{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:40:02Z","timestamp":1780569602730,"version":"3.54.1"},"reference-count":52,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Septic-induced cardiomyopathy (SICM) is a life-threatening condition in patients with septic shock. Persistent hypoperfusion despite adequate volume status and vasopressor use is associated with poor outcomes and is currently managed with inotropes. However, the superiority of available inotropic agents remains unclear. This meta-analysis aims to determine which inotropic agent may be more effective in this clinical scenario. Methods: A systematic review and meta-analysis were conducted, including data from randomized clinical trials (RCTs) comparing levosimendan and dobutamine in patients with septic shock and persistent hypoperfusion. Summary effect estimates, including odds ratios (ORs), standardized mean differences (SMDs), and 95% confidence intervals (CIs), were calculated using a random-effects model. Trial sequential analysis (TSA) was also performed. Results: Of 244 studies screened, 11 RCTs were included. Levosimendan was associated with a reduction in in-hospital mortality (OR 0.64; 95% CI: 0.47; 0.88) and ICU length of stay (SMD 5.87; 95% CI: \u20138.37; 20.11) compared with dobutamine. Treatment with levosimendan also resulted in significant reductions in BNP (SMD \u20131.87; 95% CI: \u20132.45; \u22121.2) and serum lactate levels (SMD \u20131.63; 95% CI: \u20133.13; \u22120.12). However, TSA indicated that the current evidence is insufficient to definitively confirm or exclude effects on in-hospital and 28-day mortality. Conclusions: Levosimendan may improve hemodynamics, tissue perfusion, and biomarkers, and may reduce in-hospital mortality and ICU length of stay in patients with SICM compared with dobutamine. However, TSA highlights the need for further studies to inform clinical practice and optimize inotrope selection.<\/jats:p>","DOI":"10.3390\/jcm14155496","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T08:46:55Z","timestamp":1754383615000},"page":"5496","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Levosimendan vs. Dobutamine in Patients with Septic Shock: A Systematic Review and Meta-Analysis with Trial Sequential Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4020-3729","authenticated-orcid":false,"given":"Edith Elianna","family":"Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Critical and Intensive Care Medicine, Hospital Universitario Mayor-M\u00e9deri, Bogot\u00e1 111411, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"German Alberto Devia","family":"Jaramillo","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Fundaci\u00f3n Santa Fe de Bogot\u00e1, Bogot\u00e1 110111, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6633-760X","authenticated-orcid":false,"given":"Lissa Mar\u00eda Rivera","family":"Cuellar","sequence":"additional","affiliation":[{"name":"Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2456-8823","authenticated-orcid":false,"given":"Santiago Eduardo P\u00e9rez","family":"Herran","sequence":"additional","affiliation":[{"name":"Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7089-018X","authenticated-orcid":false,"given":"David Ren\u00e9 Rodr\u00edguez","family":"Lima","sequence":"additional","affiliation":[{"name":"Critical and Intensive Care Medicine, Hospital Universitario Mayor-M\u00e9deri, Bogot\u00e1 111411, Colombia"},{"name":"Grupo de Investigaci\u00f3n Cl\u00ednica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-0208","authenticated-orcid":false,"given":"Antoine","family":"Herpain","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Erasme, 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit. 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