Characteristics of the included trials
| Study | Year | Subjects (n) | Levosimendan group | Control group | Inclusion criteria | Cardiovascular criteria | Levosimendan therapy | Control therapy | Target MAP (mm Hg) | Follow-up (day) | Primary outcome |
| Alhashemi et al 22 | 2009 | 42 | 21 | 21 | Severe sepsis/septic shock | NR | 0.05–2 µg/kg/min, 24 hours | Dobutamine 5–20 µg/kg/min, 7 days | ≥65 | ICU stay | ScvO2 and serum lactate |
| Fang and Dong26 | 2014 | 36 | 18 | 18 | Septic shock | LVEF ≤45% | Dobutamine 0.5 µg/kg/min for 24 hours; levosimendan 0.2 µg/kg/min 24 hours subsequently | Dobutamine 5 µg/kg/min, 48 hours | NR | 28 | Haemodynamics and cardiac function |
| Gordon et al 28 | 2016 | 515 | 258 | 257* | Septic shock | MAP 60–70 mm Hg | 0.05–0.2 µg/kg/min, 24 hours | Standard therapy | 65–70 | 28 | Daily SOFA score |
| Memiş et al 24 | 2012 | 30 | 15 | 15 | Septic shock | MAP ≤65 mm Hg | 0.1 µg/kg/min, 24 hours | Dobutamine 10 µg/kg/min, 24 hours | >65 | NR | Liver function |
| Meng et al 27 | 2016 | 38 | 19 | 19 | Septic shock | MAP ≥65 mm Hg and LVEF ≤45% | 0.2 µg/kg/min, 24 hours | Dobutamine 5 µg/kg/min, 24 hours | ≥65 | 28 | Haemodynamics and myocardial injury biomarkers |
| Morelli et al 30 | 2005 | 28 | 15 | 13† | Septic shock | MAP 70–80 mm Hg, PAOP ≥12 mm Hg and LVEF <45% | 0.2 µg/kg/min, 24 hours | Dobutamine 5 µg/kg/min, 24 hours | 70–80 | 30 | Haemodynamics and cardiac function |
| Morelli et al 23 | 2010 | 40 | 20 | 20 | Septic shock | MAP ≥65 mm Hg | 0.2 µg/kg/min, 24 hours | Dobutamine 5 µg/kg/min, 24 hours | 70±5 | ICU stay | Systemic and microvascular haemodynamics |
| Torraco et al 25 | 2014 | 26 | 13 | 13 | Septic shock | MAP ≥65 mm Hg | 0.2 µg/kg/min, 24 hours | Standard therapy | 65–75 | 28 | Mitochondrial function |
| Vaitsis et al 21 | 2009 | 42 | 23 | 19 | Sepsis | CI <2.2, LVEF <35% | 0.1 µg/kg/min, 24 hours | Dobutamine 5–10 µg/kg/min, 24 hours | >65 | 30 | Mortality at 7 and 30 days |
| Wang and Li29 | 2017 | 240 | 120 | 120 | Septic shock | MAP ≥65 mm Hg | 0.1–0.2 µg/kg/min, 24 hours | Standard care | ≥65 | 28 | Mortality at 28 days, ICU discharge and hospital discharge |
*A total of 256 patients were finally included for 28-day mortality analysis.
†Two patients in the control group failed to complete the study and were excluded.
CI, cardiac index; ICU, intensive care unit; LVEF, left ventricular ejection fraction; MAP, mean artery pressure; NR, not reported; PAOP, pulmonary artery occlusion pressure; ScvO2, central venous oxygen saturation; SOFA, Sequential Organ Failure Assessment.