Meta Analysis Of Levosimendan In Treatment Of Septic Shock

Objectives : Sepsis is a systemic inflammatory response syndrome initially triggered by bacterial infection which subsequently results in progressive organ dysfunction,specialwith the cardiovascular system.Studays show that about 40% of the patients with sepsis have myocardial depression,and the mortality is as high as 70%,while the mortality of septic patients without myocardial depression was about 20%.In order to reduce the severity of sepsis and sepsis mortality,the need more research on the mechanism and treatment of septic myocardial depression.Levosimendan is a calcium-sensitizing agent that improves cardiac function.Levosimendan could bind to cardiac troponin C and reducing its calcium-binding co-efficient,it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand..That is why it could avoid the arrhythmia myocardial injury even death by the traditional inotropic medicine.Studys also show that levosimendan have an effect of anti-inflammatory,antioxidant,antimyocardial apoptosis.It is mainly used in the treatment of heart failure and the peri-operative management of cardiac surgery.Leosimendan has begun to try treatment of septic shock recently.There are several randomized controlled trials that observe the effection of levosimendan in treatment septic shock compared with traditional inotropic medicine.we performed a Meta-analysis to systematically review the effection of levosimendan in the therapy of severve sepsis and septic shock,provideing evidence for the treatment in sepsis.Methods: We search the CNKI、VIP、Wanfang database、PubMed、EMBASE 、 Ovidand Cochrane library database about the randomized controlled trials of levosimendan compared with other traditional inotropic medicine(such as dobutamine、epinephrine)in the treatment of severe sepsis and septic shock from the database inception to October 2015.We set the inclusion and exclusion criterion,perform quality evaluation and extract data to the literature.Meta-analysis was performed by using RevMan5.3 software about the mortality、left ventricular ejection fraction(LVEF)、 cardiac index(CI)、 troponin I(TnI)、lactic acid(Lac)and the amount of norepinephrine.The mortality was expressed by relative risk(RR)and 95% confidence interval,while LVEF、CI、TnI、Lac was expressed by the weighted mean difference(WMD)and 95% confidence interval(95%CI).Publication bias was evaluated by funnel plot method,Egger linear regression method and Begg rank correlation method.Results:A total of 13 articles involving 491 cases was included,of which 251 ones were in levosimendan group,while the other 240 ones were in the control group.Compared with the control group,the mortality of the patients in the levosimendan group decreased significantly [RR=0.78,95%CI(0.63-0.96),P=0.02].Cardiac index[WMD=0.79,95%CI(0.56~1.03),P<0.001]、LVEF[WMD=9.03%,95%CI(6.74%~11.31%),P<0.00001] in the levosimendan group increased significantly.And the TnI [WMD=-1.22,95% CI(-1.52~-0.77),P<0.00001],lactate [WMD=-1.41,95%CI(-1.56~-1.27),P<0.00001]decreased significantly compared with the control group.There no significant difference in the amount of norepinephrine between two groups[WMD=-0.01,95%CI(-0.03~0.01),P=0.45].Conclusion: Compared with the control group,use of levosimendan can significantly reduce the mortality of paitents with septic shock,and reduce lactate and troponin I levels,it also could increase cardiac index and left ventricular ejection fraction.There no significant difference in the amount of norepinephrine between two groups.The evidence of Meta-analysis support the use of levosimendan in paitents with septic shock.