Effect of levosimendan on mortality in severe sepsis and septic shock: a meta-analysis of randomised trials.
Effect of levosimendan on mortality in severe sepsis and septic shock: a meta-analysis of randomised trials.
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左西孟旦对严重脓毒症和脓毒性休克死亡率的影响：随机试验的荟萃分析
DOI：
10.1136/bmjopen-2017-019338
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发表时间：
2018-03-30
期刊：
影响因子：
2.9
通讯作者：
Yang Y
中科院分区：
文献类型：
--
作者：
Chang W;Xie JF;Xu JY;Yang Y
目的综合最新的随机试验研究左西孟丹对严重脓毒症和感染性休克患者死亡率和临床结局的影响。方法计算机检索PubMed、EMBASE、Cochrane中央注册表、Web of Science等数据库，至2017年8月。随机试验包括在严重脓毒症或感染性休克中使用左西孟丹与任何种类的肌力调节剂进行比较，或作为标准治疗的辅助治疗，并报告死亡率。主要结果是死亡率，次要结果是临床表现，包括血清乳酸、心功能、血管升压剂需求和液体输注。结果本次荟萃分析共纳入10项研究，涉及1036名患者。结果表明，左西孟旦不能显著降低重症脓毒症和感染性休克患者的死亡率(OR0.89，95% CI 0.69~1.16，P=0.39)。左西孟旦能更有效地降低血清乳酸，并随着心脏指数和左心室射血分数的增加而增强心脏收缩能力。然而，使用它也可以增加液体输注，但不能减少去甲肾上腺素的剂量。左西孟丹与多巴酚丁胺相比，或在已证实心功能不全的患者中，没有观察到显著的死亡率益处。结论目前的证据不足以支持左西孟丹优于多巴酚丁胺或作为严重败血症和感染性休克的最佳辅助治疗。需要更多的大规模随机试验来验证左西孟旦在脓毒症中的应用。
Objective We aim to synthesise up-to-date randomised trials to investigate the effects of levosimendan on mortality and clinical outcomes in severe sepsis and septic shock. Methods A collection of databases including PubMed, EMBASE, Cochrane Central Register and Web of Science were searched updated to August 2017. Randomised trials were included when they pertain to the use of levosimendan in severe sepsis or septic shock compared with any category of inotropes, or as an adjunct to standard therapy with mortality reported. The primary outcome was mortality, and the secondary outcomes were clinical performances including serum lactate, cardiac function, vasopressor requirement and fluid infusion. Results A total of 10 studies with 1036 patients were included in this meta-analysis. The results revealed that levosimendan could not reduce mortality significantly in severe sepsis and septic shock (OR 0.89, 95% CI 0.69 to 1.16, P=0.39). Levosimendan use could reduce serum lactate more effectively, and enhance cardiac contractibility with increased cardiac index and left ventricular ejection fraction. However, its use could also increase fluid infusion but not reduce norepinephrine dose. No significant benefit in mortality could be observed of levosimendan versus dobutamine use, or in patients with proven cardiac dysfunction. Conclusions Current evidence is not sufficient to support levosimendan as superior to dobutamine or as an optimal adjunct in severe sepsis and septic shock. More large-scale randomised trials are necessary to validate levosimendan use in sepsis.
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DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
3.7
作者：
Alhashemi, Jamal A.;Alotaibi, Qamar A.;Shalabi, Sanaa A.
通讯作者：
Shalabi, Sanaa A.
影响因子：
7.1
作者：
Sato R;Nasu M
通讯作者：
Nasu M
影响因子：
168.9
作者：
Annane, Djillali;Vignon, Philippe;Bellissant, Eric
通讯作者：
Bellissant, Eric
影响因子：
38.9
作者：
Morelli, A;De Castro, S;Pietropaoli, P
通讯作者：
Pietropaoli, P