COVID-19 (Novel Coronavirus)

COVID-19 (Nuevo coronavirus)
Descripción general y recomendaciones

Fondo
● COVID-19 es una enfermedad respiratoria aguda causada por el SARS-CoV-2 , un nuevo coronavirus
estrechamente relacionado con el SARS-CoV.
● El virus se transmite de persona a persona tanto por personas sintomáticas como asintomáticas a
través del contacto cercano (dentro de 6 pies) a través de gotitas respiratorias. La transmisión también
puede ocurrir a través de aerosoles y posiblemente a través del contacto con fómites, aunque no se
cree que sea una ruta principal.
● Las características clínicamente importantes de la patogénesis del SARS-CoV-2 incluyen:
⚬ infección de células a través de la unión de la proteína de punta viral a los receptores de la enzima
convertidora de angiotensina 2 (ACE2), con entrada celular que requiere serina proteasa
transmembrana tipo 2 para escindir el receptor ACE2 y activar la proteína de punta viral.
⚬ infección de células epiteliales nasales y bronquiales y neumocitos en etapas tempranas de la
infección.
⚬ aceleración de la replicación viral y compromiso de la integridad de la barrera epitelial-endotelial en
etapas posteriores, lo que resulta en una respuesta inflamatoria desregulada y un estado de
hipercoagulabilidad.
⚬ desregulación del sistema renina-angiotensina-aldosterona, que también puede contribuir al daño
tisular relacionado con la infección.
● El COVID-19 se declaró pandemia mundial el 11 de marzo de 2020. Hasta el 13 de noviembre de 2022,

se han notificado más de 632 millones de casos en todo el mundo, incluidas más de 6,5 millones de
muertes.
● La mortalidad secundaria a la COVID-19 es muy variable y está relacionada con la edad, la gravedad de
la enfermedad y las comorbilidades. La mortalidad estimada es
⚬ 0,3%-2,3% para todos los pacientes.
⚬ 10%-23% para pacientes hospitalizados.
⚬ 26%-50% para pacientes ingresados en UCI.
⚬ 37%-88% para pacientes que requieren ventilación mecánica invasiva u oxigenación por membrana
extracorpórea (ECMO).
Evaluación
● Los síntomas leves a severos pueden surgir de 2 a 14 días después de la exposición, con un período de
incubación promedio de 5 días.
● Los síntomas pueden incluir:
⚬ fiebre o escalofríos.
⚬ tos, dificultad para respirar o dificultad para respirar.
⚬ dolor de cabeza, dolores musculares o corporales, mareos o fatiga.
⚬ dolor de garganta, congestión o secreción nasal.
⚬ nueva pérdida del olfato o del gusto.
⚬ náuseas, vómitos, diarrea, dolor abdominal o anorexia.
⚬ confusión o alteración de la conciencia.
⚬ sarpullido.
● La infección asintomática puede ocurrir hasta en un 30% de los pacientes.
● Prueba de amplificación de ácido nucleico SARS-CoV-2
⚬ es actualmente la prueba de elección para confirmar el diagnóstico ( Recomendación fuerte ).

⚬ se recomienda para personas sintomáticas en la comunidad que se sospecha que tienen COVID-19,
incluso cuando la sospecha clínica es baja ( Recomendación fuerte ).
⚬ puede recomendarse para personas asintomáticas en ciertas situaciones, como aquellas con
inmunodepresión que requieren ingreso hospitalario, antes de la introducción de nuevos
inmunosupresores, antes del procedimiento, exposición conocida y hospitalización en áreas con alta
prevalencia de COVID-19.
● Varias muestras pueden ser apropiadas para las pruebas de ácido nucleico del SARS-CoV-2. Las
muestras de las vías respiratorias superiores, incluidos los hisopos nasofaríngeos, de cornete medio o
nasales, son las más utilizadas.
● No se recomiendan las pruebas serológicas para el diagnóstico de la infección por SARS-CoV-2 durante
las primeras 2 semanas después del inicio de los síntomas ( recomendación débil ).
administración
● La decisión de manejar a un paciente en un entorno hospitalario o ambulatorio debe tomarse caso por
caso.
⚬ Los pacientes con enfermedad leve (ausencia de neumonía viral e hipoxia) pueden no requerir
hospitalización.
⚬ Los pacientes con enfermedad moderada pueden requerir hospitalización según las comorbilidades
y el riesgo de progresión clínica.
⚬ Las manifestaciones graves que requieren hospitalización y atención de apoyo incluyen neumonía,
hipoxemia, síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico, miocardiopatía,
arritmia y lesión renal aguda.
● Para pacientes no hospitalizados
⚬ Proporcione atención de apoyo, considere la terapia específica de COVID-19 para pacientes con alto
riesgo de progresión, tome medidas para reducir el riesgo de transmisión (incluido el aislamiento del
paciente) y aconseje a los pacientes sobre cuándo contactar a los proveedores de atención médica y
buscar una evaluación en persona ( Recomendación fuerte ).
⚬ Uno de los siguientes medicamentos recomendados para pacientes con alto riesgo de progresión de
la enfermedad; tratamiento oportuno recomendado para pacientes con inmunodepresión (
Recomendación fuerte ).
– Terapias preferidas (enumeradas en orden de preferencia):
● Nirmatrelvir/ritonavir (Paxlovid) por vía oral dos veces al día durante 5 días ( Recomendación
fuerte ); revise cuidadosamente todos los medicamentos concomitantes para detectar
posibles interacciones farmacológicas.
● Remdesivir 200 mg IV el día 1 seguido de 100 mg IV los días 2 y 3 ( recomendación débil ).
– Terapias alternativas si las terapias preferidas no están disponibles, no son factibles de

administrar o son clínicamente inapropiadas:
● Molnupiravir 800 mg por vía oral dos veces al día durante 5 días para adultos ≥ 18 años (
Recomendación débil ); no recomendado para pacientes embarazadas debido a problemas de
toxicidad fetal, pero puede ser elegido por el paciente después de estar completamente
informado de los riesgos, especialmente si tiene > 10 semanas de gestación
● Bebtelovimab 175 mg IV dosis única administrada durante ≥ 30 segundos para adultos ≥ 18
años ( Recomendación débil ).
⚬ Omicron es la variante dominante en los Estados Unidos, por lo tanto, bamlanivimab más
etesevimab, casirivimab más imdevimab y sotrovimab actualmente no se recomiendan en los
Estados Unidos ( Recomendación fuerte ).
● Recomendaciones de tratamiento de los Institutos Nacionales de Salud (NIH) para pacientes

hospitalizados.
⚬ Para todos los pacientes hospitalizados, se debe continuar la terapia anticoagulante o
antiplaquetaria para condiciones médicas subyacentes a menos que se desarrolle una hemorragia
significativa u otras contraindicaciones presentes ( Recomendación fuerte ).
⚬ Para adultos hospitalizados pero que no requieren oxígeno suplementario:
– No se recomienda la dexametasona u otros corticosteroides sistémicos a menos que los

pacientes ya estén recibiendo corticosteroides para otras indicaciones y deben continuar la
terapia según las indicaciones de su profesional de la salud ( Recomendación fuerte ).
– Se puede considerar Remdesivir 200 mg IV una vez al día durante 1 día, luego 100 mg IV una vez
al día durante 4 días (o hasta el alta hospitalaria, lo que ocurra primero) para pacientes con alto
riesgo de progresar a COVID-19 grave ( Recomendación débil ).
– No se recomienda la terapia antitrombótica profiláctica (Recomendación fuerte ).
– Los pacientes con COVID-19 leve a moderado con inmunocompromiso que están hospitalizados
por motivos distintos al COVID-19 deben ser tratados de inmediato con agentes antivirales o
terapia con anticuerpos monoclonales anti-SARS-CoV-2 ( Recomendación fuerte ).
⚬ Para adultos hospitalizados con oxígeno suplementario que no requieren suministro de oxígeno a
través de un dispositivo de alto flujo, ventilación no invasiva, ventilación mecánica invasiva u
oxigenación por membrana extracorpórea (ECMO)
– Considere remdesivir 200 mg IV durante 1 día seguido de remdesivir 100 mg IV una vez al día
durante 4 días o hasta el alta para pacientes que requieren oxígeno mínimo ( Recomendación
débil ).
– Para la mayoría de los otros pacientes, considere
● Remdesivir (en la dosis y duración anteriores) más dexametasona 6 mg IV u oral una vez al día
durante 10 días o hasta el alta ( recomendación débil ).
● Dexametasona sola si remdesivir no está disponible ( Recomendación débil ).
– Para los pacientes que toman dexametasona con necesidades de oxígeno rápidamente
crecientes e inflamación sistémica, considere agregar una segunda terapia inmunomoduladora
(preferiblemente baricitinib o tocilizumab; alternativamente tofacitinib o sarilumab si no están
disponibles) ( Recomendación débil ).
– Recomendaciones de anticoagulación:
● Dosis terapéutica de heparina recomendada para pacientes no embarazadas con niveles de

dímero D por encima del límite superior normal que no tienen un mayor riesgo de hemorragia
( Recomendación débil ); continuar durante 14 días o hasta el alta hospitalaria.
● Dosis profiláctica de heparina recomendada para otros pacientes sin evidencia de
tromboembolismo venoso a menos que esté contraindicado ( Recomendación fuerte );
considerar dosis profiláctica para pacientes embarazadas ( Recomendación débil ).
⚬ Para pacientes hospitalizados que requieren suministro de oxígeno a través de un dispositivo de alto
flujo o ventilación no invasiva, pero no ventilación mecánica invasiva o ECMO:
– Inicie 1 de los siguientes:
● Dexamethasone plus baricitinib orally once daily for 14 days or until hospital discharge with
dose dependent on estimated glomerular filtration rate (eGFR) (Strong recommendation).
● Dexamethasone plus tocilizumab 8 mg/kg actual body weight IV (maximum 800 mg)
administered as single dose (Weak recommendation).
● If neither baricitinib or tocilizumab is available or feasible, consider either tofacitinib or
sarilumab (Weak recommendation).
● If baricitinib, tofacitinib, tocilizumab, or sarilumab are not available, dexamethasone 6 mg IV or
orally once daily for 10 days or until discharge (Strong recommendation).
● Consider addition of remdesivir to immunomodulator combination therapy in some patients,
including patients with immunocompromise (Weak recommendation).
● Anticoagulation recommendations:
⚬ Prophylactic dose of heparin recommended for patients without evidence of venous

thromboembolism unless contraindicated (Strong recommendation); consider prophylactic
dose for pregnant patients (Weak recommendation).
⚬ Use of intermediate dose or therapeutic dose of anticoagulation for venous
thromboembolism prophylaxis recommended against except in clinical trial (Weak
recommendation)
⚬ If patients transferred to ICU after starting on therapeutic dose of heparin, switch to
prophylactic dose unless venous thromboembolism confirmed (Weak recommendation).
⚬ For hospitalized patients requiring invasive ventilation or ECMO
– Initiate 1 of the following:
● Dexamethasone plus baricitinib orally once daily for 14 days or until hospital discharge with
dose dependent on estimated glomerular filtration rate (eGFR) (Weak recommendation).
● Dexamethasone plus tocilizumab 8 mg/kg actual body weight IV (maximum 800 mg)
administered as single dose (Weak recommendation).
● If neither baricitinib or tocilizumab is available or feasible, consider either tofacitinib or
sarilumab (Weak recommendation).
● If baricitinib, tofacitinib, tocilizumab, or sarilumab are not available, dexamethasone 6 mg IV or
orally once daily for 10 days or until discharge (Strong recommendation).
– In patients initially receiving remdesivir alone who progress to needing invasive mechanical
ventilation or ECMO, start dexamethasone and continue remdesivir until treatment course
completed.
– Some experts may consider addition of remdesivir to dexamethasone in patients who have been
recently intubated (Weak recommendation).
– Anticoagulation recommendations:
● Prophylactic dose of heparin recommended for patients without evidence of venous

thromboembolism unless contraindicated (Strong recommendation); consider prophylactic
dose for pregnant patients (Weak recommendation).
● Use of intermediate dose or therapeutic dose of anticoagulation for venous
thromboembolism prophylaxis recommended against except in clinical trial (Weak
recommendation).
● If patients transferred to ICU after starting on therapeutic dose of heparin, switch to
prophylactic dose unless venous thromboembolism confirmed (Weak recommendation).
⚬ considerations for patients hospitalized with COVID-19 who are immunocompromised:
– Most patients with COVID-19 who are immunocompromised should receive therapies at the
doses and durations recommended for the general population (Strong recommendation).
– In some cases, immunomodulatory drug regimens may need to be adjusted to reduce risk of
drug-drug interactions, overlapping toxicities, and secondary infections; consult with appropriate
specialists about risks and benefits associated with temporary dose reduction or discontinuation
(Weak recommendation).
– Insufficient evidence for or against high-titer convalescent plasma; some clinicians would
consider use in patients with severe or progressive COVID-19 and inadequate response to
therapy.
⚬ For all hospitalized patients meeting criteria for dexamethasone, alternative corticosteroids including
prednisone, methylprednisolone, or hydrocortisone may be used if dexamethasone is unavailable
(Weak recommendation).
● Additional management may be needed for manifestations of severe disease, including hypoxemia and
acute respiratory distress syndrome (ARDS), septic shock, and coagulopathy.
● See COVID-19 Management for full details on supportive care and therapeutic management of COVID-
19.
Infection Control and Prevention
● Infection control measures continue to evolve and requirements may differ regionally.
⚬ General community guidance includes cleaning hands often, avoiding close contact and crowded
public settings, wearing a mask in indoor public places with high community transmission (N95 or
equivalent preferred), testing to prevent spread, covering coughs and sneezes, cleaning and
disinfecting frequently touched surfaces, and health monitoring.
⚬ Quarantine is recommended for persons with close contact who are not up to date with vaccination
or who have not recovered from COVID-19 within 90 days.
⚬ Isolation is recommended for persons with confirmed or probable COVID-19 regardless of
vaccination status.
● Vaccination is the most effective way to prevent COVID-19, and monoclonal antibodies have been
tested for pre- and post-exposure prophylaxis.
● Screening may be useful to identify persons who are asymptomatic and have no known or suspected
exposure to SARS-CoV-2 in schools, workplace settings, for travel, or public surveillance.
● See COVID-19 Infection Control and Prevention for guidance on and efficacy of infection control,
immunization, prophylaxis, and screening strategies for the prevention of COVID-19.
Related Topics
● freely available COVID-19 specific topics
⚬ COVID-19 Management
⚬ COVID-19 Infection Control and Prevention
⚬ COVID-19 and Pediatric Patients
⚬ COVID-19 and Special Populations
⚬ COVID-19 and Patients With Cancer
⚬ COVID-19 and Cardiovascular Disease Patients
⚬ COVID-19 and Patients with Chronic Kidney Disease (CKD) and End-stage Renal Disease (ESRD)
⚬ COVID-19 and Pregnant Patients
⚬ COVID-19-associated Coagulopathy
● additional related DynaMed topics
⚬ Severe Acute Respiratory Syndrome (SARS)

⚬ Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
⚬ Acute Respiratory Distress Syndrome (ARDS)
⚬ Sepsis in Adults
⚬ Sepsis in Children
⚬ Upper Respiratory Infection (URI) in Adults and Adolescents
⚬ Community-acquired Pneumonia in Adults
General Information
Description
● global pandemic of acute respiratory disease caused by a novel coronavirus (SARS-CoV-2) 1 , 2
● SARS-CoV-2 is a member of beta genus coronaviruses closely related to SARS-CoV (Nat Microbiol 2020
Apr;5(4):536 )
● common signs of COVID-19 include fever, cough, and shortness of breath 1
● there is no specific antiviral treatment for COVID-19 1
⚬ supportive care may help to relieve symptoms and should include support of vital organ functions in
severe cases
⚬ variety of agents under investigation
Image 1 of 5
COVID-19 virion
Illustration of SARS-CoV-2 particle.
Image courtesy of KTSDesign/Science Photo Library.
Also Called
● coronavirus disease 2019
● SARS-CoV-2
● 2019-nCoV
Definitions
● World Health Organization (WHO) case definitions for public health surveillance
⚬ suspected case either
– patient with severe acute respiratory illness (fever, cough, onset within 10 days, and requiring
hospitalization), OR
– asymptomatic individual with positive SARS-CoV-2 antigen test, OR
– patient meeting clinical or epidemiological criteria
● clinical criteria either
⚬ acute onset of fever and cough OR

⚬ ≥ 3 of
– fever
– cough
– general weakness or fatigue
– headache
– myalgia
– sore throat
– coryza
– dyspnea
– anorexia, nausea, or diarrhea
● epidemiological criteria includes either
⚬ contact with a probable or confirmed case, OR

⚬ linked to a COVID-19 cluster
– group of symptomatic individuals linked by time, location, and common exposure with ≥
1 nucleic acid amplification testing (NAAT) confirmed case, OR
– ≥ 2 epidemiologically linked symptomatic cases with positive antigen test
⚬ probable case any of
– patient who meets clinical criteria and is a contact of a probable or confirmed case or
epidemiologically linked to a cluster
– death not otherwise explained in adult with respiratory distress preceding death and who is a
contact of a probable or confirmed case or epidemiologically linked to a cluster
⚬ confirmed case any of
– positive SARS-CoV-2 nucleic acid amplification test

– patient who meets clinical or epidemiological criteria with positive antigen test
⚬ Reference - WHO COVID-19 Case definition 2022 Jul 22
● severity of disease
⚬ WHO severity definitions
– critical COVID-19 defined by meeting criteria for acute respiratory distress syndrome (ARDS),
sepsis, or septic shock or the need for life-sustaining therapy such as mechanical ventilation or
vasopressor therapy
– severe COVID-19 defined by any of
● oxygen saturation < 90% on room air

