Clinical efficacy and safety of recombinant human brain natriuretic peptide in the treatment of sepsis complicated by heart failure: a systematic review and meta-analysis.

BACKGROUND: Heart failure is among the most prevalent organ dysfunctions in sepsis and carries a high mortality rate. Currently, no specific drugs are available. Recombinant human brain natriuretic peptide (rhBNP) has demonstrated efficacy in treating isolated heart failure. This study aims to evaluate the feasibility of using rhBNP in the management of sepsis complicated by heart failure (SCHF). METHODS: Eight databases were searched for qualified randomized controlled trials (RCTs) from inception to 19 July 2025, with no language restrictions. The primary outcomes included 28-day mortality and left ventricular ejection fraction (LVEF). The secondary outcomes included total clinical effective rate (TCER), APACHE II scores, cardiac output (CO), and adverse events (AEs). The meta-analyses were conducted by R (version 4.5.0). We utilized the Trial Sequential Analysis (TSA) software to perform TSA. Subsequently, the quality of the evidence was assessed using the GRADE framework (the Grading of Recommendation, Assessment, Development, and Evaluation system). This study was registered with PROSPERO (CRD 42023491344). RESULTS: Ten Chinese RCTs involving 1,182 patients were included. Pooled analysis showed that rhBNP combined with conventional Western therapy (CWT) was associated with reduced 28-day mortality (RR = 0.73, 95% CI: 0.58–0.92, p = 0.006) and APACHE II scores (MD = -4.18, 95% CI: -7.80 to -0.55, p = 0.024), and improved TCER (RR = 1.26, 95% CI: 1.12–1.41, p < 0.0001), LVEF (MD = 4.91, 95% CI: 2.56–7.26, p < 0.0001), and CO (MD = 0.47, 95% CI: 0.21–0.74, p = 0.0005). However, rhBNP did not significantly reduce AEs (RR = 0.77, 95% CI: 0.54–1.08, p = 0.13). The certainty of evidence was graded as low for CO and AEs, and very low for 28‑day mortality, LVEF, TCER, and APACHE II scores. CONCLUSIONS: Adjunctive rhBNP may offer cardiac and survival benefits in sepsis complicated by heart failure, but the evidence is of low certainty, non‑generalizable, and safety concerns persist. These hypothesis‑generating findings require confirmation by rigorously designed, multinational RCTs.