trials.
Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Comparative efficacy of levosimendan and dobutamine in sepsis-related cardiac impairment: a meta-analysis.European journal of clinical pharmacology · 2026Pooled it
- Efficacy and safety of levosimendan in patients with sepsis: a systematic review and network meta-analysis.Frontiers in pharmacology · 2024Pooled it
- Levosimendan versus dobutamine for sepsis-induced cardiac dysfunction: a systematic review and meta-analysis.Scientific reports · 2021Pooled it
- Effects of levosimendan on respiratory muscle function in patients weaning from mechanical ventilation.Intensive care medicine · 2019Trial
- To the Editor: Levosimendan in sepsis-induced cardiac dysfunction: consolidating evidence within a complex clinical landscape.European journal of clinical pharmacology · 2026Article
- Sepsis-induced cardiomyopathy: mechanisms, epidemiology, diagnosis, and treatments.Frontiers in immunology · 2026Review
- Septic Cardiomyopathy: Difficult Definition, Challenging Diagnosis, Unclear Treatment.Journal of clinical medicine · 2025Review
- Levosimendan versus dobutamine in septic cardiomyopathy: a randomized clinical trial on cardiac function and safety.Frontiers in cardiovascular medicine · 2025Article
- Recent trends in septic shock management: a narrative review of current evidence and recommendations.Annals of medicine and surgery (2012) · 2024Review
- Levosimendan: efficacy and safety in pediatric heart failure treatment.Revista da Associacao Medica Brasileira (1992) · 2024Article
- Levosimendan for sepsis-induced myocardial dysfunction: friend or foe?Frontiers in cardiovascular medicine · 2024Review
- Fluid management in septic patients with pulmonary hypertension, review of the literature.Frontiers in cardiovascular medicine · 2023Review
- Research Progress on the Mechanism and Management of Septic Cardiomyopathy: A Comprehensive Review.Emergency medicine international · 2023Review
- Effectiveness of levosimendan and role of cardiac magnetic resonance in cardiogenic shock due to COVID-19 related lymphocytic myocarditis in the course of viral sepsis.Archive of clinical cases · 2023Article
- Early administration of dobutamine in the treatment of septic shock patients with tumor-a retrospective comparative cohort study.Annals of translational medicine · 2022Article
- Article
- Septic cardiomyopathy: Diagnosis and management.Journal of intensive medicine · 2022Review
- A cohort study investigating the occurrence of differences in care provided to men and women in an intensive care unit.Scientific reports · 2021Article
- Effects of Levosimendan on Systemic Perfusion in Patients with Low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Score: Experience from a Single Center in Taiwan.Acta Cardiologica Sinica · 2021Article
- Alprostadil attenuates LPS-induced cardiomyocyte injury by inhibiting the Wnt5a/JNK/NF-κB pathway.Herz · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveWe aim to synthesise up-to-date randomised trials to investigate the effects of levosimendan on mortality and clinical outcomes in severe sepsis and septic shock.
methodsA collection of databases including PubMed, EMBASE, Cochrane Central Register and Web of Science were searched updated to August 2017. Randomised trials were included when they pertain to the use of levosimendan in severe sepsis or septic shock compared with any category of inotropes, or as an adjunct to standard therapy with mortality reported. The primary outcome was mortality, and the secondary outcomes were clinical performances including serum lactate, cardiac function, vasopressor requirement and fluid infusion.
resultsA total of 10 studies with 1036 patients were included in this meta-analysis. The results revealed that levosimendan could not reduce mortality significantly in severe sepsis and septic shock (OR 0.89, 95% CI 0.69 to 1.16, P=0.39). Levosimendan use could reduce serum lactate more effectively, and enhance cardiac contractibility with increased cardiac index and left ventricular ejection fraction. However, its use could also increase fluid infusion but not reduce norepinephrine dose. No significant benefit in mortality could be observed of levosimendan versus dobutamine use, or in patients with proven cardiac dysfunction.
conclusionsCurrent evidence is not sufficient to support levosimendan as superior to dobutamine or as an optimal adjunct in severe sepsis and septic shock. More large-scale randomised trials are necessary to validate levosimendan use in sepsis.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.