● signs of pneumonia
● signs of severe respiratory distress
⚬ in adults, accessory muscle use, inability to complete full sentences, respiratory rate > 30
breaths per minute
⚬ in children, very severe chest wall in-drawing, grunting, central cyanosis, or presence of
general danger signs (inability to breastfeed or drink, lethargy, convulsions, or reduced
level of consciousness)
– non-severe COVID-19 defined as absence of any criteria for severe or critical COVID-19
– Reference - WHO Therapeutics and COVID-19 (WHO 2022 July 14 )
⚬ National Institutes of Health (NIH) COVID-19 severity definitions
– asymptomatic or presymptomatic infection: positive SARS-CoV-2 nucleic acid amplification or

antigen test without symptoms consistent with COVID-19
– mild illness: typical symptoms including fever, cough, sore throat, malaise, headache, muscle
pain, nausea, vomiting, diarrhea, loss of taste and smell, but without shortness of breath,
dyspnea, or abnormal chest imaging
– moderate illness: clinical or radiologic evidence of lower respiratory disease and saturation of
oxygen (SpO2) ≥ 94% on room air at sea level
– severe illness: SpO2 < 94% on room air at sea level, ratio of arterial partial pressure of oxygen to
fraction of inspired oxygen (PaO2/FiO2) < 300 mm Hg, respiratory frequency > 30 breaths per
minute, or lung infiltrates > 50%
– critical illness: respiratory failure, septic shock, and/or multiple organ dysfunction
– Reference - NIH COVID-19 Treatment Guideline (NIH 2022 Sep 26 )
Epidemiology
Geographic distribution
● worldwide, although rate of infection varies by location and pandemic stage (World Health Organization
Coronavirus disease pandemic 2021 )
Who is most affected
STUDY
● SUMMARY
majority of cases of COVID-19 occur in adults
COHORT STUDY: Zhonghua Liu Xing Bing Xue Za Zhi 2020 Feb 10;41(2):145
Details
⚬ based on retrospective cohort study

⚬ 44,672 patients with confirmed COVID-19 with symptom onset between December 8, 2019 and
February 11, 2020, in China's Infectious Disease Information System were evaluated
⚬ 86.6% of patients aged 30-79 years
⚬ percentage of cases by age
– 0.9% in patients aged 0-9 years

– 17% in patients aged 30-39 years
– 3.2% in patients ≥ 80 years old
⚬ Reference - Zhonghua Liu Xing Bing Xue Za Zhi 2020 Feb 10;41(2):145 [Chinese], also published in
China CDC Weekly 2020;2(8):113 [English]
STUDY
● SUMMARY
median age of patients with COVID-19 in United States decreased between May and August 2020
POPULATION-BASED SURVEILLANCE: MMWR Morb Mortal Wkly Rep 2020 Oct 2;69(39):1404 | Full
Text
Details
⚬ based on population-based surveillance study

⚬ 3.2 million patients with confirmed COVID-19 were reported to state health departments in United
States from May 1 to August 31, 2020
⚬ median age of patients decreased from 46 years in May to 38 years in August
⚬ between June and August, incidence was highest among persons aged 20-29 years, who accounted
for > 20% of all cases
Table 1. Proportion of COVID-19 Cases by Age Range in United States, May-August
2020
Age Group Percent Percent Percent Percent

Cases in Cases in Cases in Cases in
May June July August
0-9 years 2.3% 3.3% 3.9% 4%
10-19 years 5.1% 7.5% 10.1% 11.5%
20-29 years 15.5% 20.2% 23.2% 21%
30-39 years 16.9% 17.6% 17.8% 16.5%
40-49 years 16.4% 16% 15.2% 14.9%
50-59 years 16.4% 14.6% 13.4% 13.9%
60-69 years 11.9% 9.9% 8.7% 9.4%
70-79 years 7% 5.5% 4.6% 5.2%
≥ 80 years 8.5% 5.5% 3.1% 3.7%
⚬ Reference - MMWR Morb Mortal Wkly Rep 2020 Oct 2;69(39):1404 full-text
● 167 confirmed cases of COVID-19 linked to skilled nursing facility in Washington, United States after
contact tracing from first identified case (N Engl J Med 2020 Mar 27 early online )
Incidence/Prevalence
● outbreak started in December 2019 in Wuhan, Hubei Province, China and declared a global pandemic
on March 11, 2020 (WHO Situation Report 2020 Mar 11 PDF )
● Evidence • Updated 17 Nov 2022
632,179,816 confirmed cases of COVID-19 including 6,590,768 deaths worldwide reported by World
Health Organization (WHO) as of Nov 13, 2022
⚬ cumulative and newly reported COVID-19 case and deaths by WHO region
Table 2. WHO Weekly Epidemiological Update

Region Cumul New Change Cumul New Change
ative Cases in New ative Deaths in New
Cases in Last Cases Deaths in Last Deaths
7 Days in Last 7 Days in Last
7 Days 7 Days
Europe 262,602 696,911 -21% 2,125,4 2,341 -41%

,977 87
Americ 180,816 418,334 12% 2,861,9 3,051 -10%

as ,250 62
Wester 95,670, 1,163,3 18% 278,833 643 14%

n 191 43
Pacific
South- 60,538, 50,214 15% 800,857 353 -80%

East 645
Asia
Eastern 23,174, 10,841 -12% 348,805 61 7%

Mediter 729
ranean
Africa 9,376,2 5,894 -8% 174,811 8 -86%

60
Global 632,179 2,345,5 2% 6,590,7 7,457 -30%

,816 37 68
⚬ Reference - WHO Weekly Epidemiological Update 2022 Nov 16

⚬ current situation by country, territory, or area can be found at WHO Coronavirus (COVID-19)
Dashboard
● United States and territories
⚬ 97,889,652 cases of COVID-19 including 1,070,947 deaths reported in United States and territories as
of November 16, 2022 (CDC COVID Data Tracker 2022 Nov 16 )
⚬ United States COVID-19 community levels based on filled hospital beds, hospital admissions, and
total case numbers can be found at CDC COVID-19 by County
⚬ United States county-level transmission rates can be found at CDC COVID-19 Data Tracker Integrated
County View
● other resources for real-time case counts, maps, and graphs
⚬ Johns Hopkins Center for Systems Science and Engineering (CSSE)

⚬ The Weather Channel (An IBM Business)
⚬ Worldometer
● 48% reported to be positive for SARS-CoV-2 in cohort study of 11,544 persons with symptoms
suggestive of COVID-19 or known SARS-CoV-2 contact presenting to emergency departments in New
York City, United States between March 1 and April 8, 2020 (Reference - BMJ 2020 May 22;369:m1966
full-text )
STUDY
● SUMMARY
cumulative incidence of clinically or laboratory confirmed COVID-19 hospital admissions ranges
from 14.7 to 23.3 per 100,000 insured persons in Washington and California, United States through
April 22, 2020
ESTUDIO DE COHORTE : BMJ 2020 22 de mayo; 369: m1923

Detalles
⚬ based on cohort study

⚬ 9,596,321 persons from health insurance database enrolling residents of Washington and California
were assessed through April 22, 2020
⚬ most members received employer-sponsored health insurance and population assessed may include
higher proportion of persons with higher incomes than national average
⚬ 1,840 patients were hospitalized with laboratory- or clinically-confirmed COVID-19
⚬ cumulative incidence of COVID-19-related hospital admissions per 100,000 insured persons through
April 22, 2020
– overall
● 14.7 in Washington
● 15.6 in northern California
● 23.3 in southern California
– among patients ≥ 80 years old
● 46.7 in Washington
● 74 in northern California
● 90.4 in southern California
⚬ Reference - BMJ 2020 May 22;369:m1923
RESUMEN
● DEL ESTUDIO
las muertes por COVID-19 representan el 19,2% de las muertes muestreadas en Lusaka, Zambia, con
< 2% probado para COVID-19 antes de la muerte
ESTUDIO TRANSVERSAL : BMJ 2021 17 de febrero; 372: n334

Detalles

⚬ 372 persons who died between June 15 and October 1, 2020 with postmortem at University Teaching
Hospital morgue in Lusaka, Zambia were assessed
⚬ 364 persons (97.8%) were tested for SARS-CoV-2 infection within 48 hours of death using
postmortem nasopharyngeal swab and reverse transcriptase quantitative polymerase chain reaction
(RT-PCR) and included in analysis
⚬ 70 persons (19.2%) (median age 48 years, 69% men) had SARS-CoV-2 infection by postmortem RT-
PCR
– 51 persons died in community (not in medical facility) and were not tested before death
– 19 persons died in medical facility, of which 6 had been tested before death
– 7 persons were children
– 53 persons were < 60 years old
⚬ 7 persons (1.8%) were tested for SARS-CoV-2 infection prior to death

⚬ most common comorbidities included tuberculosis (31%), hypertension (27%), HIV/AIDS (23%),
alcohol abuse (17%), and diabetes (13%)
⚬ Reference - BMJ 2021 Feb 17;372:n334 full text
RESUMEN
● DEL ESTUDIO
0,8% de la población general en Islandia SARS-CoV-2 positivo entre el 13 de marzo y el 4 de abril de
2020
ESTUDIO DE COHORTE : N Engl J Med 2020 14 de abril temprano en línea | Texto completo
Detalles

⚬ 22,279 persons in Iceland had nasopharyngeal and oropharyngeal samples tested for SARS-CoV-2
– 9,199 persons with symptoms, recent travel to high-risk countries, or contact with patients with
known COVID-19 were targeted for testing between January 31 and March 31, 2020
– 10,797 persons accepted open invitation to test between March 13 and April 1, 2020
– 2,283 persons accepted random telephone text-based invitation to test between April 1 and April
4, 2020
⚬ positive SARS-CoV-2 test in
– 13.3% of targeted individuals

– 0.8% of screened individuals
● 0.8% (95% CI 0.6%-1%) of those accepting open invitation

● 0.6% (95% CI 0.3%-0.9%) of those invited at random
⚬ Reference - N Engl J Med 2020 Apr 14 early online full-text
● seropositividad
RESUMEN
⚬ DEL ESTUDIO
Tasas de infección por SARS-CoV-2 estimadas por seroprevalencia estimadas entre 6 y 24 veces
mayores que los casos de COVID-19 informados durante marzo de 2020 hasta principios de mayo
de 2020 en diversas regiones de los Estados Unidos
ESTUDIO TRANSVERSAL : JAMA Intern Med 2020 Jul 21 temprano en línea

Detalles
– based on cross-sectional study

– 16,025 persons (36% aged ≥ 65 years, 55% women) in 10 geographical sites across United States
had serum testing for antibodies to SARS-CoV-2 spike protein between March 23, 2020 and May
12, 2020
– serologic survey used convenience sampling of sera collected for routine screening in outpatient
and inpatient settings
– adjusted seroprevalence estimates ranged from 1% in San Francisco Bay area, California (tested
April 23-27) to 6.9% in New York City, New York (tested March 23-April 1)
– site-specific population estimates of SARS-CoV-2 infection were derived from adjusted SARS-CoV-2
seroprevalence estimates and compared to COVID-19 case numbers reported on final day of test
collection in each geographical site
– ratio of estimated SARS-CoV-2 infections to reported COVID-19 cases (reflecting degree of
potential underascertainment)
● 6 (95% CI 4.33-7.8) in Connecticut (statewide)
● 6.8 (95% CI 3.6-11.1) in Philadelphia metropolitan area, Pennsylvania
● 9 (95% CI 3.2-22.7) in San Francisco Bay area, California
● 10.2 (95% CI 4.3-19.5) in Minneapolis metropolitan area, Minnesota
● 10.5 (95% CI 5.5-15.5) in Utah (statewide)
● 11.2 (95% CI 6.9-19.2) in western Washington state
● 11.2 (95% CI 6-19.5) in southern Florida
● 11.9 (95% CI 8.6-15.4) in New York City metropolitan area
● 15.7 (95% CI 10.6-22.4) in Louisiana (statewide)
● 23.8 (95% CI 14.8-34.7) in Missouri (statewide)
– Reference - JAMA Intern Med 2020 Jul 21 early online
RESUMEN
⚬ DEL ESTUDIO
Tasas estimadas de seropositividad en la población general entre el 5 % y el 10 % en Ginebra,
Suiza, entre el 6 de abril y el 9 de mayo de 2020, y las tasas no parecen aumentar con el tiempo.
ESTUDIO DE COHORTE : Lancet 2020 11 de junio temprano en línea

Detalles
– based on prospective population-based cohort study

– 2,766 adults and children ≥ 5 years old from 1,339 households between April 6 and May 9, 2020,
in Geneva, Switzerland, were evaluated for antibodies (IgG) against SARS-CoV-2
● 16.4% were aged 5-19 years
● 70.2% were aged 20-64 years
● 13.3% ≥ 65 years old
– estimated seropositivity rates by week
● 4.8% (95% CI 2.4%-8%) at week 1

● 8.5% (95% CI 5.9%-11.4%) at week 2
● 10.9% (95% CI 7.9%-14.4%) at week 3
● 6% (95% CI 4.3%-9.4%) at week 4
● 10.8% (95% CI 8.2%-13.9%) at week 5
– seropositivity rate in week 1 was significantly lower than in week 2; no significant differences in
rates from weeks 2 through 5
– compared to adults aged 30-49 years, younger and older patients had lower rates of seropositivity
● for children aged 5-9 years (relative risk 0.32, 95% CI 0.11-0.63)
● for adults ≥ 65 years old (relative risk 0.5, 95% CI 0.28-0.78)
– Reference - SEROCoV-POP study (Lancet 2020 Jun 11 early online full text )
RESUMEN
⚬ DEL ESTUDIO
seropositividad 4,6% en población general en España entre el 27 de abril y el 11 de mayo de 2020
ESTUDIO DE COHORTE : Lancet 2020 3 de julio temprano en línea | Texto completo

Detalles
– based on population-based cohort study

– 61,075 adults and children from 35,883 households in Spain between April 27 and May 11, 2020
were assessed by questionnaire and serological tests for SARS-CoV-2
– 66% had no history of symptoms compatible with COVID-19
– serological tests included
● chemiluminescent microparticle immunoassay requiring venipuncture performed on 85% of

adults and children
● point-of-care rapid test requiring fingerprick blood performed on all adults and children
– overall seropositivity assessed by immunoassay 4.6% (95% CI 4.3%-5%)
● age
⚬ 3.8% (95% CI 3.2%-4.6%) in 6,527 persons aged 0-19 years

⚬ 5% (95% CI 4.3%-5.8%) in 7,569 persons aged 20-34 years
⚬ 4.5% (95% CI 3.8%-5.3%) in 10,602 persons ≥ 65 years old
● presence of symptoms
⚬ 16.9% (95% CI 15.4%-18.5%) in 7,273 persons with anosmia, ageusia, or ≥ 3 symptoms

⚬ 3.9% (95% CI 3.4%-4.4%) in 10,669 persons with 1-2 symptoms without anosmia or ageusia
⚬ 2% (95% CI 1.8%-2.3%) in 34,016 asymptomatic persons
● contact status with confirmed COVID-19 cases
⚬ 37.4% (95% CI 31.8%-43.3%) in 860 persons who had contact with household member with
confirmed COVID-19
⚬ 13.7% (95% CI 11.2%-16.7%) in 1,284 persons who had contact with noncohabitating family
member or friend with confirmed COVID-19
⚬ 9.9% (95% CI 8%-12.2%) in 1,461 persons who had contact with coworker with confirmed
COVID-19
⚬ 3.4% (95% CI 3.1%-3.7%) in 47,385 persons who had no contact with confirmed COVID-19
– overall seropositivity assessed by point-of-care test 5% (95% CI 4.7%-5.4%)

– Reference - ENE-COVID study (Lancet 2020 Jul 3 early online full-text ), editorial can be found
in Lancet 2020 Jul 3 early online
⚬ Seroprevalencia de SARS-CoV-2 del 8 % en 28 503 adultos que recibieron diálisis en julio de 2020 en
Estados Unidos en un estudio transversal ( Lancet, 25 de septiembre de 2020 , texto completo
en línea temprano )
Factores de riesgo
● contacto cercano (< 6 pies), prolongado (≥ 15 minutos) con una persona con
⚬ COVID-19 sintomático entre las 48 horas anteriores al inicio de los síntomas hasta que se
cumplieron los criterios para la interrupción del aislamiento domiciliario
⚬ Prueba COVID-19 positiva sin síntomas entre las 48 horas de la recolección de la muestra hasta que
se cumplieron los criterios para la interrupción del aislamiento en el hogar
⚬ Referencia: guía de salud pública de los CDC para la exposición relacionada con la comunidad ( CDC
2021 Mar 1 )
● revisión sistemática sin metanálisis de 18 estudios observacionales que evalúan la transmisión aérea
del SARS-CoV-2 a una distancia > 2 m en entornos comunitarios cerrados se puede encontrar en BMJ
2022 Jun 29;377:e068743 texto completo
● viajes o residencia en áreas con transmisión alta o creciente (guía de salud pública de los CDC para la
exposición potencial al COVID-19 asociada con viajes internacionales o nacionales [ CDC 5 de
noviembre de 2021 ])
● ocupación
RESUMEN
⚬ DEL ESTUDIO
Se informó que el riesgo de infección por SARS-CoV-2 fue del 11% para los proveedores de
atención médica en el Reino Unido entre enero y octubre de 2020
ESTUDIO DE COHORTE : PLoS Med 2021 Oct;18(10):e1003816

Detalles
– based on cohort study

– 5,596 healthcare providers and 66,184 patients hospitalized in 4 hospitals in the United Kingdom
were assessed for SARS-CoV-2 infection between January and October 2020
● at start of pandemic, patients with SARS-CoV-2 infection were housed in standard rooms, all
patients encouraged to wear masks, and visitors were generally not permitted
● mitigation strategies evolved over study period, including availability of testing, asymptomatic
screening of healthcare providers and patients, use of personal protective equipment,
universal masking, and isolation of exposed patients and healthcare providers
– 1.4% of patients had community- or hospital-acquired SARS-CoV-2 infection

– 11% of healthcare providers (mean age 39 years, 78% female) had SARS-CoV-2 infection (49.8%
were nurses, 22.1% allied healthcare providers, 15.9% physicians, and 12.2% nonclinical staff)
– patients and healthcare providers were considered infectious for up to 10 days after infection
– factors associated with increased risk of SARS-CoV-2 infection in healthcare staff included
● working as nurse (adjusted odds ratio [OR] 1.54, 95% CI 1.17-20.04)

