SynthesisEuropean journal of clinical pharmacology2026
Comparative efficacy of levosimendan and dobutamine in sepsis-related cardiac impairment: a meta-analysis.
Synthesis in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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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.
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Who cites it
1 citing paper in PubMed.
- To the Editor: Levosimendan in sepsis-induced cardiac dysfunction: consolidating evidence within a complex clinical landscape.European journal of clinical pharmacology · 2026Article
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Authors and funding
5 authors.
Funding
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Abstract
backgroundSepsis-induced cardiac dysfunction significantly impacts patient outcomes, with inotropic support playing a crucial role in management. Levosimendan and dobutamine are commonly used, but their comparative efficacy remains debated. This meta-analysis evaluates the efficacy and safety of levosimendan versus dobutamine in sepsis-related cardiac impairment, focusing on mortality, intensive care unit (ICU) outcomes, and infection risks.
methodsWe systematically analyzed randomized controlled trials (RCTs) comparing levosimendan and dobutamine in septic patients with cardiac dysfunction. Primary outcomes included mortality and ICU length of stay, while secondary outcomes assessed pneumonia, peritonitis, and urinary tract infection (UTI) risks. Model selection for pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) was based on heterogeneity, employing random-effects models for substantial heterogeneity (I² > 50%) and fixed-effects models otherwise. Meta-analyses were performed using Rev-Man 5.4. STUDY REGISTRATION: Prospero ID (CRD420261283881).
resultsThe meta-analysis included 9 RCTs (n = 289 patients) in total. For mortality, data were available from 8 RCTs (n = 239 patients), revealing no significant reduction with levosimendan compared to dobutamine (OR: 0.89, 95% CI: 0.52-1.54, P = 0.68; I²=0%). For ICU length of stay, 7 RCTs (n = 241 patients) were included, showing no significant difference (MD - 2.02 days, 95% CI - 6.44 to 2.39; P = 0.37; I²=83%). Regarding hospital-acquired infections, pneumonia was analyzed in 5 RCTs (n = 143 patients) (OR: 1.05, 95% CI: 0.48-2.29, P = 0.90; I²=0%), peritonitis in 3 RCTs (n = 98 patients) (OR 1.56, 95% CI 0.62-3.95; P = 0.35; I²=0%), and urinary tract infections in 3 RCTs (n = 91 patients) (OR: 0.70, 95% CI: 0.17-2.81, P = 0.61; I²=0%).
conclusionCurrent evidence indicates that levosimendan does not reduce mortality or ICU length of stay compared to dobutamine in sepsis-induced cardiac dysfunction, and infection risks are comparable. The high heterogeneity in ICU outcomes warrants cautious interpretation. These findings do not support the routine preferential use of levosimendan over dobutamine. Larger, well-designed trials are needed to identify specific patient subgroups that may benefit from levosimendan.
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