First Author: Ibrahim Khalil, MBBS – Dhaka Medical College Co-Author: Sunjida Amin Promi, MBBS – MBBS, Chattogram Medical College and Hospital, Bangladesh Co-Author: Md Abu Sayed, MBBS – MBBs, Chattogram Medical College and Hospital, Bangladesh Co-Author: Sigma Walin, MBBS – MBBS, Dhaka Medical College and Hospital, Dhaka, Bangladesh Co-Author: Manisha Das, MBBS – MBBS, Dhaka Medical College and Hospital, Dhaka, Bangladesh
Introduction: Sepsis-induced myocardial dysfunction (SIMD) is a severe complication that needs inotropic support. This study hypothesizes that varying doses of levosimendan, a calcium sensitizer, can improve cardiac function and reduce mortality in SIMD patients compared to dobutamine.
Methods: We performed a Bayesian network meta-analysis of 8 randomized controlled trials (RCTs) involving 296 patients, comparing levosimendan at doses of 0.05, 0.1, and 0.2 mcg/kg/min to dobutamine at 5 mcg/kg/min. Outcomes measured included 28-day mortality (relative risk [RR] with 95% credible interval [CrI]), and changes in cardiac index (CI), lactic acid levels, left ventricular ejection fraction (LVEF), heart rate, and stroke volume index (SVI) reported as mean differences (MD) with 95% CrI. A random-effects model addressed variability, and the surface under the cumulative ranking curve (SUCRA) was used to rank interventions.
Results: Among the analyzed 8 RCTs, levosimendan at 0.2 mcg/kg/min showed the best results for reducing 28-day mortality (RR 0.73, SUCRA 69.28), followed by 0.05 mcg/kg/min (RR 0.75, SUCRA 65.09) and 0.1 mcg/kg/min (RR 0.87, SUCRA 45.58), with dobutamine having the lowest ranking (SUCRA 20.05). For cardiac index, levosimendan at 0.2 mcg/kg/min (MD 0.40, SUCRA 74.81) and 0.1 mcg/kg/min (MD 0.39, SUCRA 69.39) outperformed dobutamine (SUCRA 5.80). It also significantly reduced lactic acid levels (MD -1.09, SUCRA 99.29) and increased SVI (MD 4.88, SUCRA 98.44). LVEF improved the most with levosimendan at 0.2 mcg/kg/min (MD 4.22, SUCRA 86.22), with dobutamine having a SUCRA of 19.51. Heart rate decreased significantly with levosimendan at 0.2 mcg/kg/min (MD -2.09, SUCRA 84.91) compared to dobutamine (SUCRA 15.09).
Conclusions: Levosimendan at 0.2 mcg/kg/min reduces mortality, lactic acid levels, and heart rate while improving cardiac index, LVEF, and stroke volume index in SIMD patients compared to dobutamine. These results suggest levosimendan is a superior inotropic agent, though more large-scale trials are needed to confirm these findings.