● working in ward with patient with hospital-acquired SARS-CoV-2 infection (adjusted OR 1.33,
95% CI 1.21-1.45)
● working in same ward with healthcare provider with SARS-CoV-2 infection (adjusted OR 1.45,
95% CI 1.34-1.55)
– additional SARS-COV-2 infections per 1,000 healthcare providers
● 0.8 (95% CrI 0.3-1.6) per day of exposure to patient with hospital-acquired SARS-CoV-2
infection
● 0.8 (95% CrI 0.6-1) per day of exposure to healthcare provider with SARS-CoV-2 infection
● 0.2 (95% CrI 0.2-0.2) per day of exposure to patient with community-acquired SARS CoV-2
infection
– Reference - PLoS Med 2021 Oct;18(10):e1003816
RESUMEN
⚬ DEL ESTUDIO
durante los períodos de apertura de la escuela, los maestros pueden tener un mayor riesgo de dar
positivo por SARS-COV-2 o un evento relacionado con COVID-19, pero pueden tener un riesgo
similar de hospitalización por COVID-19 en comparación con los adultos en edad laboral en la
población general de Escocia
ESTUDIO DE COHORTE : BMJ 2021 Sep 1;374:n2060

Detalles
– based on nested case-control study

– 132,420 adults aged 21-65 years (mean age 43 years) who tested positive for SARS-CoV-2 or who
had hospital diagnosis of COVID-19 living in Scotland between March 2020 to July 2021were age-,
sex-, and general practice-matched to 1,306,566 controls
– analysis included
● 25,586 teachers (with about mean age 43 years, 80% women, ≥ 1 comorbidity in 16%)
● 756,646 adults of working age in general population (with about mean age 43 years, 51% men,
≥ 1 comorbidity in 18%)
● 25,001 household members of teachers
– outcomes
● COVID-19 event defined as positive polymerase chain reaction (PCR) test for SARS-CoV-2,
hospital discharge with COVID-19 diagnosis regardless of test results, or death with COVID-19
listed as cause regardless of test results
● hospitalization for COVID-19 defined as positive PCR test for SARS-CoV-2 during hospitalization
or within 28 days prior to hospitalization, or hospital discharge with COVID-19 diagnosis
● severe COVID-19 defined as positive PCR test for SARS-CoV-2 and death or admission to
intensive care unit within 28 days of positive test
– school policies changed over study period from full closure to in-person teaching with physical
distancing, mask-mandates, and changes in class size
– at end of follow-up, proportion who had first dose of COVID-19 vaccine was higher than adults of
working age in general population
– comparing teachers vs. adults of working age in general population during school opening in
autumn 2020
● COVID-19 event in 15.9% vs. 9.9% (adjusted rate ratio [RR] 1.48, 95% CI 1.4-1.57)
● hospitalization for COVID-19 in 0.52% vs. 0.54% (adjusted RR 1.2, 95% CI 0.89-1.61)
● severe COVID-19 in 0.03% vs. 0.11% (adjusted RR 0.45, 95% CI 0.13-1.55)
– consistent results during school opening in summer 2021

– comparing household members of teachers to adults of working age in general population
● no significant difference in risk of hospitalization for COVID-19 in autumn 2020

● household members of teachers had decreased risk of hospitalization in summer 2021
(adjusted RR 0.33, 95% CI 0.16-0.67)
– Reference - BMJ 2021 Sep 1;374:n2060
RESUMEN
⚬ DEL ESTUDIO
Trabajadores de la salud que atienden a pacientes con mayor riesgo de COVID-19 que requieren
ingreso hospitalario en comparación con la población activa general o los trabajadores de la salud
que no atienden a los pacientes
ESTUDIO DE COHORTE : BMJ 2020 Oct 28;371:m3582 | Texto completo

Detalles

– 158,445 healthcare workers (mean age 44 years) and 229,905 household members of healthcare
workers (mean age 31 years) in Scotland were assessed between March 1 and June 6, 2020
– risk of hospital admission for COVID-19
● 0.2% for patient-facing healthcare worker

● 0.12% for general population in Scotland
● 0.07% for non-patient facing healthcare worker
● 0.07% for household member of patient facing healthcare worker
● 0.06% for working age (18-65 year) general population in Scotland
● 0.04% for household member of non-patient facing healthcare worker
– increased risk of COVID-19 among patient facing healthcare workers (adjusted hazard ratio 3.06,
95% CI 1.73-5.43) compared to non-patient facing healthcare workers
– no significant difference in risk of hospital admission for COVID-19 in
● non-patient facing healthcare workers compared to general working age population

● household members of healthcare working in non-patient facing roles compared to general
population
● household members of healthcare workers in patient facing roles compared to household
members of non-patient facing healthcare workers in adjusted analysis
– Reference - BMJ 2020 Oct 28;371:m3582 full-text
RESUMEN
● DEL ESTUDIO
trabajar en condiciones más confinadas asociadas con un mayor riesgo de COVID-19 en comparación
con la combinación de condiciones al aire libre y confinadas en los miembros de la tripulación a
bordo del portaaviones
ESTUDIO DE COHORTE : N Engl J Med 2020 11 de noviembre temprano en línea

Detalles

⚬ 4,779 adult crew members ≤ 59 years old (mean age 27 years, 78% men) on aircraft carrier U.S.S.
Theodore Roosevelt were followed for ≥ 10 weeks after 3 members tested positive for SARS-CoV-2
infection 13 days after ship left port
– 4 days after first positive test, ship reached port
● any patients with confirmed COVID-19 removed from ship

● members with ≥ 1 negative reverse transcriptase polymerase chain reaction test for SARS-CoV-
2 and without symptoms were quarantined off ship in single rooms in hotels (eventually 4,079
members)
● essential personnel who were uninfected remained aboard ship in port
⚬ between March 23 and May 18, 2020, 1,271 members (26.6%) tested positive for SARS-CoV-2
– 76.9% asymptomatic at time of positive test

– 55% developed symptoms at some point
– > 1,000 infections identified within 5 weeks after first laboratory-confirmed infection
⚬ 1.3% testing negative for SARS-CoV-2 had suspected COVID-19 based on clinical criteria
⚬ 72.1% did not contract infection
⚬ factors associated with increased risk of COVID-19 included
– working in more confined conditions compared to combination of open-air and confined

conditions (reference air crew)
● weapons crew (odds ratio [OR] 2.7, 95% CI 1.92-3.8)
● supply crew (OR 2.41, 95% CI 1.78-3.26)
● engineering crew (OR 1.85, 95% CI 1.29-2.67)
● reactor crew (OR 1.73, 95% CI 1.29-2.36)
– enlisted personnel compared to officers (OR 1.48, 95% CI 1.17-1.87)

– obesity (OR 1.33, 95% CI 1.11-1.61)
⚬ belonging to deck crew associated with decreased risk compared to belonging to air crew (OR 0.18,
95% CI 0.07-0.52)
⚬ 16.7% of 48 medical crew (who wore personal protective equipment) tested positive for SARS-CoV-2
⚬ Reference - N Engl J Med 2020 Nov 11 early online
RESUMEN
● DEL ESTUDIO
riesgo de infección hospitalaria por SARS-CoV-2 estimado en 0,18 %-0,58 % para pacientes
hospitalizados en el Reino Unido entre enero y octubre de 2020
ESTUDIO DE COHORTE : PLoS Med 2021 Oct;18(10):e1003816

Detalles

⚬ 66,184 hospitalized patients and 5,596 healthcare providers from 4 hospitals in the United Kingdom
were assessed for SARS-CoV-2 infection between January and October 2020
– at start of pandemic, patients with SARS-CoV-2 infection were housed in standard rooms, all
patients encouraged to wear masks, and visitors were generally not permitted
– mitigation strategies evolved over study period, including availability of testing, asymptomatic
screening of healthcare providers and patients, use of personal protective equipment, universal
masking, and isolation of exposed patients and healthcare providers
⚬ hospital-acquired SARS-CoV-2 infection defined as first positive PCR test at ≥ 4 days, 6 days, or 8 days
after admission (assuming incubation period of 3, 5, or 7 days)
⚬ community-acquired SARS-CoV-2 infection defined as positive PCR test in patients who were not
hospitalized in 20 days prior to admission
⚬ patients and healthcare providers were considered infectious for up to 10 days after infection
⚬ hospital-acquired infection rate of patients was 0.58% for assumed incubation period of 3 days,
0.38% for assumed incubation period of 5 days, and 0.18% for assumed incubation period of 7 days
⚬ 11% of healthcare providers tested positive over study period
⚬ factors associated with increased risk of hospital-acquired SARS-CoV-2 infection in patients included
(assuming incubation period of 5 days)
– hospitalization in same ward with patient with hospital-acquired SARS-CoV-2 infection (adjusted
odds ratio [OR] 1.76, 95% CI 1.51-2.04)
– hospitalization in ward with healthcare provider with SARS-CoV-2 infection (adjusted OR 1.45, 95%
CI 1.22-1.77)
⚬ no significant difference in risk of SARS-CoV-2 infection for hospitalization in same ward with patient
with community-acquired SARS-CoV-2 infection (adjusted OR 1.12, 95% CI 0.96-1.26)
⚬ estimated additional SARS-COV-2 infections per 1,000 patients
– 7.5 (95% CrI 5.5- 9.5) per day of exposure to another patient on same ward with hospital-acquired
SARS-CoV-2 infection
– 2 (95% CrI 1.6 to 2.2) per day of exposure to healthcare provider with SARS-CoV-2 infection
– 1.7 (95% CrI 1.3 to 2.2) per day of exposure to another patient with community-acquired SARS-
CoV-2 infection
⚬ Reference - PLoS Med 2021 Oct;18(10):e1003816
RESUMEN
● DEL ESTUDIO
vivir con niños y adolescentes asociado con un mayor riesgo de infección por SARS-CoV-2 y
hospitalización relacionada en adultos ≤ 65 años y mayor riesgo de infección y hospitalización
relacionada con la unidad de cuidados intensivos (UCI) y muerte en adultos > 65 años
COHORT STUDY: BMJ 2021 Mar 18;372:n628 | Full Text
Details
⚬ based on population-based cohort study

⚬ 2 cohorts of adults living in England during first two waves of COVID-19 infections were assessed
through OpenSAFELY platform
⚬ wave 1 cohort assessed between February 1, 2020 and August 31, 2020 when swab tests were mainly
available to people in high-risk jobs or on admission to hospital and not summarized here
⚬ wave 2 cohort (between September 1, 2020 and December 18, 2020, tests for SARS-CoV-2 were more
readily available) included
– 9,266,919 adults ≤ 65 years old
● 63% did not live with children

● 19.9% lived with only children aged 0-11 years, 9.6% lived with only adolescents aged 12-18
years, and 7.5% lived with children and adolescents
– 2,706,505 adults > 65 years old
● 96.7% did not live with children

● 1.6% lived with only children aged 0-11 years, 1.1% lived with only adolescents aged 12-18
years, and 0.6% lived with children and adolescents
⚬ outcomes in adults
– ≤ 65 years old: 2.61% had COVID-19 infection, 0.04% hospitalized with COVID-19, 0.01% admitted
to ICU with COVID-19, and 0.01% died of COVID-19
– > 65 years old: 1.28% had COVID-19 infection, 0.16% hospitalized with COVID-19, 0.03% admitted
to ICU with COVID-19, and 0.15% died of COVID-19
⚬ analysis of adults ≤ 65 years old
– living with children and adolescents associated with increased risk of COVID-19-related
hospitalization compared to not living with children/adolescents (adjusted hazard ratio [HR] 1.44,
95% CI 1.28-1.63)
– consistent results for COVID-19-related hospitalization for living with only children aged 0-11
years and for living with only adolescents aged 12-18 years
– consistent results for association between living with children and/or adolescents and risk of
SARS-CoV-2 infection
– no significant differences in risk of ICU admission comparing living with children and/or
adolescents to not living with children/adolescents
⚬ analysis of adults > 65 years old
– compared to not living with children/adolescents, living with children and adolescents associated
with
● increased risk of COVID-19-related ICU admission (adjusted HR 1.86, 95% CI 1.11-3.14)
● increased COVID-19 mortality (adjusted HR 1.44, 95% CI 1.05-1.97)
– living with children and/or adolescents associated with increased risk of SARS-CoV-2 infection
(adjusted HR ranged from 1.15 to 1.27)
⚬ Reference - BMJ 2021 Mar 18;372:n628 full-text , correction can be found in BMJ 2021 Mar
22;372:n794
STUDY
● SUMMARY
mean secondary transmission rate of Omicron variant to family and household contacts reported to
be 43%
SYSTEMATIC REVIEW: JAMA Netw Open 2022 Apr 1;5(4):e229317
Details
⚬ based on systematic review of observational studies

⚬ systematic review of 135 observational studies evaluating household secondary transmission of
SARS-CoV-2 in 1,375,806 children and adults
⚬ transmissibility of SARS-CoV-2 within household or family calculated as number of new infections
among contacts after exposure to index case divided by total number of household contacts
⚬ mean household SARS-CoV-2 secondary attack rate by variant regardless of index case or contact
vaccination status
– 43% (95% CI 35%-50%) for Omicron variant in analysis of 7 studies
– 36% (95% CI 33%-39.5%) for Alpha variant in analysis of 11 studies
– 30% (95% CI 23%-37%) for Delta variant in analysis of 16 studies
– 22.5% (95% CI 19%-27%) for Beta variant in analysis of 3 studies
⚬ mean household SARS-CoV-2 secondary attack rate for Omicron variant by vaccination status
– by index case vaccination status in analysis of 4 studies
● 51% (95% CI 42%-60.5%) for unvaccinated

● 77% (95% CI 77%-99%) for partially vaccinated
● 51% (95% CI 48%-54%) for fully vaccinated
● 38% (95% CI 30%-47%) for booster vaccinated
– by household contact vaccination status in analysis of 4 studies
● 44% (95% CI 32%-56%) for unvaccinated

● 57% (95% CI 48%-65%) for partially vaccinated
● 51% (95% CI 48%-55%) for fully vaccinated
● 33% (95% CI 24.5%-42%) for booster vaccinated
⚬ Reference - JAMA Netw Open 2022 Apr 1;5(4):e229317 full text
⚬
DynaMed Commentary
Household contacts included anyone living in the same residence as an index case. Family
contacts included family members of index cases, including members who lived outside the
household (JAMA Netw Open 2020 Dec 1;3(12):e2031756 full-text ).
STUDY
● SUMMARY
risk of infection associated with exposure to person with laboratory-confirmed SARS-CoV-2
infection may vary from < 1% to 10% depending on exposure setting, with household exposure
associated with increased risk compared to each of healthcare, entertainment or workplace, and
public transportation settings in China
COHORT STUDY: Ann Intern Med 2020 Dec 1;173(11):879

Details
⚬ based on prospective cohort study

⚬ 3,410 persons (median age 44 years, 53% men) with close contact to ≥1 of 391 persons (median age
48 years, 50% men) with laboratory-confirmed COVID-19 (index person) identified in Guangzhou,
China via surveillance, tracing, and screening, and via cell phone database for identifying contact on
public transportation were assessed
⚬ close contact defined as having had exposure of any duration and without effective protection ≤ 2
days prior to symptom onset in index person (for asymptomatic index person, exposure ≤ 2 days
prior to laboratory test sampling)
⚬ index cases were quarantined before diagnosis if they were suspected cases and household contacts
were separated from index case before diagnosis was made in index case
⚬ close contacts were quarantined for 14 days following last index patient exposure
⚬ exposure setting was household (29.8%), entertainment venue or workplace (25.6%), public
transportation (24%), healthcare (19.9%), and multiple settings (0.7%)
⚬ 127 (3.7%) persons with close contact developed laboratory-confirmed COVID-19
– 6.3% had asymptomatic infection

– 15.7% had mild, 68.5% had moderate, and 9.4% had severe or critical disease
⚬ COVID-19 infection rates in persons with close contact by exposure setting
– 10.3% with household

– 1.3% with entertainment venue or workplace (adjusted odds ratio [OR] 0.12, 95% CI 0.06-0.22 vs.
household setting)
– 1% with healthcare setting (adjusted OR 0.13, 95% CI 0.05-0.32 vs. household setting)
– 0.1% with public transportation setting (adjusted OR 0.01, 95% CI 0-0.09 vs. household setting)
– 13% with multiple settings (adjusted OR 1.2, 95% CI 0.32-4.58 vs. household setting)
⚬ COVID-19 infection rates in persons with close contact by severity of disease in index person
– 0.3% with exposure to asymptomatic index person (adjusted OR 0.37, 95% CI 0.04-3.79 vs.
moderate disease)
– 3.3% with exposure to index person with mild disease (adjusted OR 0.56, 95% CI 0.33-0.94 vs.
moderate disease)
– 5.6% with exposure to index person with moderate disease
– 6.2% with exposure to index person with severe or critical disease (adjusted OR 1.04, 95% CI 0.57-
1.9 vs. moderate disease)
⚬ symptoms in index case associated with increased risk of infection in person with close contact
include
– expectoration (adjusted OR 4.39, 95% CI 2.92-6.61)
– fever (adjusted OR 1.78, 95% CI 1.01-3.13)
⚬ Reference - Ann Intern Med 2020 Dec 1;173(11):879 full-text
● health disparities
STUDY
⚬ SUMMARY
lower quality diet associated with increased risk of COVID-19 and risk may be higher for adults
living in areas with greater socioeconomic deprivation in the United Kingdom and the United
States
COHORT STUDY: Gut 2021 Sep 6 early online

