Meta-Analysis Of The Clinical Efficacy Of Levosimendan Compared With Dobutamine In The Treatment Of Sepsis

Objective: Sepsis,one of the leading causes of death in intensive care medicine,is a disease caused by infection that can endanger the function of multiple organs and life.Levosimendan is a new calcium ion sensitizer and a kind of positive myotropic drugs,which is often used in the clinical treatment of refractory heart failure and perioperative period,but its efficacy in the treatment of sepsis is still controversial.In this paper,a meta-analysis was used to compare the efficacy of levosimendan and dobutamine in the treatment of sepsis patients.Method: Using levosimendan,sepsis and septic shock as search terms,English databases Embase,Pub Med,Web of Science,Cochrane library were searched.Chinese databases: China National Knowledge Network(CNKI),Wanfang Data,VIP Database,China Biomedical Literature Database(CBM).Published randomized controlled trials of levosimendan in patients with sepsis were searched,and the primary outcome measures were mortality.Secondary outcome measures were left ventricular ejection fraction(LVEF),cardiac troponin I(c Tn I),B-type brain natriuretic peptide(BNP),cardiac index(CI),lactic acid(Lac)and length of ICU stay.The time is from the construction of the library to December 2022.Stata 14.0software was used for all data consolidation,publication bias monitoring and sensitivity analysis.Results: A total of 17 studies were included in this meta-analysis,with a total of 793 patients,400 patients in the levosimendan group and 393 patients in the dobutamine group.The results of meta-analysis showed that the mortality of sepsis patients treated by levosimendan group was statistically different from that of the control group,and the levosimendan group had an advantage.(Fixed effect RR=0.79,95%confidence interval [CI] [0.66-0.94],Z=2.64,P=0.008 < 0.05).Compared with dobutamine in secondary outcome indicators,there were statistical significance in left ventricular ejection fraction(LVEF),cardiac troponin I(c Tn I),B-type brain natriuretic peptide(BNP),cardiac index(CI),lactic acid(Lac)and length of ICU stay,and the levosimendan group had advantages.Conclusions: Current evidence supports that levosimendan versus dobutamine reduces mortality in patients with sepsis,reduces cardiac troponin I(c Tn I)and B-type brain natriuretic peptide(BNP)markers,increases left ventricular ejection fraction(LVEF)and cardiac index(CI),reduces lactic acid(Lac),and reduces length of ICU stay.