Trial reportIntensive care medicine2019
Levosimendan in septic shock in patients with biochemical evidence of cardiac dysfunction: a subgroup analysis of the LeoPARDS randomised trial.
Trial report in Intensive care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 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
33 citing papers in PubMed, 3 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Comparative efficacy of levosimendan and dobutamine in sepsis-related cardiac impairment: a meta-analysis.European journal of clinical pharmacology · 2026Pooled it
- Early high-sensitivity troponin elevation and short-term mortality in sepsis: a systematic review with meta-analysis.Critical care (London, England) · 2025Pooled it
- Efficacy and safety of levosimendan in patients with sepsis: a systematic review and network meta-analysis.Frontiers in pharmacology · 2024Pooled it
- Septic Cardiomyopathy in the ICU: Echocardiographic Phenotypes, Global Longitudinal Strain, and Right Ventricular Assessment.Diagnostics (Basel, Switzerland) · 2026Review
- To the Editor: Levosimendan in sepsis-induced cardiac dysfunction: consolidating evidence within a complex clinical landscape.European journal of clinical pharmacology · 2026Article
- Clinical practice in using corticosteroids and adjunctive sepsis therapies at the bedside among European ICUs: an ESICM-endorsed survey.Intensive care medicine experimental · 2026Article
- Current standard of care for septic shock.Intensive care medicine · 2026Review
- Coxsackie and adenovirus receptor is a novel regulator of inflammatory response in endotoxin-induced failing heart.Journal of molecular and cellular cardiology plus · 2025Article
- Review
- Sepsis-Induced Cardiomyopathy and Cardiac Arrhythmias: Pathophysiology and Implications for Novel Therapeutic Approaches.Biomedicines · 2025Review
- Levosimendan vs. Dobutamine in Patients with Septic Shock: A Systematic Review and Meta-Analysis with Trial Sequential Analysis.Journal of clinical medicine · 2025Review
- Metabolic septic shock sub-phenotypes, stability over time and association with clinical outcome.Intensive care medicine · 2025Article
- Septic Cardiomyopathy: Difficult Definition, Challenging Diagnosis, Unclear Treatment.Journal of clinical medicine · 2025Review
- Sepsis-induced cardiomyopathy: understanding pathophysiology and clinical implications.Archives of toxicology · 2025Review
- Levosimendan versus dobutamine in septic cardiomyopathy: a randomized clinical trial on cardiac function and safety.Frontiers in cardiovascular medicine · 2025Article
- Observational
- Therapeutic Strategies Targeting Mitochondrial Dysfunction in Sepsis-induced Cardiomyopathy.Cardiovascular drugs and therapy · 2024Review
- Levosimendan for sepsis-induced myocardial dysfunction: friend or foe?Frontiers in cardiovascular medicine · 2024Review
- Precision fluid and vasoactive drug therapy for critically ill patients.Pharmacotherapy · 2023Review
- Levosimendan in the Treatment of Patients with Severe Septic Cardiomyopathy.Life (Basel, Switzerland) · 2023Article
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 1 country.
Funding
Abstract
purposeMyocardial dysfunction is common in sepsis but optimal treatment strategies are unclear. The inodilator, levosimendan was suggested as a possible therapy; however, the levosimendan to prevent acute organ dysfunction in Sepsis (LeoPARDS) trial found it to have no benefit in reducing organ dysfunction in septic shock. In this study we evaluated the effects of levosimendan in patients with and without biochemical cardiac dysfunction and examined its non-inotropic effects.
methodsTwo cardiac biomarkers, troponin I (cTnI) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five inflammatory mediators were measured in plasma from patients recruited to the LeoPARDS trial at baseline and over the first 6 days. Mean total Sequential Organ Failure Assessment (SOFA) score and 28-day mortality were compared between patients with normal and raised cTnI and NT-proBNP values, and between patients above and below median values.
resultsLevosimendan produced no benefit in SOFA score or 28-day mortality in patients with cardiac dysfunction. There was a statistically significant treatment by subgroup interaction (p = 0.04) in patients with NT-proBNP above or below the median value. Those with NT-proBNP values above the median receiving levosimendan had higher SOFA scores than those receiving placebo (mean daily total SOFA score 7.64 (4.41) vs 6.09 (3.88), mean difference 1.55, 95% CI 0.43-2.68). Levosimendan had no effect on the rate of decline of inflammatory biomarkers.
conclusionAdding levosimendan to standard care in septic shock was not associated with less severe organ dysfunction nor lower mortality in patients with biochemical evidence of cardiac dysfunction.
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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.