Details
– based on prospective cohort study

– 592,571 adults (median age 56 years, 68% female, 96% White) living in the United Kingdom (92%)
or the United States (8%) from smartphone-based COVID-19 Symptom Study and who were
negative for SARS-CoV-2 or symptoms of COVID-19 at baseline were followed from March 24 to
December 2, 2020
– diet information was collected for prepandemic period and grouped into quartiles using healthful
Plant-Based Diet Index (hPDI) score (range 14-70 points, with 14 points indicating lowest quality)
● highest-quality diet quartile had median score 56 points
● intermediate-quality quartiles had median score 51 points (combined intermediate quartiles)
● lowest-quality quartile had (median score 45 points)
– COVID-19 events detected using algorithm to predict SARS-CoV-2 infection based on symptoms,
age, and sex due to low availability of testing at start of pandemic
– analysis of PCR-confirmed COVID-19 also performed
– follow-up 3,886,274 person-months
– percent wearing mask "most of time or always" among groups ranged from 71.6% to 76.4%
– incidence rate of COVID-19 using symptom-based algorithm per 10,000 person-months (p for
trend < 0.001)
● 72 for highest quartile (adjusted hazard ratio [HR] 0.91, 95% CI 0.88-0.94 vs. lowest quartile)
● 77.6 for intermediate quartiles (adjusted HR 0.91, 95% CI 0.89-0.93 vs. lowest quartile)
● 104.1 for lowest quartiles
– incidence rate of PCR-confirmed Covid-19 per 10,000 person-months (p for trend < 0.001)
● 12.9 for highest quartile (adjusted HR 0.82, 95% CI 0.78-0.86 vs. lowest quartile)
● 13.6 intermediate quartiles (adjusted HR 0.88, 95% CI 0.85-0.92 vs. lowest quartile)
● 16.4 for lowest quartile
– compared to persons with score in highest quartile and living in areas with low socioeconomic
deprivation, persons with score in lowest quartile had increased risk of COVID-19 using symptom-
based algorithm and who lived in areas with
● low socioeconomic deprivation (adjusted HR 1.08, 95% CI 1.03-1.14)
● intermediate socioeconomic deprivation (adjusted HR 1.23, 95% CI 1.17-1.29)
● high socioeconomic deprivation (adjusted HR 1.47, 95% CI 1.38-1.56)
– compared to lowest quartile to highest quartile, absolute excess rate of COVID-19 per 10,000
person-months
● 22.5% (95% CI 19%-26%) for persons living in areas with low deprivation
● 40.8% (95% CI 32%-50%) for living in areas with high deprivation
– Reference - Gut 2021 Sep 6 early online
⚬ ecological analysis showing association of higher levels of social vulnerability with reduced rates of
COVID-19 testing and increased rates of COVID-19 positivity, incidence, and mortality compared to
neighborhoods with lower social vulnerability within same city in United States can be found in Ann
Intern Med 2021 Mar 30 early online full-text
● genetic associations
STUDY
⚬ SUMMARY
O blood group and Rh-negative group associated with reduced risk of SARS-CoV-2 infection
ESTUDIO DE COHORTE : Ann Intern Med 2020 Nov 24 temprano en línea | Texto completo
Detalles

– 225,556 persons (mean age 54 years, 71% female) with blood group assessed between 2007 and
2019 and SARS-CoV-2 nucleic acid testing between January 15 and June 30, 2020 in Ontario,
Canada were evaluated
– requirement for known blood type resulted in cohort that was older and included more females
and patients with comorbidities
– 7,071 persons (3.1%) had SARS-CoV-2 infection
● blood groups associated with reduced risk of SARS-CoV-2 infection
⚬ O-negative group compared to all other groups (adjusted relative risk [RR] 0.74, 95% CI
0.66-0.83)
⚬ Rh-negative group compared to Rh-positive group (adjusted RR 0.79, 95% CI 0.73-0.85)
⚬ O group compared to all other groups (adjusted RR 0.88, 95% CI 0.84-0.92)
● blood groups associated with increased risk of SARS-CoV-2 infection compared to A group
⚬ B group (adjusted RR 1.21, 95% CI 1.13-1.29)

⚬ AB group (adjusted RR 1.15, 95% CI 1.03-1.28)
– 1,328 patients had severe COVID-19 or died
● blood groups associated with reduced risk of severe COVID-19 or death
⚬ Rh-negative group compared to Rh-positive group (adjusted RR 0.82, 95% CI 0.68-0.96)

⚬ O group compared to all other groups (adjusted RR 0.87, 95% CI 0.78-0.97)
● B group associated with increased risk of severe COVID-19 or death compared to A group
(adjusted RR 1.21, 95% CI 1.04-1.4)
– Reference - Ann Intern Med 2020 Nov 24 early online full-text
RESUMEN
⚬ DEL ESTUDIO
polimorfismos en los loci 9q34.2 y 3p21.31 asociados con riesgo de COVID-19 grave; el grupo
sanguíneo A puede tener un mayor riesgo de enfermedad grave que otros grupos sanguíneos
ANÁLISIS GENÉTICO : N Engl J Med 2020 Jun 17 temprano en línea

Detalles
– based on genetic analysis

– 1,610 severe COVID-19 patients with respiratory failure and 2,205 controls from Spain and Italy
were assessed in genome-wide association analysis
– single-nucleotide polymorphisms significantly associated with severe COVID-19 with respiratory
failure
● rs11385942 at locus 3p21.31 with associations spanning SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6,
and XCR1 genes
● rs657152 at locus 9q34.2 with association coinciding with ABO blood group
– compared to other blood groups
● blood group A associated with increased risk for severe COVID-19 (adjusted odds ratio 1.45,
95% CI 1.2-1.75)
● blood group O associated with reduced risk for severe COVID-19 (adjusted odds ratio 0.65,
95% CI 0.53-0.79)
– Reference - N Engl J Med 2020 Jun 17 early online full text
⚬ Las variantes putativas raras de pérdida de función del receptor tipo toll-like (TLR)-7 cromosómico X
se asociaron con defectos inmunológicos en la respuesta de interferón tipo I y II en 4 hombres con
COVID-19 grave en una serie de casos ( JAMA 2020 Jul 24 temprano en línea)
RESUMEN
● DEL ESTUDIO
entre las personas con discapacidad intelectual o del desarrollo que reciben servicios residenciales,
mayor edad, síndrome de Down, mayor número de residentes y enfermedad renal crónica, cada uno
asociado con un mayor riesgo de positividad de COVID-19
ESTUDIO DE COHORTE : JAMA Netw Open 2021 Jun 1;4(6):e2112862 | Texto completo
Detalles

⚬ 543 persons (median age 57 years, 60% men, 49.5% White) with intellectual or developmental
disability receiving residential services in New York, New York, from March 1 to October 1, 2020, were
assessed
⚬ types of residential services
– 19.7% had supportive residence defined as up to 23 hours/week of assistance with activities of

independent daily living
– 69.2% had supervised living defined as 24/7 on-site staff support for assistance with activities of
daily living, with or without intermittent nursing care
– 11.1% had intermediate care facilities residence defined as 24/7 on-site staff support for complex
medical needs with 24-hour nursing coverage
⚬ case rates of persons with intellectual or developmental disability vs. overall population in New York,
New York (no p values reported)
– COVID-19 positive case rate per 100,000 persons 16,759 vs. 2,978
– mortality rate per 100,000 persons 6,446 vs. 286
– case-fatality rate 38.5% vs. 9.6%
⚬ increased risk of COVID-19 positivity associated with
– increased age (odds ratio [OR] 1.04, 95% CI 1.02-1.06)

– Down syndrome (OR 2.91, 95% CI 1.49-5.69)
– increased number of residents (OR 1.07, 95% CI 1-1.14)
– chronic kidney disease (OR 4.17, 95% CI 1.9-9.15)
⚬ Reference - JAMA Netw Open 2021 Jun 1;4(6):e2112862 full-text
Etiología y patogenia
Patógeno (incluyendo variantes)
● nuevos grupos de coronavirus con coronavirus del síndrome respiratorio agudo severo (SARS-CoV)
⚬ género Betacoronavirus
⚬ no hay consenso sobre la posición taxonómica exacta dentro del subgénero Sarbecovirus
⚬ especie coronavirus relacionado con el síndrome respiratorio agudo severo
⚬ nombre designado SARS-CoV-2
⚬ Referencia - Nat Microbiol 2020 Abr;5(4):536
● Seguimiento de la Organización Mundial de la Salud (OMS) de las variantes del SARS-CoV-2
⚬ variantes de preocupación
– variantes que cumplen con la definición de variante de interés (abajo) y también asociadas con ≥
1 de
● mayor transmisibilidad o cambio perjudicial en la epidemiología
● aumento de la virulencia o cambio en la presentación de la enfermedad
● disminución de la eficacia de los diagnósticos, las vacunas, la terapia o las medidas sociales y
de salud pública
– Omicron (linaje Pango B.1.1.529; clados Nextrain 21K, 21L, 21M, 22A, 22B, 22C) es la única
variante actual de preocupación
– Subvariantes de Omicron bajo seguimiento
● BA.4 (Siguiente cepa 22A)

● BA.5 (Siguiente cepa 22B)
● BA.2.12.1 (Siguiente cepa 22C)
● BA.2.75 (Siguiente cepa 22D)
⚬ variantes de interés
– asociado con cambios genéticos que se prevé o se sabe que afectan las características del virus,
como la transmisibilidad, la gravedad de la enfermedad, el escape inmunitario, el escape
diagnóstico o terapéutico, y causan una transmisión comunitaria significativa o múltiples grupos
en múltiples países con una prevalencia creciente u otros impactos epidemiológicos que sugieren
una salud pública global emergente riesgo
– no hay variantes actuales de interés
⚬ variantes bajo seguimiento
– asociado con cambios genéticos que se predice que afectarán las características del virus, pero
evidencia poco clara del impacto fenotípico o epidemiológico
– no hay variantes actuales bajo supervisión
⚬ Referencias - OMS 2022 2 de agosto
● Clasificaciones y definiciones de variantes del SARS-CoV-2 de los Centros para el Control y la Prevención
de Enfermedades (CDC)
⚬ variantes de preocupación (VOC)
– variants with increased transmissibility, more severe disease, significant reduction in

neutralization by antibodies generated during vaccination or previous infection, reduced
treatment or vaccine effectiveness, or failures of diagnostic detection
– Omicron (B.1.1.529, BA.1, BA.1.1, BA.2, BA.3, BA.5, and BA.5)
● Nextstrain clade 21K

● first identified in South Africa
● attributes
⚬ increased transmissibility
⚬ reduction in neutralization by some monoclonal antibody therapies
⚬ reduction in neutralization by post-vaccination sera; breakthrough infections are expected,
but vaccination remain effective at preventing severe illness, hospitalizations, and death
⚬ no variants of interest identified (variants with genetic markers associated with changes to receptor
binding, reduced neutralization by antibodies generated against vaccination or previous infection,
reduced treatment efficacy, potential impact on diagnosis, or predicted increase in disease severity
or transmissibility)
⚬ variants being monitored (VBMs)
– variants with data indicating potential or clear impact on authorized or approved medical
countermeasures or association with more severe disease or increased transmission but
circulating at very low levels in United States or no longer detected
– current VBMs
● Alpha (B.1.1.7 and Q lineages)
● Beta (B.1.351 and descendent lineages)
● Gamma (P.1 and descendent lineages)
● Delta (B.1.617.2 and AY lineages)
● Epsilon (B.1.427 and B.1.429)
● Eta (B.1.525)
● Iota (B.1.526)
● Kappa (B.1.617.1)
● Mu (B.1.621 and B.1.621.1)
● Zeta (P.2)
● 1.617.3
⚬ no se identificaron variantes de alta consecuencia (variantes con evidencia clara de eficacia

significativamente reducida de las medidas de prevención o contramedidas médicas en relación con
las variantes que circulaban anteriormente)
⚬ Referencias - Clasificación y definiciones de variantes del CDC SARS-CoV-2 2022 26 de abril , CDC
Lo que necesita saber sobre las variantes 2022 26 de abril
Transmisión
● la secuenciación genética sugiere que los murciélagos son un reservorio natural de SARS-CoV-2, aunque
se planteó la hipótesis de que el contagio a los humanos involucraría a un huésped intermedio como el
pangolín 1
● síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) se transmite de persona a persona
⚬ la mayor parte de la transmisión ocurre a través de la exposición a fluidos respiratorios que

transportan virus infecciosos por
– inhalación de gotitas respiratorias muy finas y partículas de aerosol
– depósito de gotitas y partículas respiratorias en las membranas mucosas expuestas en la boca, la
nariz o los ojos por salpicaduras y aerosoles directos (como al toser)
– tocar las membranas mucosas con las manos que se han ensuciado directamente con fluidos
respiratorios que contienen virus o indirectamente al tocar superficies con virus en ellas
– Referencia - Resumen científico de los Centros para el Control y la Prevención de Enfermedades:
Transmisión del SARS-CoV-2 ( CDC 7 de mayo de 2021 )
⚬ la viabilidad del SARS-CoV-2 sugiere que es posible la transmisión por aerosoles y fómites
– mediana de la vida media estimada del SARS-CoV-2
● 6,8 horas en plástico

● 5,6 horas en acero inoxidable
● 3,5 horas en cartón
● 1,1 horas en aerosol
● 0,8 horas en cobre
– estabilidad del SARS-CoV-2 similar a la del SARS-CoV-1

– Referencia - N Engl J Med 2020 16 de abril; 382 (16): 1564
⚬ El SARS-CoV-2 puede ser transmitido por personas que no muestran síntomas 1
– la excreción viral en el tracto respiratorio superior comienza alrededor de 2 a 3 días antes del
inicio de los síntomas con una carga viral máxima alrededor del momento del inicio de los
síntomas
– los portadores presintomáticos pueden transmitir el virus 1-3 días antes de desarrollar síntomas
– tasa de transmisión de personas con infección verdaderamente asintomática desconocida
⚬ transmisión después de la resolución de los síntomas 1
– ácido nucleico viral detectable en frotis de garganta hasta 6 semanas después del inicio de los
síntomas, pero los cultivos virales suelen ser negativos 8 días después del inicio de los síntomas
– la transmisión puede no ocurrir > 5 días después del inicio de los síntomas
● se ha informado transmisión vertical
RESUMEN
⚬ DEL ESTUDIO
Positividad para SARS-CoV-2 determinada por la reacción en cadena de la polimerasa con
transcriptasa inversa (RT-PCR) notificada en el 1,8 % de los recién nacidos de madres con
infección confirmada por SARS-CoV-2
REVISIÓN SISTEMÁTICA : BMJ 2022 16 de marzo; 376: e067696 | Texto completo

Detalles
– based on systematic review of observational studies

– systematic review of 206 cohort studies, and 266 case series and case reports evaluating 18,237
neonates born to 28,952 mothers with confirmed SARS-CoV-2 infection during pregnancy
– 97% of studies used RT-PCR to test SARS-CoV-2 infection in neonates
– SARS-CoV-2 positivity rate in neonates
● 1.8% (95% CI 1.2%-2.5%) using RT-PCR in analysis of 140 studies with 14,271 neonates
● 2.5% (95% CI 0.5%-5.55%) using anti-SARS-CoV-2 specific antibodies in analysis of 15 studies
with 583 neonates
● 1.3% (95% CI 0.6%-2.2%) in analysis of 69 studies with 4,643 neonates born to mothers with
diagnosis during antenatal period
● 0.93% (95% CI 0.15%-2.12%) when testing was done within 24 hours of birth in analysis of 32
studies with 2,640 neonates
– timing of SARS-CoV-2 mother-to-child transmission assessed in 536 neonates from all studies
● 448 neonates exposed in utero
⚬ 422 neonates had live birth, of which 4 neonates (0.95%) had confirmed mother-to-child
transmission
⚬ 26 neonates had fetal death, of which 3 neonates (11.5%) had confirmed mother-to-child
transmission
● 18 neonates had intrapartum exposure, of which 2 neonates (11.1%) had confirmed mother-
to-child transmission
● 70 neonates had early postnatal exposure, of which 5 neonates (7.1%) had confirmed mother-
to-child transmission
– outcomes assessed in 800 neonates and fetuses with positive SARS-CoV-2 test at birth
● 93.6% were alive at end of follow-up

● 2.8% were neonatal deaths
● 2.5% were stillbirths
● 1% were miscarriages or abortions
– Reference - BMJ 2022 Mar 16;376:e067696 full-text
RESUMEN
⚬ DEL ESTUDIO
gravedad de la COVID-19 materna asociada con un mayor riesgo de positividad para el SARS-CoV-
2 en recién nacidos de madres con infección confirmada por el SARS-CoV-2
REVISIÓN SISTEMÁTICA : BMJ 2022 16 de marzo; 376: e067696 | Texto completo
Detalles

– systematic review of 206 cohort studies, and 266 case series and case reports evaluating 18,237
neonates born to 28,952 mothers with confirmed SARS-CoV-2 infection during pregnancy
– 97% of studies used RT-PCR to test SARS-CoV-2 infection in neonates
– SARS-CoV-2 positivity rate in neonates
● 1.8% (95% CI 1.2%-2.5%) using RT-PCR in analysis of 140 studies with 14,271 neonates
● 2.5% (95% CI 0.5%-5.55%) using anti-SARS-CoV-2 specific antibodies in analysis of 15 studies
with 583 neonates
● 1.3% (95% CI 0.6%-2.2%) in analysis of 69 studies with 4,643 neonates born to mothers with
diagnosis during antenatal period
● 0.93% (95% CI 0.15%-2.12%) when testing was done within 24 hours of birth in analysis of 32
studies with 2,640 neonates
– factors associated with increased risk of SARS-CoV-2 positivity in neonates at birth
● severe maternal COVID-19 (odds ratio [OR] 2.4, 95% CI 1.3-4.4) in analysis of 22 studies with
2,842 mother-infant dyads
● maternal death (OR 14.1, 95% CI 4.1-48) in analysis of 7 studies with 725 mother-infant dyads
● maternal admission to intensive care unit (OR 3.5, 95% CI 1.7-6.9) in analysis of 19 studies with
2,851 mother-infant dyads
● maternal postnatal infection (OR 5, 95% CI 1.2-20.1) in analysis of 12 studies with 750 mother-
infant dyads
– Reference - BMJ 2022 Mar 16;376:e067696 full-text
● Periodo de incubación y número reproductivo del SARS-CoV-2
⚬ Evidencia • Actualizado 12 Sep 2022
RESUMEN DEL ESTUDIO

Se informó que la variante Omicron tiene un período de incubación promedio de 3,4 días
REVISIÓN SISTEMÁTICA : JAMA Netw Open 2022 Aug 1;5(8):e2228008 | Texto completo
Detalles

