Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials
Prevention of cardiorenal syndrome through treatment with inotropic agents remains challenging. This network meta-analysis evaluated the safety and renoprotective effects of inotropes on patients with advanced heart failure (HF) using a frequentist random-effects model. A systematic database search...
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MDPI AG
2021-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/18/4120 |
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| author | Wei-Cheng Chen Meng-Hsuan Lin Chieh-Lung Chen Yi-Ching Lai Chih-Yu Chen Yu-Chao Lin Chin-Chuan Hung |
| author_facet | Wei-Cheng Chen Meng-Hsuan Lin Chieh-Lung Chen Yi-Ching Lai Chih-Yu Chen Yu-Chao Lin Chin-Chuan Hung |
| author_sort | Wei-Cheng Chen |
| collection | DOAJ |
| description | Prevention of cardiorenal syndrome through treatment with inotropic agents remains challenging. This network meta-analysis evaluated the safety and renoprotective effects of inotropes on patients with advanced heart failure (HF) using a frequentist random-effects model. A systematic database search was performed until 31 January 2021, and a total of 37 trials were included. Inconsistency, publication bias, and subgroup analyses were conducted. The levosimendan group exhibited significantly decreased mortality compared with the control (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.46–0.84), milrinone (OR: 0.50; 95% CI: 0.30–0.84), and dobutamine (OR: 0.75; 95% CI: 0.57–0.97) groups. In terms of renal protection, levosimendan (standardized mean difference (SMD): 1.67; 95% CI: 1.17–2.18) and dobutamine (SMD: 1.49; 95% CI: 0.87–2.12) more favorably improved the glomerular filtration rate (GFR) than the control treatment did, but they did not significantly reduce the incidence of acute kidney injury. Furthermore, levosimendan had the highest P-score, indicating that it most effectively reduced mortality and improved renal function (e.g., GFR and serum creatinine level), even in patients with renal insufficiency. In conclusion, levosimendan is a safe alternative for protecting renal function on cardiorenal syndrome in patients with advanced HF. |
| first_indexed | 2024-03-10T07:34:24Z |
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| institution | Directory Open Access Journal |
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| last_indexed | 2024-03-10T07:34:24Z |
| publishDate | 2021-09-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-f8e6c9551f3444699c32fb70ea4a53612023-11-22T13:39:47ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-011018412010.3390/jcm10184120Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled TrialsWei-Cheng Chen0Meng-Hsuan Lin1Chieh-Lung Chen2Yi-Ching Lai3Chih-Yu Chen4Yu-Chao Lin5Chin-Chuan Hung6Graduate Institute of Biomedical Sciences, China Medical University, 91 Hsueh-Shih Road, Taichung 404333, TaiwanDepartment of Pharmacy, College of Pharmacy, China Medical University, 100 Jingmao Road, Bei-tun Dist., Taichung 406040, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, TaiwanDepartment of Cardiovascular Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, TaiwanDepartment of Pharmacy, College of Pharmacy, China Medical University, 100 Jingmao Road, Bei-tun Dist., Taichung 406040, TaiwanPrevention of cardiorenal syndrome through treatment with inotropic agents remains challenging. This network meta-analysis evaluated the safety and renoprotective effects of inotropes on patients with advanced heart failure (HF) using a frequentist random-effects model. A systematic database search was performed until 31 January 2021, and a total of 37 trials were included. Inconsistency, publication bias, and subgroup analyses were conducted. The levosimendan group exhibited significantly decreased mortality compared with the control (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.46–0.84), milrinone (OR: 0.50; 95% CI: 0.30–0.84), and dobutamine (OR: 0.75; 95% CI: 0.57–0.97) groups. In terms of renal protection, levosimendan (standardized mean difference (SMD): 1.67; 95% CI: 1.17–2.18) and dobutamine (SMD: 1.49; 95% CI: 0.87–2.12) more favorably improved the glomerular filtration rate (GFR) than the control treatment did, but they did not significantly reduce the incidence of acute kidney injury. Furthermore, levosimendan had the highest P-score, indicating that it most effectively reduced mortality and improved renal function (e.g., GFR and serum creatinine level), even in patients with renal insufficiency. In conclusion, levosimendan is a safe alternative for protecting renal function on cardiorenal syndrome in patients with advanced HF.https://www.mdpi.com/2077-0383/10/18/4120levosimendanheart failurecardiorenal syndromemortalitynetwork meta-analysis |
| spellingShingle | Wei-Cheng Chen Meng-Hsuan Lin Chieh-Lung Chen Yi-Ching Lai Chih-Yu Chen Yu-Chao Lin Chin-Chuan Hung Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials Journal of Clinical Medicine levosimendan heart failure cardiorenal syndrome mortality network meta-analysis |
| title | Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials |
| title_full | Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials |
| title_short | Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials |
| title_sort | comprehensive comparison of the effect of inotropes on cardiorenal syndrome in patients with advanced heart failure a network meta analysis of randomized controlled trials |
| topic | levosimendan heart failure cardiorenal syndrome mortality network meta-analysis |
| url | https://www.mdpi.com/2077-0383/10/18/4120 |
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