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Evidencia usada para actualizar la lista de afecciones subyacentes que aumentan el riesgo que tiene una persona de enfermarse gravemente a causa del COVID-19

Evidencia usada para actualizar la lista de afecciones subyacentes que aumentan el riesgo que tiene una persona de enfermarse gravemente a causa del COVID-19

Las actualizaciones de la lista de afecciones subyacentes que aumentan el riesgo de que personas adultas de cualquier edad puedan enfermarse gravemente a causa del COVID-19 se basan en informes publicados, artículos de prensa, borradores sin revisión y datos internos disponibles entre el 1 de diciembre del 2019 y el 1 de septiembre del 2020. Esta lista es un documento dinámico que puede ser actualizado periódicamente por los CDC, y que puede cambiar rápidamente a medida que evoluciona la ciencia. Enfermarse gravemente a causa del COVID-19 implica por definición: hospitalización, admisión a una UCI, intubación o asistencia respiratoria mecánica, o muerte.

El nivel de evidencia para cada afección fue determinado por los revisores de los CDC según la información disponible acerca del COVID-19. Se agregaron afecciones a la lista (si no estaban ya en la lista anterior de afecciones subyacentes [publicada originalmente en marzo del 2020]) si la evidencia acerca de una asociación con el hecho de enfermarse gravemente a causa del COVID-19 cumplía con cualquiera de los siguientes criterios:

  • Evidencia más sólida y contundente: definida como evidencia contundente de múltiples estudios pequeños o una fuerte asociación de un estudio grande,
  • Evidencia mixta: definida como múltiples estudios que llegaron a diferentes conclusiones acerca del riesgo asociado a una afección, o
  • Evidencia limitada: definida como evidencia contundente de una cantidad pequeña de estudios. 

Los calificadores de las afecciones que figuran en la lista anterior fueron añadidos o quitados en caso de haber una fuerte evidencia que respaldase que se deba realizar una ampliación acerca de la afección. Las afecciones que figuran en la lista anterior se debían quitar en caso de haber evidencia fuerte y sólida que demostrase la falta de asociación con los resultados graves. Según este criterio, no se quitaron afecciones de la lista anterior de afecciones subyacentes, con fecha de marzo del 2020; sin embargo, en la actualización más reciente de octubre del 2020, el hábito de fumar pasó de la categoría "evidencia mixta" a "evidencia sólida".

*Las actualizaciones sobre el hábito de fumar se basaron en la evidencia disponible entre el 1 de diciembre del 2019 y el 20 de julio del 2020.

Evidencia usada para actualizar la lista de afecciones subyacentes que aumentan el riesgo que tiene una persona de enfermarse gravemente a causa del COVID-19
Nivel de evidencia Afección Evidencia del impacto sobre la gravedad del COVID-19 Notas
Evidencia más sólida y contundente Cáncer Revisión sistemática [6]
Estudio de cohortes [7,8]
Series de casos [9]
Nuevo en la lista actualizada del 17 de julio del 2020
Enfermedad renal crónica Series de casos [10, 11, 12]
Estudios de cohortes [13, 14, 15]
En la versión anterior de la lista figura como "Enfermedad renal crónica que requiere diálisis"
EPOC Metanálisis [4, 16]
Series de casos [17]
Estudio de cohortes [14]
En la versión anterior de la lista
Afecciones cardiacas, tales como insuficiencia cardiaca, enfermedad de la arteria coronaria o miocardiopatías Estudio de cohortes [1, 2]
Metanálisis [3, 4]
Series de casos [5]
En la versión anterior de la lista figura como "Afecciones cardiacas graves"
Obesidad (IMC >30 kg/m2) Estudios de cohortes [18, 19, 20, 21, 22]
Estudios transversales [23]
Figura en la lista anterior
Obesidad grave (IMC ≥40 kg/m2) Estudio de cohortes [98, 99]
Estudio sectorial [95]
Metanálisis [107]
Figura en la lista anterior
Enfermedad de células falciformes Series de casos [24, 25, 26, 27, 28] En la versión anterior de la lista
Fumar Metanálisis [3, 16*, 63, 64, 65, 66, 101, 102, 104, 105] En la versión anterior de la lista
Trasplantes de órganos sólidos Series de casos [12, 29, 30, 31, 32, 33, 34]
Metanálisis [100]
Nuevo en la lista actualizada del 25 de junio del 2020
Diabetes mellitus tipo 2 Series de casos [11]
Estudio longitudinal [35]
Estudio de cohortes [36, 37]
Metanálisis [38]
Estudio sectorial [114]
En la versión anterior de la lista
Evidencia mixta Asma Estudio de cohortes [14, 39, 40, 41]
Series de casos [17]
En la versión anterior de la lista
Enfermedad cerebrovascular Metanálisis [42, 43, 44, 45]
Síntesis de evidencia [46]
Estudio de cohortes [1, 2, 47, 48, 49]
Nuevo en la lista actualizada del 25 de junio del 2020
Hipertensión Estudio de cohortes [1, 2, 49, 50, 51, 91, 93]
Series de casos [92]
Revisión sistemática [52]
Metanálisis [3, 4, 53, 94]
Nuevo en la lista actualizada del 25 de junio del 2020
Embarazo Revisión sistemática [54]
Estudio de casos y controles [55]
Series de casos [56, 57, 58, 59]
Estudio de cohortes [60, 61, 62]
En la versión anterior de la lista
Uso de corticoides u otros medicamentos inmunosupresores Series de casos [67, 68, 69]
Estudio de cohortes [70, 71]
En la versión anterior de la lista
Evidencia limitada Trasplantes de médula ósea Revisión [72] En la versión anterior de la lista
VIH Series de casos [73, 74]
Estudio de cohortes [109, 110, 111, 112]
En la versión anterior de la lista
Deficiencias inmunitarias Series de casos [75]
Revisión sistemática [76]
En la versión anterior de la lista
Trastornos metabólicos congénitos Estudio de cohortes [47, 77] Nuevo en la lista actualizada del 25 de junio del 2020; específico a poblaciones pediátricas para este momento
Enfermedad hepática Metanálisis [78]
Estudio de cohortes [79, 80]
Revisión de bibliografía [81]
En la versión anterior de la lista
Afecciones neurológicas Estudio sectorial [82]
Estudio de cohortes [41, 49, 77]
Nuevo en la lista actualizada del 25 de junio del 2020; específico a poblaciones pediátricas para este momento
Otras enfermedades pulmonares crónicas Metanálisis [4]
Series de casos [17]
Estudio de cohortes [14, 83]
En la versión anterior de la lista
Sobrepeso (IMC >25 kg/m2, pero <30 kg/m2) Estudio de cohortes [96, 106]
Series de casos [97]
Metanálisis [115]
No incluido en la lista anteriormente
Pediatría Revisión sistemática [84, 85]
Estudio sectorial [82, 86, 107]
Estudio de cohortes [77, 87, 88, 103, 108, 113]
Nuevo en la lista actualizada del 17 de julio del 2020
Talasemia Series de casos [89]
Estudio sectorial [90]
En la versión anterior de la lista
Diabetes mellitus tipo 1 Series de casos [11]
Estudio de cohortes [36, 37]
Metanálisis [38]
Estudio sectorial [114]
En la versión anterior de la lista

*Cuestiones metodológicas encontradas por otros autores; analizado nuevamente por Guo [64] y una asociación que encontraron un factor de riesgo de mayor gravedad.

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Última actualización: 6 de oct. del 2020