– systematic review of 142 observational studies reporting incubation period of COVID-19 in 8,112
persons
● 65.5% of studies were conducted between January and March 2020 and 76% of studies were
conducted in China
● incubation period defined as time from infection to onset of signs and symptoms or first
positive test for SARS-CoV-2
– pooled mean incubation period overall 6.6 days (95% CI 6.3-6.9 days) in analysis of all studies
(range 1.8-18.9 days), results limited by significant heterogeneity
● wild-type strain 6.6 days (95% CI 6.3-7 days) in analysis of 119 studies
● by variant type
⚬ 3.4 days (95% CI 2.9-4 days) for Omicron variant in analysis of 5 studies with 829 patients
⚬ 4.4 days (95% CI 3.8-5 days) for Delta variant in analysis of 6 studies with 2,368 patients
⚬ 4.5 days (95% CI 1.8-7.2 days) for Beta variant in 1 study with 10 patients
⚬ 5 days (95% CI 4.9-5.1 days) for Alpha variant in 1 study with 6,374 patients
● by age
⚬ 7.4 days (95% CI 5.8-9.1 days) in adults > 60 years old in analysis of 8 studies
⚬ 8.8 days (95% CI 8.2-9.4 days) in persons < 18 years old in analysis of 8 studies
● by disease severity
⚬ 7 days (95% CI 6.1-7.9 days) in patients with nonsevere illness in analysis of 5 studies
⚬ 6.7 days (95% CI 4.5-8.8 days) in patients with severe illness in analysis of 5 studies
– Reference - JAMA Netw Open 2022 Aug 1;5(8):e2228008 full-text
⚬ estudio seleccionado en revisión sistemática
RESUMEN
– DEL ESTUDIO
Se informó que COVID-19 tiene un período de incubación promedio de 5,2 días y se estima que
cada caso transmite la infección a otras 2,2 personas en Wuhan, China
ESTUDIO DE COHORTE : N Engl J Med 2020 26 de marzo; 382 (13): 1199

Detalles
● based on cohort study

● 425 adolescents and adults aged 15-89 years (median age 59 years, 38% ≥ 65 years old, 56%
men) with first confirmed COVID-19 pneumonia in Wuhan, China, were assessed
⚬ 47 patients had illness onset before closure (January 1) of Huanan Seafood Wholesale
Market (64% had exposure to wet market [Huanan Seafood Wholesale Market or other])
⚬ 248 patients had illness onset between closure of Huanan Seafood Wholesale Market and
January 11, 2020, when real-time polymerase chain reaction (PCR) reagents for
identification were provided to Wuhan (16% had exposure to wet market)
⚬ 130 patients had illness onset during January 12-22, 2020 (6% had exposure to wet market)
● incubation period assessed in 10 patients
⚬ mean incubation period 5.2 days (95% CI 4.1-7 days)

⚬ 95th percentile of distribution of incubation period 12.5 days (95% CI 9.2-18 days)
⚬ mean time between successive cases (mean serial interval) 7.5 days (95% CI 5.3-19 days)
● mean duration from illness onset to first medical visit
⚬ 5.8 days (95% CI 4.3-7.5 days) in 45 patients with onset before January 1, 2020
⚬ 4.6 days (95% CI 4.1-5.1 days) in 207 patients with onset between January 1 and 11, 2020
● assessment of epidemic curve up to January 4, 2020
⚬ on average, each patient spreads infection to 2.2 other people (basic reproductive number)
⚬ mean epidemic growth rate 0.1 per day (95% CI 0.05-0.16 per day)
⚬ mean doubling time 7.4 days (95% CI 4.2-14 days)
● Reference - N Engl J Med 2020 Mar 26;382(13):1199
RESUMEN
⚬ DEL ESTUDIO
Se estima que cada infección por SARS-CoV-2 de una persona con seguro de salud ingresada en el
hospital transmite la infección a una media de 1,3 a 2,5 personas antes de las medidas de
mitigación y < 1 después de las medidas de mitigación en Washington y California, Estados
Unidos.

Detalles
– based on modeling study

– 9,596,321 persons from health insurance database enrolling residents of Washington and
California were assessed through April 22, 2020
– most members received employer-sponsored health insurance and population assessed may
include higher proportion of persons with higher incomes than national average
– 1,840 patients were hospitalized with laboratory or clinically confirmed COVID-19 and served as
basis for analysis
– reproductive number estimates (RE)
● for infections acquired on March 1, 2020
⚬ 1.31-1.53 in Washington
⚬ 1.39-1.54 in northern California
⚬ 2.06-2.49 in southern California
● for infections acquired on April 1, 2020
⚬ 0.78-0.86 in Washington
⚬ 0.81-0.9 in northern California
⚬ 0.78-0.87 in southern California
– Reference - BMJ 2020 May 22;369:m1923
RESUMEN
⚬ DEL ESTUDIO
tiempo de duplicación de 6,4 días estimado en función de las infecciones por SARS-CoV-2
exportadas desde Wuhan, China, al 25 de enero de 2020
ESTUDIO DE MODELADO : Lancet 2020 29 de febrero; 395 (10225): 689

Detalles
– based on modeling study

– statistical model used number of SARS-CoV-2 (then referred to as 2019-nCoV) infections exported
from Wuhan, China, to cities outside mainland China from December 1, 2019 to January 25, 2020
– estimated SARS-CoV-2 basic reproductive number (R0) 2.68 (95% CrI 2.47-2.86)
– estimated epidemic doubling time 6.4 days (95% CrI 5.8-7.1)
– assuming no reduction in transmissibility, Wuhan epidemic estimated to peak around April 2020,
with local epidemics across cities in mainland China estimated to lag by 1-2 weeks
– assuming decreased transmissibility by 1-(1/R0) ≥ 63%, epidemics estimated to fade out
– Reference - Lancet 2020 Feb 29;395(10225):689 , correction can be found in Lancet 2020 Feb
29;395(10225):e41
● transmisión asintomática/presintomática
RESUMEN
⚬ DEL ESTUDIO
en pacientes de edad avanzada que viven en un centro de enfermería especializada, el 56 % de los
que dieron positivo para SARS-CoV-2 informaron ser asintomáticos o presintomáticos y el
tiempo de duplicación de los casos se estima en 3,4 días
ESTUDIO DE COHORTE : N Engl J Med 2020 28 de mayo; 382 (22): 2081

Detalles

– 89 elderly adults living in skilled nursing facility in King County, Washington, that had first positive
test for SARS-CoV-2 on March 3, 2020, were offered 2 opportunities for testing about 1 week apart
and were followed until April 3, 2020
– testing for SARS-CoV-2 was performed on nasopharyngeal and oropharyngeal samples according
to Centers for Disease Control and Prevention guidelines
● first survey testing conducted 10 days after index positive test included all assenting residents
● second survey testing conducted 6-7 days after first survey included residents who had
negative test on first survey
– all symptomatic healthcare personnel were advised to be tested by their healthcare provider
(asymptomatic staff members were not tested as part of study)
– residents were classified by clinical symptoms
● symptomatic: ≥ 1 new or worsened typical symptom (subjective fever or temperature > 100
degrees F [37.8 degrees C], cough, or shortness of breath) or atypical symptom (chills, malaise,
increased confusion, rhinorrhea, nasal congestion, sore throat, myalgia, dizziness, headache,
nausea, or diarrhea) of COVID-19 in previous 14 days
● asymptomatic: no symptoms or only stable chronic symptoms
● presymptomatic: developed symptoms within 7 days after testing
– 76 residents were tested in first survey
● 23 residents (30%) tested positive
⚬ 48% were presymptomatic

⚬ 39% had typical symptoms
⚬ 8.7% had atypical symptoms
⚬ 4.3% were asymptomatic
● 1 resident who tested positive before first survey had negative test result and had typical
symptoms
– 49 residents who tested negative on first survey were retested in second survey
● 24 residents (49%) tested positive
⚬ 54.2% were presymptomatic

⚬ 29.2% had typical symptoms
⚬ 8.3% had atypical symptoms
⚬ 8.3% were asymptomatic
● 25 residents (51%) tested negative
– median time to symptom onset 4 days

– estimated doubling time 3.4 days (95% CI 2.5-5.3 days)
– 23 days after first positive test
● 57 residents (64%) tested positive for SARS-CoV-2 during surveys, clinical evaluation, or
postmortem examination
⚬ 26% died
⚬ 19% were admitted to hospital
⚬ 5% were admitted to intensive care unit
● 51 out of 138 staff were tested, and 26 had positive test (19% of total staff)
– Reference - N Engl J Med 2020 May 28;382(22):2081
RESUMEN
⚬ DEL ESTUDIO
alrededor del 20% al 30% de los pacientes con infección por SARS-CoV-2 pueden ser
asintomáticos, y el riesgo de transmisión puede no ser menor después del contacto con pacientes
asintomáticos que con pacientes sintomáticos
REVISIÓN SISTEMÁTICA : PLoS Med 22 de septiembre de 2020;17(9):e1003346

Detalles
– based on systematic review of observational studies limited by clinical heterogeneity

– systematic review of 94 studies (including case series, cohort studies, case controls, and statistical
modelling studies) evaluating prevalence of asymptomatic infection and transmission risk in
patients with laboratory-confirmed SARS-CoV-2 through June 10, 2020
– in patients with laboratory-confirmed SARS-CoV-2 infection
● asymptomatic defined as no symptoms for duration of follow-up

● presymptomatic defined as no symptoms at first clinical assessment but with development of
symptoms by end of follow-up
– studies varied in duration of follow-up (including 14 days since exposure, 7 days after diagnosis,
or until negative reverse transcription PCR test)
– settings included hospitals, nursing homes, workplaces, and screening as part of contact tracing
– pooled rates of asymptomatic SARS-CoV-2 infection
● 20% (95% CI 17%-25%) in analysis of 79 studies with 6,616 patients with infection
● 31% (95% CI 26%-37%) in analysis of 7 screening studies with 303 patients with infection (out of
10,090 screened after possible exposure)
– rates of presymptomatic SARS-CoV-2 infection varied widely across 31 studies reporting this
outcome; no pooled rate reported
– no significant differences in risk of SARS-CoV-2 infection comparing contact with symptomatic
patient to
● asymptomatic patients (relative risk 0.35, 95% CI 0.1-1.27) in analysis of 5 trials with 7,629
patients
● presymptomatic patients (relative risk 0.63, 95% CI 0.18-2.26) in analysis of 2 trials with 3,164
patients
– Reference - PLoS Med 2020 Sep 22;17(9):e1003346 full text

– consistent findings in systematic review of 61 observational studies or reports evaluating
asymptomatic SARS-CoV-2 infection in children and adults (Ann Intern Med 2021 Jan 22 early
online full text )
RESUMEN
⚬ DEL ESTUDIO
Se estima que la excreción viral del SARS-CoV-2 alcanza su punto máximo antes o al inicio de los
síntomas en pacientes con COVID-19
ESTUDIO DE COHORTE : Nat Med 2020 May;26(5):672

Detalles
– based on retrospective cohort study and modeling study

– in cohort study
● 94 adults with laboratory-confirmed COVID-19 had viral loads assessed using PCR of throat
swabs from time of symptom onset up to 32 days after symptom onset
● 66% were moderately ill (presenting with fever and/or respiratory symptoms and radiographic
evidence of pneumonia) and none were classified as severely or critically ill on hospital
admission
● viral loads were highest at symptom onset and decreased gradually until below detection limit
on about day 21
– in modeling study
● 77 transmission pairs within and outside mainland China were evaluated
⚬ estimated mean serial interval (time between onset of symptoms in successive cases in
transmission chain) 5.8 days (95% CI 4.8-6.8 days)
⚬ mean incubation period (time between infection and symptom onset) assumed to be 5.2
days based on previous study
⚬ infectiousness inferred to begin 2.3 days before symptom onset (95% CI 0.8-3 days) with
peak infectiousness at 0.7 days before symptom onset (95% CI -0.2 to 2 days)
● estimated proportion of presymptomatic transmission 44% (95% CI 25%-69%)
– Reference - Nat Med 2020 May;26(5):672
● SARS-CoV-2 en muestras no respiratorias
RESUMEN
⚬ DEL ESTUDIO
Detección de SARS-CoV-2 en muestra fecal/anal reportada en 52% y persiste por un promedio de
12.5 días más que en muestra respiratoria en pacientes con COVID-19
REVISIÓN SISTEMÁTICA : Aliment Pharmacol Ther 2020 27 de agosto temprano en línea | Texto
completo
Detalles

– systematic review of 95 case series and case reports evaluating 2,175 patients with COVID-19 and
testing of stool samples or anal swabs for SARS-CoV-2 RNA
– pooled positive rate for SARS-CoV-2 RNA in fecal/anal sample 51.8% (95% CI 43.8%-59.7%) in
analysis of 44 studies including ≥ 10 patients, results limited by significant heterogeneity
– mean duration of viral detection in fecal/anal sample was 25 days (range 3-70) after symptom
onset or first positive SARS-CoV-2 test in any specimen in analysis of 42 studies
– in analysis of 54 studies performing serial respiratory and fecal/anal sample testing
● 64% of 443 patients with positive fecal/anal sample had persistent positive fecal/anal sample
after negative respiratory sample
● mean duration of positive fecal/anal sample after negative respiratory sample was 12.5 days
(maximum duration 33 days)
– Reference - Aliment Pharmacol Ther 2020 Aug 27 early online full-text
RESUMEN
⚬ DEL ESTUDIO
SARS-CoV-2 may persist longer in stool than in both sputum or saliva and serum in patients with
COVID-19 DynaMed Level 3
COHORT STUDY: BMJ 2020 Apr 21;369:m1443 | Full Text

Details
– based on retrospective cohort study

– 96 consecutive patients with laboratory-confirmed COVID-19 admitted to First Affiliated Hospital,
Zhejiang province, China, between January 19 and February 15, 2020, were assessed until March
20, 2020
● 74 patients (median age 57 years, 66% male) had severe disease
● 22 patients (median age 47 years, 41% male) had mild disease
– 100% received antivirals, 81% received glucocorticoids, 55% received gammaglobulin, and 34%
received antibiotics
– 3,497 samples were evaluated for SARS-CoV-2 RNA by quantitative PCR, including
● 1,846 respiratory samples (sputum and saliva)

● 842 stool samples
● 629 serum samples
● 180 urine samples
– all patients tested negative for viral RNA at end of follow-up

– detection rate of viral RNA
● 100% for respiratory samples

● 59% for stool samples
● 41% for serum samples
● 1% for urine samples
– median duration of viral detection
● 22 days (interquartile ranges from 17 to 31 days) in stool samples (p = 0.02 vs. respiratory
samples and p < 0.001 vs. serum samples)
● 18 days (interquartile ranges from 13 to 29 days) in respiratory samples
● 16 days (interquartile ranges from 11 to 21 days) in serum samples
– comparing patients with severe vs. mild disease, median viral duration in respiratory samples 21
days vs. 14 days (p = 0.04), no significant differences for stool and serum samples
– in patients with severe disease
● duration of virus was 28 days in patients treated with glucocorticoids continuously for > 10
days vs. 16 days in patients treated with glucocorticoids continuously for ≤ 10 days (p < 0.001)
● other factors associated with increased median viral duration included
⚬ male sex (p = 0.01)

⚬ age > 60 years (p = 0.01)
– viral load
● respiratory samples had highest viral load, followed by stool samples, and was lowest in serum
samples
● patients with severe disease had significantly higher viral loads in respiratory samples
compared to mild disease (p = 0.03), no significant differences in stool and serum samples
– Reference - BMJ 2020 Apr 21;369:m1443 full-text
● discussion on risk of transmission of coronaviruses (including SARS-CoV-2) associated with aerosol-

generating procedures can be found in Ann Intern Med 2020 May 22 early online
Pathogenesis
● SARS-CoV-2 infects cells in a similar manner to other virulent coronaviruses 1 , 2
⚬ viral spike protein binds angiotensin-converting enzyme 2 (ACE2) receptor

⚬ cell entry requires type 2 transmembrane serine protease (TMPRSS2) to cleave ACE2 receptor and
activate viral spike protein
⚬ cell entry occurs via endocytosis
⚬ many cell types coexpress ACE2 and TMPRSS2 including lung alveolar epithelial cells, nasal goblet
secretory cells, cholangiocytes, colonocytes, esophageal keratinocytes, gastrointestinal epithelial
cells, pancreatic beta cells, renal proximal tubules, and podocytes
⚬ mechanism of extrapulmonary spread is unclear
● early in infection, SARS-CoV-2 infects nasal and bronchial epithelial cells and pneumocytes 1 , 2
⚬ inflammatory response is initiated, which recruits T cells, monocytes, and neutrophils

⚬ immune cells produce tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and IL-6
⚬ direct cytotoxicity, apoptosis, and reduced proliferation causes T cell lymphopenia and dysregulated
immune response
● in later stages of infection, viral replication accelerates and epithelial-endothelial barrier integrity is
compromised 1 , 2
⚬ SARS-CoV-2 can cause direct and indirect endothelial cell damage and thrombo-inflammation
⚬ excessive thrombin production, inhibition of fibrinolysis, and activated complement leads to
microthrombi deposition and microvascular dysfunction
⚬ neutrophil extracellular traps further damage the endothelium and activate coagulation pathways
● dysregulated inflammatory response ("cytokine storm") 1 , 2
⚬ further recruits monocytes and neutrophils, which infiltrate airspaces, causing
– alveolar interstitial thickening

– increased vascular permeability
– pulmonary edema (appearing as ground glass opacities on computed tomography) and leading to
acute respiratory distress syndrome
⚬ activa el sistema de cinina-calicreína que contribuye aún más a la fuga vascular local y al
angioedema
⚬ estimula la coagulación que conduce a la formación de microtrombos
⚬ inicia ciclo de endotelialitis promoviendo trombo-inflamación
● la desregulación del sistema renina-angiotensina-aldosterona (SRAA) también puede contribuir al daño
tisular relacionado con la infección 2
RESUMEN
● DEL ESTUDIO
Hallazgos histopatológicos y ultraestructurales en casos fatales de COVID-19 en el estado de
Washington, Estados Unidos
SERIE DE CASOS : Lancet 2020 16 de julio temprano en línea | Texto completo

Detalles
⚬ based on case series

⚬ postmortem examinations were conducted on 14 adults (median age 73 years) who died with severe
COVID-19 in Washington state, United States, between February and March 2020
⚬ histopathologic examination included
– light microscopy in all patients

– electron microscopy for detection of SARS-CoV-2 viral particles in 2 patients
– immunohistochemical staining for SARS-CoV-2 spike protein in 4 patients
– quantitative reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA
detection in 3 patients
⚬ median time to death after symptom onset was 7 days

