ÁP DỤNG CHỈ SỐ PHÂN SUẤT TỐNG MÁU TOÀN BỘ (GEF) ĐO BẰNG PHƯƠNG PHÁP HÒA LOÃNG NHIỆT XUYÊN PHỔI TRONG ĐIỀU TRỊ BỆNH NHÂN SỐC NHIỄM KHUẨN

Abstract

Objective: To investigate the correlation between Global Ejection Fraction (GEF) and Left Ventricular Ejection Fraction (LVEF) at multiple time points in septic shock patients. Methods:.A prospective observational study was conducted on 45 patients ≥18 years old diagnosed with septic shock according to Sepsis-3 criteria at A9 Emergency Center, Bach Mai Hospital, from August 2024 to August 2025. GEF was assessed by transpulmonary thermodilution, while LVEF was obtained by cardiologists using echocardiography at predefined time points. Hemodynamic parameters, lactate, norepinephrine dose, SOFA, and APACHE II scores were recorded. Correlation analysis was performed using Spearman’s coefficient, and the diagnostic performance of GEF was evaluated by ROC curves. Results: Patients aged ≥60 years accounted for 60%, with males representing 64.4%. The predominant source of infection was the respiratory tract (68.9%). Pathogens were identified in 77.7% of cases, mainly Gram-negative bacteria, including A. baumannii (22.8%), E. coli (17.1%), and K. pneumoniae (17.1%). The overall mortality rate was 57.8%. Non-survivors had significantly higher lactate, SOFA, and APACHE II scores compared with survivors (p<0.05). A total of 142 paired GEF–LVEF measurements demonstrated a strong correlation (r=0.696, p<0.001). The optimal GEF cut-off values for predicting LVEF were: EF ≥40% (14%, AUC 0.677), EF ≥50% (18%, AUC 0.795), and EF ≥60% (21%, AUC 0.835), with 100% specificity at all thresholds. Conclusion:  GEF demonstrated a strong correlation with LVEF and may serve as a complementary or alternative marker for cardiac function assessment in septic shock patients, particularly when echocardiography is not feasible. - Diagnostic performance of GEF: EF ≥40%: cut-off 14%, AUC 0.677, Se 58,5%, Sp 100%. EF ≥50%: cut-off 18%, AUC 0.795, Se 61,3%, Sp 100%. EF ≥60%: cut-off 21%, AUC 0.835, Se 70,8%, Sp 100%.