title: Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate the clinical efficacy of levosimendan versus dobutamine in critically ill patients requiring inotropic support.
  
  
  METHODS
  Clinical trials were searched in PubMed, EMBASE, and the Cochrane Central Registry of Clinical Trials, as well as Web of Science. Studies were included if they compared levosimendan with dobutamine in critically ill patients requiring inotropic support, and provided at least one outcome of interest. Outcomes of interest included mortality, incidence of hypotension, supraventricular arrhythmias, and ventricular arrhythmias.
  
  
  RESULTS
  Data from a total of 3052 patients from 22 randomized controlled trials (RCTs) were included in the analysis. Overall analysis showed that the use of levosimendan was associated with a significant reduction in mortality (269 of 1373 [19.6%] in the levosimendan group, versus 328 of 1278 [25.7%] in the dobutamine group, risk ratio (RR)=0.81, 95% confidence interval (CI) 0.70-0.92, P for effect=0.002). Subgroup analysis indicated that the benefit from levosimendan could be found in the subpopulations of cardiac surgery, ischemic heart failure, and concomitant β-blocker therapy in comparison with dobutamine. There was no significant difference in the incidence of hypotension, supraventricular arrhythmias, or ventricular arrhythmias between the two drugs.
  
  
  CONCLUSIONS
  In contrast with dobutamine, levosimendan is associated with a significant improvement in mortality in critically ill patients requiring inotropic support. Patients having cardiac surgery, with ischemic heart failure, and receiving concomitant β-blocker therapy may benefit from levosimendan. More RCTs are required to address the questions about no positive outcomes in the subpopulation in a cardiology setting, and to confirm the advantages in long-term prognosis.
authors: Department of Gastroenterology, the First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou 310006, China.
authors: Xuan
authors: X
authors: Huang
authors: Shu
authors: S
authors: Lei
authors: Mei-fei
authors: MF
authors: Zhu
authors: Rong-lin
authors: RL
authors: Jiang
authors: Li-quan
authors: LQ
authors: Huang
authors: Guo-lian
authors: GL
authors: Xia
authors: Yi-hui
authors: YH
authors: Zhi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000517:prevention & control; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality* / Q000451:nursing; D004280:Dobutamine / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007022:Hypotension / Q000401:mortality / Q000517:prevention & control; D011724:Pyridazines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012307:Risk Factors; D000077464:Simendan; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine
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