⚬ all patients had clinically significant comorbidities, including hypertension, chronic kidney disease,
obstructive sleep apnea, diabetes, and obesity
⚬ light microscopy findings
– pulmonary system findings
● spectrum of diffuse alveolar damage (intra-alveolar fibrin, hyaline membranes, or loosely

organizing connective tissue in the alveolar septal walls) in 12 patients (86%)
● microscopic hemorrhage with diffuse alveolar damage in 3 patients
● focal bronchial or bronchiolar neutrophilic inflammation in 9 patients
● chronic interstitial inflammation in most patients
● focal pulmonary microthrombi in 5 patients
● emphysematous change in 3 patients
● extensive chronic interstitial fibrosis in 1 patient
– cardiac system findings
● fibrosis in all patients

● myocyte hypertrophy in 13 patients (93%)
● myocarditis with aggregates of lymphocytes surrounding necrotic myocytes in 1 patient
– kidney findings
● presence of mild-to-severe arterionephrosclerosis and diabetic nephropathy

● features suggestive of acute tubular injury including extensive tubular epithelial vacuolization
in 11 patients (79%)
● chronic inflammation of renal parenchyma and focal segmental glomerulosclerosis in 1 patient
– liver findings
● mostly chronic changes associated with preexisting comorbidities

● centrilobular necrosis consistent with hypoperfusion injury in 4 patients
● no prominent inflammation
– brain was examined in 5 patients, with acute pathology with scattered punctate subarachnoid
hemorrhages and rare microhemorrhage in brainstem in 1 patient
⚬ electron microscopy findings
– SARS-CoV-2 viral particles detected in lung, trachea, kidney, and large intestine of 2 patients
– viral particles present inside tracheal epithelial cells and extracellular space adjacent to cell
membrane or mixed with luminal mucus
– viral particles seen in type 1 and 2 pneumocytes
– in kidney, viral particles seen in tubular epithelial cells and rarely in endothelial cells
⚬ immunohistochemical staining in lung sections of 4 patients
– positive SARS-CoV-2 staining in all patients

– alveolar pneumocytes and sloughed ciliated respiratory epithelium in bronchioles detected
⚬ SARS-CoV-2 RNA detected in lung, trachea, subcarinal lymph node, kidney, large intestine, and spleen
of all 3 patients, and in liver, heart, and blood of 2 patients
⚬ Reference - Lancet 2020 Jul 16 early online full-text
RESUMEN
● DEL ESTUDIO
infección por SARS-CoV-2 con eliminación de 382 nucleótidos asociada con un menor riesgo de
hipoxia que requiere oxígeno suplementario en comparación con el SARS-CoV-2 de tipo salvaje
ESTUDIO DE COHORTE : Lancet 2020 29 de agosto;396(10251):603 | Texto completo

Detalles

⚬ 251 patients hospitalized with PCR-confirmed SARS-CoV-2 infection in Singapore between January 22
and March 21, 2020, and who had residual samples for screening for 382-nucleotide deletion (delta
382) in open reading frame 8 genomic region of SARS-CoV-2 were assessed
⚬ 131 patients who were enrolled in PROTECT study had clinical data and were included in analysis
– 70% (median age 47 years) were infected with wild-type virus only
– 22% (median age 37 years) were infected with delta 382 variant only
– 8% (median age 46 years) were infected with mix of wild-type virus and delta 382 variant
⚬ rates of hypoxia requiring supplemental oxygen
– 28% with wild-type virus only

– 0% with delta 382 variant only (adjusted odds ratio 0.07, 95% CI 0-0.48 vs. wild-type only)
– 30% with mix of wild-type virus and delta 382 variant (not significant vs. wild-type only)
⚬ mortality (no significant differences)
– 2% with wild-type virus only

– 0% with delta 382 variant only
– 0% with mix of wild-type virus and delta 382 variant
⚬ patients infected with delta 382 variant only presented later after symptom onset and had lower
rates of fever, median C-reactive protein level, and median lactate dehydrogenase level compared to
patients infected with wild-type virus only (p ≤ 0.05 for all)
⚬ in analysis of 97 patients at admission, patients infected with delta 382 variant had lower
concentrations of growth factors associated with lung injury and regeneration (including hepatocyte
growth factor [HGF], leukemia inhibitory factor [LIF], and vascular endothelial growth factor-A [VEGF-
A]) and higher concentrations of PIGF-1 (placental growth factor) and RANTES (regulated on
activation, normal T cell expressed and secreted) (CCL5) compared to wild-type virus (p < 0.05 for all)
⚬ in analysis of 44 patients without pneumonia, patients infected with delta 382 variant had
upregulation of T-cell activation-associated cytokines (interferon gamma, TNF-alpha, IL-2, and IL-5)
while growth factors associated with lung injury (HGF, LIF, and VEGF-A) were lower compared to wild-
type virus (p < 0.05 for all)
⚬ Reference - Lancet 2020 Aug 29;396(10251):603 full-text
Respuesta inmune
● la respuesta inmune a la infección por SARS-CoV-2 es un área de investigación en curso
⚬ después de unirse a los receptores de la enzima convertidora de angiotensina 2 (ACE2) de la

superficie celular, el SARS-CoV-2 es reconocido por el receptor tipo toll 3 (TLR3), TLR4, TLR7 e inicia la
respuesta inflamatoria del huésped
⚬ respuesta inmune humoral
– anticuerpos dirigidos principalmente contra la glucoproteína espiga del SARS-CoV-2 y la proteína

de la nucleocápside
– cinética de la respuesta de anticuerpos
● La inmunoglobulina M (IgM) alcanza títulos altos alrededor de 10 a 12 días después del inicio
de los síntomas y tiende a disminuir después de alrededor de 18 días.
● la inmunoglobulina A (IgA) se produce dentro de 1 semana y alcanza su punto máximo
alrededor de 20-22 días
● la inmunoglobulina G (IgG) aumenta durante 3 semanas y comienza a disminuir después de
aproximadamente 8 semanas
– la inmunidad humoral puede no ser duradera, particularmente en pacientes con enfermedad
leve
⚬ respuesta inmune celular
– Se han detectado células T CD4 y CD8 específicas del SARS-CoV-2 7-10 días después del inicio de
los síntomas y se contraen el día 20
– Las células T CD4 eran predominantemente de fenotipo T helper 1 (Th1) y producían interferón
gamma, interleucina 2 (IL-2) y factor de necrosis tumoral alfa (TNF-alfa)
– Las células T CD8 producen interferón gamma y TNF-alfa, además de mediar en la función
citolítica.
– inmunodominancia para epítopos en proteínas estructurales, incluidas proteínas de espiga,
membrana y nucleocápside
⚬ La reinfección rara vez se ha informado, aunque no está claro si representa una disminución de la
inmunidad, cepas virales distintas o ambas.
⚬ Se han detectado células T específicas del SARS-Co-V-2 en individuos no infectados, lo que sugiere
una reactividad cruzada con los coronavirus estacionales, pero se desconoce si la inmunidad
preexistente puede ofrecer alguna protección
⚬ Referencia - Lancet 2020 13 de octubre temprano en línea texto completo
● seroprevalencia y cinética de la respuesta inmune
RESUMEN
⚬ DEL ESTUDIO
6,9 % de seroprevalencia de pan-inmunoglobulinas contra el SARS-CoV-2 en la primavera de
2020 en Wuhan, China, con seroconversión a anticuerpos neutralizantes en aproximadamente el
64 % de las personas con síntomas en comparación con el 35 % de las personas sin síntomas
ESTUDIO TRANSVERSAL : Lancet 20 de marzo de 2021; 397 (10279): 1075 | Texto completo
Detalles
– based on cross-sectional study

– 9,702 persons from 3,599 families from 13 districts of Wuhan, China had venous blood samples
collected on April 14 and April 15, 2020
– 9,542 persons from 3,556 families with sufficient sample for serum testing for antibodies to SARS-
CoV-2 spike protein were included in analysis
– 532 persons (from 391 families) tested positive for pan-immunoglobulins against SARS-CoV-2 at
baseline
● 100% positive for IgG antibodies
● 15.8% positive for IgA antibodies
● 13% positive for IgM antibodies
● 39.8% positive for neutralizing antibodies
– adjusted seroprevalence of pan-immunoglobulins against SARS-CoV-2
● 6.92% (95% CI 6.41%-7.43%) overall

● 5.99% (95% CI 5.5%-6.48%) in 9,118 persons without symptoms
● 26.13% (95% CI 21.95%-30.31%) in 424 persons with symptoms
– 363 persons positive for pan-immunoglobulins completed first follow-up on June 11-13, 2020
● 97.5% positive for IgG antibodies

● 3.9% positive for IgM antibodies
– 454 persons positive for pan-immunoglobulins completed second follow-up between October 9
and December 5, 2020
● 91% positive for IgG antibodies
● 1.5% positive for IgM antibodies
– seroconversion rates of neutralizing antibodies comparing persons with laboratory- and

computed tomography (CT)-confirmed infection vs. persons with symptoms vs. asymptomatic
persons in analysis of 335 persons positive for pan-immunoglobulins who completed 2 follow-up
visits
● 66.7% vs. 63.6% vs. 34.8% (overall p < 0.0001) at baseline
● 51.9% vs. 63.6% vs. 37.2% (overall p = 0.0009) at first follow-up
● 59.3% vs. 63.6% vs. 40.7% (overall p = 0.003) at second follow-up
– no significant difference in neutralizing antibody levels at first and second follow-up compared to
baseline
– Reference - Lancet 2021 Mar 20;397(10279):1075 full-text editorial can be found in Lancet
2021 Mar 20;397(10279):1037
RESUMEN
⚬ DEL ESTUDIO
en adultos con COVID-19 confirmado por laboratorio, prevalencia máxima estimada de
anticuerpos IgM de alrededor del 80 % con niveles máximos aproximadamente 20 días después
del inicio de los síntomas, y prevalencia máxima de anticuerpos IgG del 95 % con niveles
máximos aproximadamente 25 días
REVISIÓN SISTEMÁTICA : Ann Intern Med 16 de marzo de 2021 temprano en línea | Texto
completo
Detalles

– systematic review of 66 observational studies reporting antibody response in 16,525 adults with
real-time polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection who had serologic
testing for antibodies
● 42 studies included patients with varying disease severity, 9 studies included only patients with
asymptomatic or mild disease, 10 studies included only patients with moderate, severe, or
critical disease
● 38% of studies conducted in China, 33% in Europe, 18% in United States or Canada, 11% in
other countries including Korea, Japan, Thailand, Singapore, India, or Brazil
– most studies evaluated prevalence of antibodies (IgM, IgG, neutralizing antibodies, and IgA) within
first 28 days from symptom onset or diagnosis and had < 100 days follow-up
– meta-analysis was not conducted due to heterogeneity in patient population, immunoassays
used, and timing of test
– median peak prevalence of antibodies
● 80% (range 9%-98%) for IgM antibodies with peak levels at about 20 days after symptom onset
or diagnosis in analysis of 21 studies with 6,073 patients
⚬ first detection around 7 days
⚬ levels declining by 27 days
● 95% (range 15%-100%) for IgG antibodies with peak levels at about 25 days after symptom
onset or diagnosis in analysis of 24 studies with 9,136 patients
⚬ first detection around 12 days
⚬ levels declining by 60 days but still detectable at 120 days
● 83% (range 75%-89%) for IgA antibodies at 2-122 days after symptom onset or diagnosis in
analysis of 5 studies with 747 patients
● 99% (range 76%-100%) for neutralizing antibodies with peak levels at about 30 days after
symptom onset or diagnosis in analysis of 8 studies with 979 patients
– older age, greater disease severity, and presence of symptoms associated with higher antibody
levels
– Reference - Ann Intern Med 2021 Mar 16 early online full-text
RESUMEN
⚬ DEL ESTUDIO
en adultos hospitalizados con COVID-19 confirmado por laboratorio, la positividad de RT-PCR
para SARS-CoV-2 parece alcanzar su punto máximo dentro de los 3 días posteriores al inicio de la
enfermedad, y las tasas de seroconversión de IgM e IgG parecen alcanzar su punto máximo a las 5
semanas
ESTUDIO DE COHORTE : Ann Intern Med 2020 8 de diciembre temprano en línea | Texto completo
Detalles

– 3,192 adults (median age 62 years, 50% women) who were hospitalized with COVID-19 between
January 18 and March 31, 2020 in China and had RT-PCR tests for SARS-CoV-2 were evaluated
● 67% had laboratory-confirmed COVID-19 (≥ 1 positive test for SARS-CoV-2 by real-time PCR)
● 33% had clinical diagnosis of COVID-19 based on epidemiologic history, clinical manifestations,
and antibody response without positive results on nucleic acid testing
● most common symptoms included fever (69.5%), cough (51.9%), dyspnea (31.8%), diarrhea
(19.2%), and fatigue (15.1%)
– 12,780 RT-PCR tests for SARS-CoV-2 were performed using nasopharyngeal (92%) or
oropharyngeal (8%) swabs from 3,192 patients (median testing frequency per patient was 4 times)
– 3,064 swabs (24%) tested positive for SARS-CoV-2 by RT-PCR
– among patients with laboratory-confirmed COVID-19
● rates of SARS-CoV-2 RT-PCR positivity by time from disease onset (first symptoms or first
positive RT-PCR)
⚬ 89.2% at 0-3 days
⚬ 80.1% at 3-7 days
⚬ 69.9% at 2 weeks
⚬ 41.9% at 3 weeks
⚬ 27.4% at 4 weeks
⚬ 22.9% at 5 weeks
⚬ 21.4% at ≥ 10 weeks
● IgM seroconversion rates
⚬ 19.3% at 1 week
⚬ 55.6% at 3 weeks
⚬ 81.5% at 5 weeks
● IgG seroconversion rates
⚬ 44.6% at 1 week
⚬ 54.2% at 2 weeks
⚬ 93.3% at 4 weeks
⚬ 100% at 4-5 weeks
– among patients with clinically diagnosed COVID-19, IgG seroconversion rates were 28.6% at 1
week, 60.9% at 2 weeks, and 96.7% at 6 weeks
– median duration of SARS-CoV-2 RT-PCR positivity was 24 days in critically ill patients (requiring
intubation or involving shock, other organ failure, or admission to intensive care unit) vs. 18 days
in mild-to-severely ill patients (p < 0.001)
– Reference - Ann Intern Med 2020 Dec 8 early online full-text
⚬ SARS-CoV-2 IgG/IgM detectado en 10 de 11 bebés nacidos de madres con COVID-19 (1 bebé dio
positivo para COVID-19) en 6 estudios en revisión sistemática ( J Med Virol 2020 Oct 22 temprano en
línea )
● protección contra la reinfección
RESUMEN
⚬ DEL ESTUDIO
entre las personas no vacunadas previamente infectadas, la tasa de reinfecciones confirmadas
puede aumentar de 10,5 por 100 000 días-persona en riesgo dentro de los 2 meses posteriores a la
primera infección a 30,2 por 100 000 días-persona en ≥ 1 año después de la primera infección
ESTUDIO DE COHORTE : N Engl J Med 2022 25 de mayo temprano en línea

Detalles

– 5,724,810 persons ≥ 16 years old who had been previously infected with SARS-CoV-2 or who had
received 2 doses of mRNA COVID-19 vaccine (Pfizer-BioNTech) from Israeli Ministry of Health
database between August and end of September 2021 were assessed
– 45% aged 16-39 years, 30% aged 40-59 years, and 25% ≥ 60 years old
– predominant circulating SARS-CoV-2 strain globally was Delta during study period
– in March 2021, unvaccinated persons who recovered from COVID-19 became eligible to receive 1
dose of Pfizer-BioNTech ≥ 3 months after recovery
– reinfection defined as positive polymerase-chain-reaction test for SARS-CoV-2 after ≥ 90 days from
previous positive SARS-CoV-2 test
– adjusted rate of confirmed infections per 100,000 person-days at risk
● among previously infected, unvaccinated persons
⚬ 10.5 (95% CI 8.8-12.4) within 4-6 months after previous infection

⚬ 14 (95% CI 13.3-14.8) within 6-8 months after previous infection
⚬ 30.2 (95% CI 28.5-32) at ≥ 12 months after previous infection
● among persons who first recovered from previous infection then received 1 dose of Pfizer-
BioNTech vaccine
⚬ 3.7 (95% CI 3.1-4.5) within 2 months of vaccination
⚬ 11.6 (95% CI 10-13.5) within 6-8 months of vaccination
● among persons who first received 1 dose of Pfizer-BioNTech vaccine then recovered from
infection
⚬ 10.6 (95% CI 7.6-15) within 4-6 months after previous infection
⚬ 16.2 (95% CI 14-18.5) within 6-8 months after previous infection
– Reference - N Engl J Med 2022 May 25 early online
RESUMEN
⚬ DEL ESTUDIO
antes de la aparición de las variantes Delta u Omicron y los programas de vacunación, se informó
que la infección previa por SARS-CoV-2 estaba asociada con una reducción del 87 % en el riesgo
de infección sintomática
REVISIÓN SISTEMÁTICA : Ann Intern Med 2022 25 de enero; M21 | Texto completo
Detalles
– based on systematic review of cohort studies

– systematic review of 18 cohort studies comparing risk of SARS-CoV-2 reinfection in persons with
documented SARS-CoV-2 infection to risk of incident infection in persons with no previous
infection
● all studies completed before emergence of Delta and Omicron variants and vaccination
programs
● SARS-CoV-2 infection status at baseline was based on antibody test (9 studies), PCR test (in 6
studies), or combination of antibody test and PCR (in 3 studies)
● follow-up ranged from 4 to 13 months
– reinfection rate ranged from 0% to 2.2%

– protection against reinfection defined as difference in proportion of infections between
previously uninfected persons and previously infected persons relative to proportion in previously
uninfected persons
– reduction in risk of symptomatic infection associated with previous infection
● 87% (95% CI 84%-90%) in overall analysis of 16 studies, results limited by significant

heterogeneity
● 88% (95% CI 84%-91%) for general population in analysis of 8 studies, results limited by
significant heterogeneity
● 87% (95% CI 75%-94%) for healthcare workers in analysis of 5 studies
● 92% (95% CI 80%-97%) for long-term care facility residents in analysis of 2 studies
● 82% (95% CI 76%-87%) for college students in 1 study
– among 8 studies evaluating protection against reinfection over time
● 6 studies reported no change in protection during 6-13 months of follow-up

● 2 studies reported increase in protection during 7 and 10 months of follow-up
– Reference - Ann Intern Med 2022 Jan 25;M21 full-text
RESUMEN
⚬ DEL ESTUDIO
Infección previa por SARS-CoV-2 asociada con un riesgo reducido de reinfección a los 7 meses en
trabajadores de la salud en Inglaterra
ESTUDIO DE COHORTE : Lancet 2021 17 de abril; 397 (10283): 1459

