Examinando por Autor "Giglio, Andrés"

Mostrando 1 - 7 de 7
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    Cost-effectiveness of dabigatran for thromboembolic events prevention in atrial fibrillation patients in Chile
    (BMC, 2025) Abbot, Tomas; Armijo, Nicolás; Rojas Orellana, Luis; Giglio, Andrés; Balmaceda, Carlos; Espinoza, Manuel
    Background Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, associated with significant morbidity, mortality, and economic burden due to thromboembolic events. In Chile, acenocoumarol is the most widely used anticoagulant, while access to direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban remains limited for AF patients. Among DOACs, dabigatran is the only one with an approved specific reversal agent (idarucizumab) available in the Chilean public system. Evaluating the cost-effectiveness of these alternatives is critical for informing resource allocation. Aims To evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation (AF) patients, from the Chilean public health payer perspective. Methods A Markov cohort model was used to represent the natural history of AF in terms of ischemic and hemorrhagic complications. Direct costs were obtained from local official sources and converted to US dollars (1 USD = 710.9 CLP at 2022). Data about major events and utilities were obtained from the literature. We applied an undifferentiated discount rate of 3% for costs and outcomes over a lifetime time horizon. Uncertainty was characterized through deterministic and probabilistic sensitivity analysis. We also examined the use of idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting as an additional scenario-analysis. Results Dabigatran was the most (cost-)effective among all alternatives (8.53 QALYs). Considering the Chilean costeffectiveness threshold of USD 17,200 (1 GDP per capita), dabigatran was cost-effective (USD 11,042 per QALY gained), while both rivaroxaban and apixaban were dominated by dabigatran. Regarding the second-order uncertainty, at the suggested threshold, dabigatran exhibit the highest probability of being cost-effective (approximately 60%). In the reversal agent scenario, dabigatran plus idarucizumab was also found to be cost-effective in the Chilean context. Conclusion Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents.
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    Decoding sepsis: a 16-year retrospective analysis of activation patterns, mortality predictors, and outcomes from a hospital-wide sepsis protocol
    (MDPI, 2025-08-14) Borges-Sa, Marcio; Giglio, Andrés; Aranda, Maria; Socias, Antonia; Castillo, Alberto del; Mena, Joana; Franco, Sara; Ortega, María; Nieto, Yasmina; Estrada, Victor; Rica, Roberto de la
    Background: Sepsis remains a leading cause of mortality in hospitalized patients. We evaluated characteristics and outcomes of patients identified through a comprehensive hospital-wide sepsis protocol over a 16-year period. Methods: This retrospective cohort study analyzed hospital-wide sepsis protocol activations at a tertiary care hospital in Spain from 2006 to 2022. The protocol required at least two SIRS criteria plus evidence of organ dysfunction in patients over 14 years old. We analyzed demographics, activation criteria, hospital location, mortality predictors using univariate and multivariate analyses, including propensity score modeling, and resource utilization trends. Results: A total of 10,919 patients with 14,546 protocol activations were identified. The median age was 69 years (IQR: 56–78), with 60.9% male patients. Protocol activations occurred in the emergency department (54%), ICU (34.2%), and inpatient wards (11.8%). The most common SIRS criteria were tachycardia (75.6%), tachypnea (50.4%), and fever (48.5%). Prevalent organ dysfunctions included hypotension (53%), hypoxemia (50.1%), oliguria (28.9%), and altered mental status (22%). Overall in-hospital mortality showed a significant linear downward trend from 26.5% in the first year to 13.6% in later years (p < 0.01). Propensity score analysis confirmed independent mortality predictors included hyperlactatemia (aOR 2.21), altered consciousness (aOR 2.09), hypotension (aOR 1.87), and leukopenia (aOR 1.79). ICU admission rate decreased from 58% to 24% over the study period. Conclusions: This 16-year analysis shows that comprehensive hospital-wide sepsis protocols achieve sustained mortality reduction with improved resource utilization efficiency. These findings support implementing comprehensive sepsis protocols as an effective strategy for improving sepsis outcomes.
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    Evaluating in situ Simulation in Critical Care: Insights from Healthcare Professionals
    (Dove Medical Press, DovePress, 2025-08-27) Giglio, Andrés; Ferre Contreras, Andrés; Garcia, Javiera
    Carta al editor relacionado al artículo de Sung TC y Hsu HC que lleva por nombre: Improving Critical Care Teamwork: Simulation-Based Interprofessional Training for Enhanced Communication and Safety.
