Sepsis is a major cause of morbidity and mortality, with cytokine dysregulation. Levosimendan, a calcium sensitizer with cardioprotective and anti-inflammatory properties. This study investigates the effects of levosimendan on early inflammatory cytokine levels and clinical outcomes in an experimental sepsis model. A murine sepsis model was established using lipopolysaccharide administration. Animals were divided into Sham, Sepsis Control, Low-Dose Levosimendan, and High-Dose Levosimendan groups. Serum cytokine levels (TNF-α, IL-1β, IL-6, IL-8, IL-17, and MCP-1) were measured at the 5th and 10th hours. Sepsis severity was assessed using Murine Sepsis Scores (MSS). TNF-α, IL-1β, IL-6, and MCP-1 levels were significantly elevated in the sepsis control group. Both low- and high-dose levosimendan groups exhibited an initial rise in IL-17 and IL-6, followed by a significant reduction at the 10th hour. High-dose levosimendan demonstrated the most pronounced anti-inflammatory effect, with significant reductions in TNF-α, IL-1β, and MCP-1 levels. MSS scores were significantly lower in levosimendan-treated groups, with high-dose treatment showing the greatest improvement. Levosimendan exerts a dose-dependent immunomodulatory effect in experimental sepsis, with high doses effectively suppressing pro-inflammatory cytokine levels and improving clinical outcomes. These findings highlight the potential therapeutic role of levosimendan in sepsis management, warranting further investigation in clinical settings.

Background: Continuous non-invasive hemoglobin monitoring (SpHb) may provide real-time information during surgery, but its accuracy in neurosurgery remains uncertain. We evaluated the agreement, trending ability, and diagnostic performance of SpHb compared with arterial blood gas hemoglobin during elective intracranial neurosurgery. Methods: In this prospective observational study, 60 adults undergoing elective neurosurgery with invasive arterial monitoring were included. SpHb (Masimo Radical-7) was compared with paired arterial hemoglobin values. Agreement was assessed using repeated-measures Bland–Altman analysis and mixed-effects modeling. Trending ability was evaluated using four-quadrant concordance with an exclusion zone of ±0.5 g/dL. Discrimination for severe anemia (Hb < 8 g/dL) was assessed using ROC analysis with patient-level cluster bootstrapping. Results: A total of 190 paired measurements were analyzed. Mean bias was +0.23 g/dL, with wide limits of agreement (−3.26 to +3.72 g/dL). Agreement was worse under low-perfusion-index conditions. Trending performance was preserved, with an overall concordance rate of 85.5%. SpHb showed moderate discrimination for severe anemia (AUC 0.78; 95% CI 0.61–0.93), although severe anemia events were infrequent. Conclusions: SpHb showed limited reliability for absolute hemoglobin quantification during neurosurgery but provided useful trend information. SpHb should not replace invasive hemoglobin measurements for clinical decision-making.

Bahar Oc and Ates Duman were inadvertently omitted from the author list in the original publication