Levosimendan in septic shock in patients with biochemical evidence of cardiac dysfunction: a subgroup analysis of the LeoPARDS randomised trial.

Antcliffe, David B and Santhakumaran, Shalini and Orme, Robert M L and Ward, Josie K and Al-Beidh, Farah and O'Dea, Kieran and Perkins, Gavin D and Singer, Mervyn and McAuley, Daniel F and Mason, Alexina J and Cross, Mary and Ashby, Deborah and Gordon, Anthony C (2019) Levosimendan in septic shock in patients with biochemical evidence of cardiac dysfunction: a subgroup analysis of the LeoPARDS randomised trial. Intensive care medicine. ISSN 1432-1238. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://link.springer.com/article/10.1007%2Fs00134...

Abstract

PURPOSE

Myocardial dysfunction is common in sepsis but optimal treatment strategies are unclear. The inodilator, levosimendan was suggested as a possible therapy; however, the levosimendan to prevent acute organ dysfunction in Sepsis (LeoPARDS) trial found it to have no benefit in reducing organ dysfunction in septic shock. In this study we evaluated the effects of levosimendan in patients with and without biochemical cardiac dysfunction and examined its non-inotropic effects.

METHODS

Two cardiac biomarkers, troponin I (cTnI) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five inflammatory mediators were measured in plasma from patients recruited to the LeoPARDS trial at baseline and over the first 6 days. Mean total Sequential Organ Failure Assessment (SOFA) score and 28-day mortality were compared between patients with normal and raised cTnI and NT-proBNP values, and between patients above and below median values.

RESULTS

Levosimendan produced no benefit in SOFA score or 28-day mortality in patients with cardiac dysfunction. There was a statistically significant treatment by subgroup interaction (p = 0.04) in patients with NT-proBNP above or below the median value. Those with NT-proBNP values above the median receiving levosimendan had higher SOFA scores than those receiving placebo (mean daily total SOFA score 7.64 (4.41) vs 6.09 (3.88), mean difference 1.55, 95% CI 0.43-2.68). Levosimendan had no effect on the rate of decline of inflammatory biomarkers.

CONCLUSION

Adding levosimendan to standard care in septic shock was not associated with less severe organ dysfunction nor lower mortality in patients with biochemical evidence of cardiac dysfunction.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WB Practice of medicine > WB400 Intensive care
WG Cardiovascular system. Cardiology
WO Surgery > WO500 Anaesthesia
Divisions: Clinical Support > Anaesthetics
Clinical Support > Critical Care
Emergency Services > Acute Medicine and AMU
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Depositing User: Mr Philip O'Reilly
Date Deposited: 23 Aug 2019 13:09
Last Modified: 23 Aug 2019 13:09
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2323

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