Detalles
– based on interim analysis of prospective cohort study

– 30,574 healthcare workers and hospital staff (median age 45 years, 84% women, 87% White) in
England between June 18 and December 31, 2020, were assessed
– all persons had SARS-CoV-2 antibody testing every 4 weeks, nucleic acid amplification testing with
real-time PCR every 2 weeks (anterior nasal swabs or combined nose and oropharyngeal swabs),
and completed COVID-19 symptom and exposure questionnaires every 2 weeks
– 25,661 persons with PCR and antibody test results collected through January 11, 2021, included in
analysis
● 8,278 persons (median age 45 years, 82% women) were baseline SARS-CoV-2 positive (positive
antibody or PCR test)
● 17,383 persons (median age 45 years, 85% women) were baseline SARS-CoV-2 negative
(antibody negative and no previous positive PCR or antibody test)
– 86.2% were healthcare workers with patient-facing role

– 13,401 persons vaccinated between December 8, 2020, and Jan 11, 2021 (including 3,933 positive
at baseline and 9,468 negative at baseline)
– mean follow-up of 7 months
– reinfection in 1.8% of baseline SARS-CoV-2-positive persons
– new infection in 9.8% of baseline SARS-CoV-2-negative persons
– comparing incidence of SARS-CoV-2 reinfection in persons SARS-CoV-2-positive at baseline vs.
incidence of new infections in persons negative at baseline (events/100,000 days)
● 7.6 vs. 57.3 overall (adjusted incidence rate ratio [IRR] 0.159, 95% CI 0.13-0.19)
● 2.4 vs. 37.9 in adults with COVID-19 symptoms 14 days before and after positive PCR test
(adjusted IRR 0.074, 95% CI 0.06-0.1)
● 3.7 vs. 9.9 in adults with asymptomatic infection (adjusted IRR 0.484, 95% CI 0.37-0.63)
– analysis adjusted for age, gender, ethnicity, staff role, index of multiple deprivation, region,
vaccination, and B.1.1.7 variant prevalence
– Reference - SIREN study (Lancet 2021 Apr 17;397(10283):1459 full text )
RESUMEN
⚬ DEL ESTUDIO
alrededor del 80%-83% de protección contra la reinfección con SARS-CoV-2 notificada en
personas < 65 años, y 47% de protección contra la reinfección notificada en adultos ≥ 65 años en
Dinamarca
ESTUDIO DE COHORTE : Lancet 2021 27 de marzo; 397 (10280): 1204 | Texto completo
Detalles

– 3,960,000 persons who had reverse transcriptase PCR (RT-PCR) test for SARS-CoV-2 between
February 26, 2020 and December 31, 2020 in Denmark were followed until December 31, 2020 or
until new positive test (reinfection) ≥ 90 days after first infection
– 2,432,509 persons were included in analysis
● 28,875 persons (1.19%) with previous infection contributed to exposed periods, with follow-up
of 2,447,924 person-days
● 2,405,683 persons (98.9%) without previous infection contributed to unexposed periods, with
follow-up of 174,487,793 person-days
– 138 infections occurred during ≥ 3-month follow-up

– infection rate during follow-up was 5.64 per 100,000 person-days for persons with previous
infection and 30.94 per 100,000 person-days for persons without previous infection (adjusted rate
ratio 0.21, 95% CI 0.18-0.25)
– estimated protection against reinfection
● 79% (95% CI 75%-82%) overall

● 83% (95% CI 77%-87%) for persons aged 0-34 years
● 47% (95% CI 25%-63%) for persons aged ≥ 65 years
– no significant difference in estimated protection against reinfection comparing persons with 3-6
months of follow-up to persons with ≥ 7 months of follow-up
– among persons who had RT-PCR test for SARS-CoV-2 in 2020
● 533,381 persons were tested during first surge (before June 2020), and 11,727 persons (2.2%)
were positive
● 3,480,000 persons were tested during second surge (from September 1, 2020 to December 31,
2020), and 150,159 persons (4.32%) were positive
– 525,339 persons who had COVID-19 test during first surge were followed up during second surge
● 11,068 persons tested positive during first surge, 72 persons (0.65%) tested positive again
during second surge
● 514,271 persons tested negative during first surge, 16,819 persons (3.27%) tested positive
during second surge
– infection rate per 100,000 person-days during second surge comparing persons tested positive vs.
persons tested negative during first surge
● 5.35 vs. 27.06 (adjusted rate ratio 0.195, 95% CI 0.155-0.246) overall
● 10 vs. 51.94 (adjusted rate ratio 0.189, 95% CI 0.094-0.379) in analysis of 15,604 frequently
tested nurses, doctors, social workers, and healthcare assistants
– estimated protection against reinfection during second surge 80.5% (95% CI 75%-84.5%)
– Reference - Lancet 2021 Mar 27;397(10280):1204 full-text
RESUMEN
⚬ DEL ESTUDIO
seropositividad asociada con un riesgo reducido de reinfección por SARS-CoV-2 en trabajadores
de la salud seguidos durante 6 meses
ESTUDIO DE COHORTE : N Engl J Med 2020 23 de diciembre temprano en línea

Detalles

– 12,541 healthcare workers (mean age 38 years, 73.8% women) in United Kingdom between March
27, 2020 and November 30, 2020 were assessed
● serologic testing for antibodies to SARS-CoV-2 spike protein performed using anti-trimeric
spike IgG enzyme-linked immunosorbent assay (ELISA) or anti-nucleocapsid IgG assay every 2
months
● real-time PCR test for SARS-CoV-2 infection performed using nasal and oropharyngeal swabs
every 2 weeks or when symptomatic (new persistent cough, temperature ≥ 37.8 degrees C [100
degrees F], or anosmia or ageusia)
– race/ethnicity included White (72.3%), Asian (16.1%), and Black (4%)

– at baseline, 9.4% were seropositive and 90.6% were seronegative (including 0.6% who had
seroconversion during follow-up) based on anti-spike IgG assay
– prebaseline symptoms consistent with COVID-19 reported in 69% of seropositive patients vs. 25%
of seronegative patients
– follow-up was 152,983 person-days in seropositive patients and 2,036,358 person-days in
seronegative patients
– incidence of SARS-CoV-2-positive PCR (per 10,000 days at risk) comparing baseline seropositive vs.
baseline seronegative status
● 0.13 vs. 1.09 (incidence rate ratio 0.12, 95% CI 0.03-0.47) when seropositivity status based on
anti-spike IgG assay
● 0.13 vs. 1.1 (incidence rate ratio 0.11, 95% CI 0.03-0.45) when seropositivity based on anti-
nucleocapsid IgG assay
– Reference - N Engl J Med 2020 Dec 23 early online full text
Historia y Físico
Historia
Preocupación principal
● los síntomas leves a severos pueden surgir de 2 a 14 días después de la exposición
⚬ los síntomas comunes incluyen
– fiebre o escalofríos
– tos
– falta de aliento o dificultad para respirar
– fatiga
– dolores musculares o corporales
– dolor de cabeza
– nueva pérdida del olfato o del gusto
– dolor de garganta
– congestión o secreción nasal
– náuseas o vómitos
– Diarrea
⚬ Referencias - 1 , CDC 22 de marzo de 2022
RESUMEN
● DEL ESTUDIO
fiebre, tos y fatiga características clínicas más comunes en pacientes con COVID-19 en China
REVISIÓN SISTEMÁTICA : J Med Virol 2020 Oct;92(10):1902 | Texto completo

Detalles

⚬ systematic review of 38 observational studies evaluating clinical characteristics of 3,062 patients with
COVID-19 in China between January 1 and February 28, 2020
⚬ male sex in 56.9% (95% CI 55%-58.4%) in analysis of all patients
⚬ symptoms included
– fever in 80.4% (95% CI 73%-86.9%) in analysis of 35 studies with 2,966 patients

– cough in 63.1% (95% CI 57.9%-68.2%) in analysis of 36 studies with 2,979 patients
– fatigue in 46% (95% CI 38.2%-54%) in analysis of 26 studies with 2,595 patients
– expectoration in 41.8% (95% CI 33.9%-50%) in analysis of 17 studies with 1,908 patients
– anorexia in 38.8% (95% CI 14.1%-67.1%) in analysis of 6 studies with 467 patients
– chest tightness in 35.7% (95% CI 23.2%-49.3%) in analysis of 14 studies with 660 patients
– shortness of breath in 35% (95% CI 21.7%-49.8%) in analysis of 8 studies with 1,379 patients
– dyspnea in 33.9% (95% CI 24.2%-44.3%) in analysis of 14 studies with 955 patients
– muscle soreness in 33% (95% CI 26%-40.5%) in analysis of 25 studies with 2,444 patients
– chest pain in 28.3% (95% CI 1%-72.9%) in analysis of 2 studies with 87 patients
– headache in 15.4% (95% CI 11.6%-19.6%) in analysis of 24 studies with 2,452 patients
– pharyngalgia in 13.1% (95% CI 7.4%-20.3%) in analysis of 10 studies with 751 patients
– diarrhea in 12.9% (95% CI 9%-17.4%) in analysis of 24 studies with 2,378 patients
– shivering in 11% (95% CI 5.8%-17.4%) in analysis of 5 studies with 314 patients
– nausea and vomiting in 10.2% (95% CI 5.4%-16.3%) in analysis of 10 studies with 1,638 patients
– abdominal pain in 4.4% (95% CI 2.5%-6.9%) in analysis of 5 studies with 545 patients
⚬ asymptomatic presentation in 11.9% (95% CI 2.9%-25.8%) in analysis of 5 studies with 158 patients
⚬ imaging findings
– bilateral lung involvement in 75.7% (95% CI 65.7%-84.5%) in analysis of 22 studies with 2,185
patients
– single lung involvement in 25.8% (95% CI 15.6%-37.4%) in analysis of 12 studies with 600 patients
⚬ laboratory findings included
– lymphopenia in 56.5% (95% CI 46.5%-66.4%) in analysis of 24 studies with 2,507 patients

– leukopenia in 25.9% (95% CI 19.6%-32.7%) in analysis of 22 studies with 2,258 patients
– leukocytosis in 12.6% (95% CI 8.4%-17.4%) in analysis of 15 studies with 1,992 patients
– elevated C-reactive protein in 73.6% (95% CI 66.1%-80.4%) in analysis of 21 studies with 2,238
patients
– elevated erythrocyte sedimentation rate in 65.6% (95% CI 36.8%-89.3%) in analysis of 3 studies
with 195 patients
– decreased oxygenation index in 63.6% (95% CI 32.4%-89.5%) in analysis of 4 studies with 113
patients
– elevated D-dimer in 37.2% (95% CI 17.7%-59.1%) in analysis of 6 studies with 414 patients
– abnormal liver function in 29% (95% CI 17.5%-42.1%) in analysis of 10 studies with 549 patients
– abnormal renal function in 25.5% (95% CI 5.6%-53.5%) in analysis of 5 studies with 231 patients
– elevated procalcitonin in 17.5% (95% CI 7.8%-29.9%) in analysis of 9 studies with 1,701 patients
⚬ respiratory failure or acute respiratory distress syndrome (ARDS) in 19.5% (95% CI 5%-40.3%) in
analysis of 8 studies with 1,499 patients
⚬ mortality 5.5% (95% CI 2.3%-10%) in analysis of 8 studies with 1,765 patients
⚬ Reference - J Med Virol 2020 Oct;92(10):1902 full-text
⚬ fever, fatigue, and cough most common clinical features in adults with COVID-19 pneumonia
in China
– based on 3 cohort studies
– cohort admitted to Zhongnan Hospital in Wuhan, China, January 1-28, 2020
● 138 adults aged 22-92 years (median age 56 years, 54% men) with confirmed COVID-19
pneumonia consecutively admitted to Zhongnan Hospital in Wuhan, China, January 1-28, 2020,
were evaluated through February 3, 2020
⚬ 29% were medical staff, 12.3% were already hospitalized patients, and 8.7% had exposure
to Huanan seafood market
⚬ 46.4% had ≥ 1 comorbidity, most commonly hypertension (31.2%), cardiovascular disease
(14.5%), diabetes (10.1%), malignancy (7.2%), and cerebrovascular disease (5.1%)
● median duration from first symptoms to
⚬ dyspnea 5 days
⚬ hospital admission 7 days
⚬ ARDS 8 days
● clinical features included
⚬ fever in 98.6%
⚬ fatigue in 69.6%
⚬ dry cough in 59.4%
⚬ anorexia in 39.9%
⚬ myalgia in 34.8%
⚬ dyspnea in 31.2%
⚬ expectoration in 26.8%
⚬ pharyngalgia in 17.4%
⚬ diarrhea in 10.1%
⚬ nausea in 10.1%
⚬ dizziness in 9.4%
⚬ headache in 6.5%
⚬ vomiting in 3.6%
⚬ abdominal pain in 2.2%
● 100% had bilateral patchy shadows or ground-glass opacity in lungs on chest computed
tomography
● laboratory testing revealed
⚬ lymphopenia (lymphocyte count < 1.1 × 109 cells/L) in 70.3%

⚬ prolonged prothrombin time (> 12.5 seconds) in 58%
⚬ elevated lactate dehydrogenase (> 243 units/L) in 39.9%
● severity of illness median scores in 36 patients in intensive care unit
⚬ Acute Physiology and Chronic Health Evaluation II 12 points

⚬ Sequential Organ Failure Assessment 5 points
⚬ Glasgow Coma Scale 15 points
● complications included
⚬ ARDS in 19.6%
⚬ arrhythmia in 16.7%
⚬ shock in 8.7%
⚬ acute cardiac injury in 7.2%
⚬ acute kidney injury in 3.6%
● 12.3% required invasive ventilation (4 switched to extracorporeal membrane oxygenation)

● 1.4% required continuous renal replacement therapy
● 34.1% discharged from hospital (median hospital stay 10 days)
● 4.3% died
● Reference - JAMA 2020 Mar 17;323(11):1061 , editorial can be found in JAMA 2020 Mar
17;323(11):1039
– cohort admitted to Jinyintan Hospital in Wuhan, China, by January 2, 2020
● 41 patients (mean age 49 years, 73% male) with confirmed COVID-19 pneumonia admitted to
Jinyintan Hospital in Wuhan, China, by January 2, 2020, were evaluated
⚬ 66% had exposure to Huanan seafood market
⚬ 32% had ≥ 1 comorbidity, most commonly diabetes (20%), hypertension (15%), and/or
cardiovascular disease (15%)
⚬ median duration from first symptoms to hospital admission 7 days
⚬ fever in 98%
⚬ cough in 76%
⚬ dyspnea in 55%
⚬ myalgia or fatigue in 44%
⚬ sputum production in 28%
⚬ headache in 8%
⚬ hemoptysis in 5%
⚬ diarrhea in 3%
● bilateral multiple lobular and subsegmental areas of consolidation were common findings on
chest computed tomography
⚬ lymphopenia (lymphocyte count < 1 × 109 cells/L) in 63%

⚬ elevated aspartate aminotransferase levels in 37%
⚬ leukopenia (white blood cell count < 4 × 109 cells/L) in 25%
⚬ viremia in 15%
⚬ ARDS in 29%
⚬ acute cardiac injury in 12%
⚬ secondary infection in 10%
● 10% required invasive mechanical ventilation

● 15% died
● Reference - Lancet 2020 Feb 15;395(10223):497 full-text , correction can be found in
Lancet 2020 Feb 15;395(10223):496
– cohort admitted to Jinyintan Hospital in Wuhan, China, from January 1 to 20, 2020
● 99 adults aged 21-82 years (mean age 55 years, 68% men) with confirmed COVID-19
pneumonia admitted to Jinyintan Hospital in Wuhan, China, from January 1 to 20, 2020, were
evaluated up to January 25, 2020
⚬ 49% had exposure to Huanan seafood market
⚬ 51% had ≥ 1 comorbidity, most commonly cardiovascular and cerebrovascular disease
(40%), digestive system disease (11%), and endocrine system disease (13%)
⚬ fever in 83%
⚬ cough in 82%
⚬ dyspnea in 31%
⚬ muscle ache in 11%
⚬ confusion in 9%
⚬ headache in 8%
⚬ sore throat in 5%
⚬ rhinorrhea in 4%
⚬ chest pain in 2%
⚬ diarrhea in 2%
⚬ nausea and vomiting in 1%
● chest x-ray and computed tomography findings
⚬ bilateral pneumonia in 75%

⚬ multiple mottling and ground-glass opacity in 14%
⚬ pneumothorax in 1%
⚬ increased lactate dehydrogenase (> 250 units/L) in 76%

⚬ decreased hemoglobin (< 130 g/L) in 51%
⚬ neutrophilia (neutrophil count > 6.3 × 109 cells/L) in 38%
⚬ lymphopenia (lymphocyte count < 1.1 × 109 cells/L) in 35%
⚬ leukocytosis (white blood cell count > 9.5 × 109 cells/L) in 24%
⚬ thrombocytopenia (platelet count < 125 × 109 platelets/L) in 12%
⚬ leukopenia (white blood cell count < 3.5 × 109 cells/L) in 9%
⚬ thrombocytosis (platelet count > 350 × 109 platelets/L) in 4%
⚬ ARDS in 17%
⚬ ventilator-associated pneumonia in 11%
⚬ acute respiratory injury in 8%
⚬ septic shock in 4%
⚬ acute kidney injury in 3%
● 4% required invasive mechanical ventilation

● 3% required extracorporeal membrane oxygenation
● 9% required continuous renal replacement therapy
● 31% discharged from hospital
● 11% died
● Reference - Lancet 2020 Feb 15;395(10223):507 full-text
● El estudio de cohorte basado en la población que describe las características clínicas en 1564 pacientes
con COVID-19 confirmado por laboratorio en Islandia entre el 17 de marzo y el 30 de abril de 2020 se
puede encontrar en BMJ 2020 Dec 2;371:m4529 texto completo
RESUMEN
● DEL ESTUDIO
alrededor del 80% de los casos de COVID-19 pueden ser leves
ESTUDIO DE COHORTE : Zhonghua Liu Xing Bing Xue Za Zhi 2020 17 de febrero; 41 (2): 145
Detalles