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    Hospital-wide sepsis detection: A machine learning model based on prospectively expert-validated cohort
    (MDPI, 2026-01-21) Borges-Sa, Marcio; Giglio, Andrés; Aranda, Maria; Socias, Antonia; del Castillo, Alberto; Pruenza, Cristina; Hernández, Gonzalo; Cerdá, Sofía; Socias, Lorenzo; Estrada, Victor; de la Rica, Roberto; Martin, Elisa; Martin-Loeches, Ignacio
    Background/Objectives: Sepsis detection remains challenging due to clinical heterogeneity and limitations of traditional scoring systems. This study developed and validated a hospital-wide machine learning model for sepsis detection using retrospectively developed data from prospectively expert-validated cases, aiming to improve diagnostic accuracy beyond conventional approaches. Methods: This retrospective cohort study analysed 218,715 hospital episodes (2014–2018) at a tertiary care centre. Sepsis cases (n = 11,864, 5.42%) were prospectively validated in real-time by a Multidisciplinary Sepsis Unit using modified Sepsis-2 criteria with organ dysfunction. The model integrated structured data (26.95%) and unstructured clinical notes (73.04%) extracted via natural language processing from 2829 variables, selecting 230 relevant predictors. Thirty models including random forests, support vector machines, neural networks, and gradient boosting were developed and evaluated. The dataset was randomly split (5/7 training, 2/7 testing) with preserved patient-level independence. Results: The BiAlert Sepsis model (random forest + Sepsis-2 ensemble) achieved an AUC-ROC of 0.95, sensitivity of 0.93, and specificity of 0.84, significantly outperforming traditional approaches. Compared to the best rule-based method (Sepsis-2 + qSOFA, AUC-ROC 0.90), BiAlert reduced false positives by 39.6% (13.10% vs. 21.70%, p < 0.01). Novel predictors included eosinopenia and hypoalbuminemia, while traditional variables (MAP, GCS, platelets) showed minimal univariate association. The model received European Medicines Agency approval as a medical device in June 2024. Conclusions: This hospital-wide machine learning model, trained on prospectively expert-validated cases and integrating extensive NLP-derived features, demonstrates superior sepsis detection performance compared to conventional scoring systems. External validation and prospective clinical impact studies are needed before widespread implementation.
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    National epidemiological analysis of lupus in Chile: a registry-based study from 2013 to 2024
    (Sage Publications, 2025-10) Vergara, Karen; Ramirez, Paulina; Handrujovicz, Ivana; Giglio, Andrés
    BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations and regional variations in epidemiology. Despite its clinical significance, robust epidemiological data from Latin America, particularly Chile, remain limited. This study aims to provide the first comprehensive epidemiological assessment of SLE in Chile using population-adjusted denominators and rigorous statistical methods.MethodsWe analyzed data from Chile's Specific Health Guarantees Program (GES) from July 2013 to August 2024, covering 95% of the insured population. Population denominators were obtained from Chile's National Institute of Statistics stratified by age and sex. Incidence rates were calculated using annual new case reports from 2014 to 2023, while prevalence and mortality were estimated through 2024. All analyses included 95% confidence intervals using Poisson distribution methods. Rate ratios were calculated using Poisson regression models with population offset terms. Sensitivity analyses modeled different assumptions regarding program discharge mortality proportions.ResultsThe median annual SLE incidence in Chile was 7.1 per 100,000 beneficiaries (IQR 6.3-7.7) using population-adjusted denominators. Prevalence increased from 26.7 per 100,000 in 2013 to 91.3 per 100,000 in 2024. The male-to-female incidence ratio was 1:10.61 (Rate Ratio: 0.093, 95% CI: 0.088-0.098). Mortality analysis using program discharges as a proxy revealed an overall rate of 11.9 per 1000 SLE patients (IQR 7.2-18.8), with significantly higher rates in males compared to females (Rate Ratio: 1.756, 95% CI: 1.546-1.987). Age-stratified analysis demonstrated progressive mortality increases, with patients ≥60 years showing rates of 87.4 per 1000 in males and 49.0 per 1000 in females. Sensitivity analyses modeling different assumptions about discharge mortality (70%-100% fatal) yielded mortality estimates ranging from 8.2 to 11.9 per 1000 SLE patients.ConclusionsThis study provides a comprehensive epidemiological assessment of SLE in Chile using population-adjusted denominators and statistical confidence intervals. Our findings demonstrate SLE incidence rates higher than North American estimates, significant sex disparities in both incidence and mortality, and age-related mortality progression. The sensitivity analysis addresses limitations in mortality estimation through administrative data. These findings contribute essential epidemiological parameters for healthcare planning and underscore the need for enhanced surveillance systems for autoimmune diseases in Latin America.
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    Optimal arterial pressure transducer positioning for neurocritical care patients: a review
    (Sage Publications; Mary Ann Liebert, Inc., 2025) Giglio, Andrés; Pino, Monserrat; Ferre, Andrés; Hasbun, Pablo; Aguilera, Sergio; Olson, DaiWai M.; Helbok, Raimund; Reccius, Andrés
    This narrative review addresses the critical issue of arterial transducer positioning for cerebral perfusion pressure (CPP) measurement in neurocritical care. Despite CPP’s importance in guiding management, optimal transducer placement remains ambiguous and unaddressed by current guidelines. We synthesized evidence from 20 relevant articles to inform standardization efforts. Key findings include a 10–12 mmHg CPP discrepancy between phlebostatic axis and Monro foramen transducer locations at 30 degree head elevation. There is no consensus on anatomical landmarks for “head-level” measurement, and only one guideline explicitly advises against the phlebostatic axis approach. Limited clinical evidence suggests increased institutionalization rates for patients with measurement discrepancies. Emerging dual-transducer strategies aim to address these challenges. The review highlights significant variability in CPP measurement practices, potentially impacting patient care and research interpretation. We emphasize the urgent need for standardized protocols and improved reporting in research. Addressing this variability is crucial for optimizing neurocritical care management and enhancing research comparability. Our findings underscore the importance of consistent arterial transducer positioning in neurocritical care and call for further research to establish evidence-based standardization, ultimately improving patient outcomes and research quality in this critical field.
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    When Ethics Meet Socrates in Critical Care
    (Society of Critical Care Medicine and Wolters Kluwer Health, 2025-06) Pedreros, Cesar; Saenz, Angel; Ferre, Andrés; Giglio, Andrés
    This process shows how structured philosophical dialogue can potentially transform confrontational scattered discussions into collaborative exploration of complex ethical issues in critical care maintaining mutual respect and potentially reducing the emotional burden