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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
Actualizado el 2 de nov. del 2020
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Las actualizaciones al listado de afecciones subyacentes que aumentan el riesgo de las personas adultas de enfermarse gravemente a causa del COVID-19 se basan en informes publicados, artículos de prensa, informes preliminares sin revisión y datos internos disponibles entre el 1 de diciembre del 2019 y el 16 de octubre 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. Con base en este criterio, no se eliminó ninguna afección de la lista anterior de afecciones subyacentes de marzo del 2020; sin embargo, en esta actualización más reciente de noviembre del 2020, se pasó de la sección "evidencia mixta" a la sección "evidencia sólida y contundente".

*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
Evidencia más sólida y contundente Cáncer Revisión sistemática [6]
Estudio de cohortes [7,8]
Series de casos [9]
Enfermedad renal crónica Series de casos [10, 11, 12]
Estudios de cohortes [13, 14, 15]
EPOC Metanálisis [4, 16]
Series de casos [17]
Estudio de cohortes [14]
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]
Obesidad (IMC >30 kg/m2) Estudios de cohortes [18, 19, 20, 21, 22]
Estudios transversales [23]
Obesidad grave (IMC ≥40 kg/m2) Estudio de cohortes [98, 99]
Estudio sectorial [95]
Metanálisis [107]
Embarazo Revisión sistemática [54, 116]
Estudio de casos y controles [55]
Series de casos [56, 57, 58, 59]
Estudio de cohortes [60, 61, 62, 117]
Enfermedad de células falciformes Series de casos [24, 25, 26, 27, 28]
Fumar Metanálisis [3, 16*, 63, 64, 65, 66, 101, 102, 104, 105]
Trasplantes de órganos sólidos Series de casos [12, 29, 30, 31, 32, 33, 34]
Metanálisis [100]
Diabetes mellitus tipo 2 Series de casos [11]
Estudio longitudinal [35]
Estudio de cohortes [36, 37]
Metanálisis [38]
Estudio sectorial [114]
Evidencia mixta Asma Estudio de cohortes [14, 39, 40, 41]
Series de casos [17]
Enfermedad cerebrovascular Metanálisis [42, 43, 44, 45]
Síntesis de evidencia [46]
Estudio de cohortes [1, 2, 47, 48, 49]
Hipertensión Estudio de cohortes [1, 2, 49, 50, 51, 91, 93]
Series de casos [92]
Revisión sistemática [52]
Metanálisis [3, 4, 53, 94]
Uso de corticoides u otros medicamentos inmunosupresores Series de casos [67, 68, 69]
Estudio de cohortes [70, 71]
Evidencia limitada Trasplantes de médula ósea Revisión [72]
VIH Series de casos [73, 74]
Estudio de cohortes [109, 110, 111, 112]
Deficiencias inmunitarias Series de casos [75]
Revisión sistemática [76]
Trastornos metabólicos congénitos Estudio de cohortes [47, 77]
Enfermedad hepática Metanálisis [78]
Estudio por cohortes [79, 80, 118, 119]
Revisión de bibliografía [81]
Estudio de casos y controles [120]
Afecciones neurológicas Estudio sectorial [82]
Estudio de cohortes [41, 49, 77]
Otras enfermedades pulmonares crónicas Metanálisis [4]
Series de casos [17]
Estudio de cohortes [14, 83]
Sobrepeso (IMC >25 kg/m2, pero <30 kg/m2) Estudio de cohortes [96, 106]
Series de casos [97]
Metanálisis [115]
Pediatría Revisión sistemática [84, 85]
Estudio sectorial [82, 86, 107]
Estudio por cohortes [77, 87, 88, 103, 108, 113, 121, 122, 125]
Series de casos [123, 124]
Talasemia Series de casos [89]
Estudio sectorial [90]
Diabetes mellitus tipo 1 Series de casos [11]
Estudio de cohortes [36, 37]
Metanálisis [38]
Estudio sectorial [114]

*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: 2 de nov. del 2020
Fuente del contenido: Centro Nacional de Vacunación y Enfermedades Respiratorias (NCIRD), División de Enfermedades Virales