⚬ 44,672 patients with confirmed COVID-19 with symptom onset between December 8, 2019 and
⚬ among 44,415 patients with sufficient data, severity of disease was
– mild (non-pneumonia and mild pneumonia) in 80.9%

– severe (dyspnea, respiratory rate ≥ 30/minute, blood oxygen saturation ≤ 93%, PaO2/FiO2 ratio <
300, and/or lung infiltrates > 50% within 48 hours) in 13.8%
– critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure) in 4.7%
⚬ Reference - Zhonghua Liu Xing Bing Xue Za Zhi 2020 Feb 17;41(2):145 [Chinese], also published in
China CDC Weekly 2020;2(8):113 [English]
● la edad puede afectar la gravedad de la enfermedad
RESUMEN
⚬ DEL ESTUDIO
la angustia en el pecho y la dificultad para respirar son más comunes en pacientes mayores con
COVID-19
ESTUDIO DE COHORTE : J Gerontol A Biol Sci Med Sci 2020 16 de septiembre; 75 (9): 1788
Detalles

– 203 adults (median age 54 years) with COVID-19 admitted to 1 hospital in Wuhan, China from
January 1, 2020 to February 10, 2020 were evaluated
– 55 patients were ≥ 65 years old
– comparing patients ≥ 65 years old vs. patients < 65 years old
● comorbidities in 67.3% vs. 34.5% (p < 0.01)

● median time from illness onset to hospital admission 7.1 days vs. 5.5 days (p = 0.05)
● disease severity at admission
⚬ stable in 12.7% vs. 60.1% (p < 0.01)

⚬ serious in 43.6% vs. 33.1% (not significant)
⚬ critical in 43.6% vs. 6.8% (p < 0.01)
● symptoms
⚬ chest distress in 63.6% vs. 25% (p < 0.01)

⚬ shortness of breath in 58.2% vs. 18.2% (p < 0.01)
⚬ anorexia in 9.1% vs. 0.7% (p = 0.01)
⚬ no significant differences in fever, dry cough, myalgia or arthralgia, fatigue, headache,
diarrhea, abdominal pain, nausea, vomiting, chest pain, dizziness, or dyspnea
● imaging findings
⚬ bilateral involvement in 98.2% vs. 79.7% (p < 0.01)

⚬ pleural effusion in 23.6% vs. 5.4% (p < 0.01)
⚬ 5-day disease progression in 36.4% vs. 18.9% (p = 0.01)
● laboratory findings
⚬ lymphopenia (lymphocyte count < 1 × 109/L) in 81.8% vs. 48.6% (p < 0.01)
⚬ leukocytosis (white blood cell count > 10 × 109/L) in 18.2% vs. 2.7% (p < 0.01)
⚬ abnormal blood biochemistry results more common in patients ≥ 65 years old
● median length of hospital stay 12 days vs. 10 days (not significant)

● mortality 34.5% vs. 4.7% (p < 0.001)
– Reference - J Gerontol A Biol Sci Med Sci 2020 Sep 16;75(9):1788
⚬ pacientes pediátricos
– Los síntomas más comunes en los niños son similares a los de otras infecciones respiratorias
virales.
● fiebre
● tos
● congestión nasal
● rinorrea
● dolor de garganta
– otros síntomas informados incluyen diarrea, vómitos, fatiga, dolor de cabeza, falta de apetito y
dificultad para respirar
– enfermedad respiratoria leve informada en aproximadamente la mitad de los niños con COVID-
19 confirmado o sospechado, y otro 30% informado tiene enfermedad respiratoria moderada
– síndrome inflamatorio multisistémico en niños (MIS-C), con características similares a otras
afecciones inflamatorias pediátricas, incluida la enfermedad de Kawasaki, notificada en una
pequeña cantidad de niños durante la pandemia de COVID-19; aunque es raro, los pacientes a
menudo requieren cuidados intensivos
– ver COVID-19 y pacientes pediátricos para más detalles
Historia de la enfermedad actual
● se han informado síntomas no respiratorios; pregunta por 2
⚬ síntomas gastrointestinales que incluyen náuseas y/o vómitos, diarrea, dolor abdominal y anorexia
⚬ síntomas neurológicos que incluyen dolor de cabeza, mareos, anosmia, ageusia o mialgia y síntomas
de deterioro grave como confusión o alteración de la conciencia
⚬ manifestaciones cutáneas
● manifestaciones gastrointestinales
RESUMEN
⚬ DEL ESTUDIO
prevalencia de síntomas gastrointestinales (GI) alrededor del 18% en pacientes con COVID-19
confirmado
REVISIÓN SISTEMÁTICA : Gastroenterología 2020 Jul;159(1):81 | Texto completo

Detalles

– systematic review of 69 observational studies with data on gastrointestinal symptoms and stool
viral load in patients with COVID-19
● 60 studies evaluated gastrointestinal symptoms in 4,243 children and adults (including
pregnant women) with COVID-19 in 6 countries (88% of studies in China)
– prevalence of gastrointestinal symptoms (including anorexia, nausea, vomiting, diarrhea, and

abdominal pain)
● 17.6% overall (95% CI 12.3%-24.5%) in analysis of 60 studies
⚬ 16.7% of patients (95% CI 11.4%-23.9%) in analysis of 53 studies in adults

⚬ 24.8% of patients (95% CI 9.6%-50.4%) in analysis of 4 studies in children
⚬ 20% of patients (95% CI 4.3%-58.2%) in analysis of 3 studies in pregnant women
– 48.1% of patients (95% CI 38.3%-57.9%) had stool and respiratory samples positive for SARS-CoV-2
RNA in analysis of 13 studies with 138 patients
– 70.3% of patients (95% CI 49.6%-85.1%) had positive stool test after negative respiratory test in
– in additional cohort of 59 patients with confirmed COVID-19 in Hong Kong during February 2-29,
2020
● 25.4% had gastrointestinal symptoms (22% had diarrhea)
● 15.3% had stool test positive SARS-CoV-2 RNA (38.5% in patients with diarrhea and 8.7% in
patients without diarrhea)
– Reference - Gastroenterology 2020 Jul;159(1):81 full-text
RESUMEN
⚬ DEL ESTUDIO
prevalencia internacional general de síntomas gastrointestinales < 10 %, pero se informó una
prevalencia más alta en países fuera de China en pacientes con COVID-19 confirmado por
laboratorio
REVISIÓN SISTEMÁTICA : Gastroenterología 2020 Jul;159(1):320 | Texto completo

Detalles

– systematic review of 57 observational studies with data on gastrointestinal symptoms in patients
with COVID-19
● 55 studies reported on hospitalized patients
● studies included mainly adults
● 70% of studies conducted in China (other countries included South Korea, Singapore, Japan
[cruise ship], Australia, United States, The Netherlands, Germany, Italy, Finland, Russia, Spain,
France, Sweden, and Belgium)
– 43 studies assessing 10,676 unique patients with confirmed COVID-19 were included in meta-
analysis
– overall prevalence of gastrointestinal symptoms < 10%
● diarrhea in 7.7% in analysis of 43 studies with 10,676 patients
⚬ 5.8% in patients in China

⚬ 18.3% in patients in countries other than China
● nausea or vomiting in 7.8% in analysis of 26 studies with 5,955 patients
⚬ 5.2 % in patients in China

● abdominal pain in 3.6% in analysis of 15 studies with 4,031 patients
⚬ 2.7% in patients in China

● elevated aspartate aminotransferase in 15% in analysis of 16 studies with 2,514 patients

● elevated alanine aminotransferase in 15% in analysis of 17 studies with 2,711 patients
● elevated total bilirubin in 16.7% in analysis of 10 studies with 1,841 patients in China
– Reference - Gastroenterology 2020 Jul;159(1):320 full-text
● manifestaciones neurológicas
RESUMEN
⚬ DEL ESTUDIO
Las manifestaciones neurológicas comunes informadas en niños y adultos hospitalizados con
COVID-19 confirmado por laboratorio incluyen alteración del gusto (21 %), mialgia (20 %),
alteración del olfato (19 %), dolor de cabeza (13 %), confusión aguda o delirio (11 %). ), y mareos
(7%)
REVISIÓN SISTEMÁTICA : Neurología 2021 11 de octubre temprano en línea

Detalles

– systematic review of 350 observational studies published between January 2020 and December
2020 evaluating neurologic manifestations in 145,721 patients with laboratory-confirmed COVID-
19
– 89% of patients hospitalized
– pooled prevalence of common neurologic manifestations
● in overall analysis (all results limited by significant heterogeneity)
⚬ fatigue in 32% (95% CI 30%-35%) in analysis of 169 studies with 45,766 patients
⚬ taste impairment in 21% (95% CI 15%-29%) in analysis of 38 studies with 12,631 patients
⚬ myalgia in 20% (95% CI 18%-23%) in analysis of 207 studies with 59,821 patients
⚬ smell impairment in 19% (95% CI 13%-25%) in analysis of 51 studies with 30,925 patients
⚬ headache in 13% (95% CI 12%-15%) in analysis of 202 studies with 51,969 patients
⚬ acute confusion or delirium in 11% (95% CI 7%-16%) in analysis of 19 studies with 23,921
patients
⚬ disturbance of consciousness in 7% (95% CI 5%-10%) in analysis of 25 studies with 15,129
patients
⚬ dizziness in 7% (95% CI 5%-8%) in analysis of 46 studies with 13,473 patients
● in analysis of hospitalized adults ≥ 60 years old (all results limited by significant heterogeneity)
⚬ acute confusion or delirium in 34% (95% CI 23%-46%) in analysis of 5 studies with 1,454
patients
⚬ fatigue in 20% (95% CI 11%-31%) in analysis of 9 studies with 2,186 patients
⚬ myalgia in 11% (95% CI 7%-15%) in analysis of 10 studies with 2,642 patients
⚬ headache in 5% (95% CI 2%-8%) in analysis of 10 studies with 2,398 patients
⚬ dizziness in 5% (95% CI 2%-9%) in analysis of 3 studies with 1,211 patients
● in analysis of hospitalized children and adolescents < 18 years old
⚬ headache in 10% (95% CI 5%-15%) in analysis of 13 studies with 1,615 patients, results
limited by significant heterogeneity
⚬ fatigue in 9% (95% CI 3%-18%) in analysis of 9 studies with 1,431 patients, results limited by
⚬ myalgia in 7% (95% CI 2%-15%) in analysis of 5 studies with 1,422 patients, results limited by
⚬ seizure in 4% (95% CI 2%-6%) in analysis of 2 studies with 694 patients
⚬ smell impairment in 3% (95% CI 1%-5%) in analysis of 5 studies with 346 patients
– pooled prevalence of neurologic diagnoses (all results limited by significant heterogeneity)
● neuropsychiatric disorder in 24% (95% CI 2%-61%) in analysis of 3 studies with 1,293 patients
● encephalopathy in 7% (95% CI 1%-17%) in analysis of 4 studies with 5,668 patients
● skeletal muscle injury in 5% (95% CI 1%-12%) in analysis of 4 studies with 1,545 patients
● stroke in 2% (95% CI 1%-2%) in analysis of 29 studies with 43,024 patients
⚬ ischemic stroke or transient ischemic attack in 1% (95% CI 1%-2%) in analysis of 29 studies

with 43,024 patients
⚬ hemorrhagic stroke in 0.31% (95% CI 0.15%-0.5%) in analysis of 21 studies with 36,972
patients
⚬ cerebral venous thrombosis in 0.12% (95% CI 0%-2%) in analysis of 2 studies with 14,573
patients
– compared to patients with mild-to-moderate COVID-19, patients with severe-to-critical COVID-19
● more likely to have
⚬ disturbance of consciousness (odds ratio [OR] 5.68, 95% CI 2.08-15.5) in analysis of 4 studies
with 1,102 patients
⚬ skeletal muscle injury or damage (OR 3.29, 95% CI 2.15-5.04) in analysis of 2 studies with
1,055 patients
⚬ fatigue (OR 1.27, 95% CI 1.06-1.51) in analysis of 33 studies with 7,326 patients
● less likely to have
⚬ smell impairment (OR 0.44, 95% CI 0.28-0.68) in analysis of 8 studies with 2,025 patients
⚬ taste impairment (OR 0.62, 95% CI 0.42-0.91) in analysis of 5 studies with 1,838 patients
– in patients ≥ 60 years old, ≥ 1 neurologic manifestation associated with increased mortality (OR
1.8, 95% CI 1.11-2.91)
– Reference - Neurology 2021 Oct 11 early online
RESUMEN
⚬ DEL ESTUDIO
prevalencia de disfunción olfativa informada en el 48% de los adultos con COVID-19
REVISIÓN SISTEMÁTICA : Laringoscopio 2021 Abr;131(4):865

Detalles
– based on systematic review

– systematic review of 83 observational studies (76 cross-sectional studies and 7 case-control
studies) evaluating prevalence of olfactory dysfunction in 27,492 adults with COVID-19
● mean age ranged from 28 to 70 years, 61% women, 97.5% had polymerase chain reaction
(PCR)-confirmed COVID-19
● studies conducted in 27 countries including Spain, Germany, Italy, France, Ireland, Belgium,
Romania, Switzerland, the United Kingdom, the Netherlands, Poland, Israel, China, Saudi
Arabia, Turkey, Iraq, Iran, Pakistan, Singapore, Korea, Uruguay, Argentina, Bolivia, Venezuela,
Australia, Canada, and the United States
– olfactory dysfunction overall 47.8% (95% CI 41.2% -54.5%) in analysis of all studies, results limited
by significant heterogeneity
● 54.4% (95% CI 46.2%-62.6%) in Europe in analysis of 49 studies with 20,738 patients, results
limited by significant heterogeneity
● 51.1% (95% CI 41.1%-61.1%) in North America in analysis of 7 studies with 1,148 patients,
results limited by significant heterogeneity
● 31.4% (95% CI 18.3%-44.5%) in Asia in analysis of 22 studies with 3,477 patients, results limited
by significant heterogeneity
● 10.7% (95% CI 0%-22.2%) in Australia in 1 study with 28 patients
– anosmia 35.4% (95% CI 27.7%-43%) in analysis of 43 studies with 10,979 patients

– hyposmia 36.1% (95% CI 27.6%-44.6%) in analysis of 24 studies with 5,200 patients
– dysosmia 2.5% (95% CI 0%-6%) in 1 study with 79 patients
– Reference - Laryngoscope 2021 Apr;131(4):865 full text
RESUMEN
⚬ DEL ESTUDIO
la anosmia parece altamente específica para COVID-19 en adultos que se presentan en el
departamento de emergencias Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Ann Emerg Med 2020 Oct;76(4):405 | Texto completo
Detalles
– based on diagnostic cohort study with test under investigation not applied to all patients
– 391 adults (median age 62 years) presenting to emergency department with suspected COVID-19
at 1 center in France from March 9 to April 4, 2020 were assessed
● emergency physicians rated clinical probability of COVID-19 as low, medium, or high based on
history and physical exam
● 84 patients (22.3%) had lung ultrasound
● 129 patients (33%) had chest x-ray
● reference standard for COVID-19 was RT-PCR
– anosmia was added to history assessment on March 24, 2020; overall rates of anosmia may have
been underestimated
– COVID-19 diagnosed in 57.6% by RT-PCR
– all patients included in analysis
– for diagnosis of COVID-19
● anosmia had
⚬ sensitivity 14%
⚬ specificity 98%
⚬ positive predictive value 91%
⚬ negative predictive value 46%
● emergency physician rating of high clinical probability had
⚬ sensitivity 74%
⚬ specificity 78%
– Reference - Ann Emerg Med 2020 Oct;76(4):405 full-text
⚬ la hiposmia subjetiva, la hipogeusia subjetiva, la distermia y la tos se asociaron significativamente

con una prueba positiva de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR)
para el SARS-CoV-2 en un estudio de casos y controles con 355 adultos ( Laryngoscope 2020
Nov;130(11) :2674 texto completo )
⚬ la discusión sobre la disfunción olfativa en pacientes con COVID-19 se puede encontrar en Open
Forum Infect Dis 2020 Jun;7(6):ofaa199 full-text
Historia médica pasada
● preguntar acerca de las condiciones subyacentes que pueden predisponer a una enfermedad grave
⚬ Las condiciones subyacentes asociadas con un mayor riesgo de enfermedad grave incluyen (en
orden alfabético)
– cáncer
– enfermedad renal cronica
– enfermedad cronica del higado
– enfermedades pulmonares crónicas, incluyendo
● asma (moderada a grave)

● bronquiectasias
● displasia broncopulmonar
● Enfermedad Pulmonar Obstructiva Crónica (EPOC)
● fibrosis quística
● enfermedad pulmonar intersticial
● embolia pulmonar
● hipertensión pulmonar
– demencia u otras condiciones neurológicas

– diabetes (tipo 1 o tipo 2)
– afecciones cardíacas, como insuficiencia cardíaca, enfermedad de las arterias coronarias,
cardiomiopatías o hipertensión
– infección por VIH
– inmunocompromiso
– condiciones de salud mental
– 2
sobrepeso y obesidad (índice de masa corporal ≥ 25 kg/m )
– el embarazo
– enfermedad de células falciformes o talasemia
– trasplante de órganos sólidos o células madre sanguíneas
– accidente cerebrovascular o enfermedad cerebrovascular
– trastorno por consumo de sustancias
– tuberculosis
⚬ las personas con algunos tipos de discapacidades pueden tener más probabilidades de desarrollar
COVID-19 grave debido a la comorbilidad, las desigualdades sociales o de salud, o vivir en entornos
congregados, incluidos
– cualquier tipo de discapacidad que dificulte realizar ciertas actividades, incluidas aquellas que
necesitan ayuda con el cuidado personal o las actividades diarias
– trastorno por déficit de atención/hiperactividad (TDAH)
– defecto de nacimiento
– parálisis cerebral
– Síndrome de Down
– discapacidad intelectual y del desarrollo
– discapacidad de aprendizaje
– lesión de la médula espinal
⚬ Las condiciones subyacentes que podrían estar asociadas con un mayor riesgo de enfermedad grave
en los niños incluyen
– asma y otras enfermedades pulmonares crónicas
– diabetes
– cardiopatía congénita
– desordenes genéticos
– complejidad medica
– desordenes metabólicos
– trastornos neurológicos
– obesidad
– anemia drepanocítica
⚬ Referencia: información de los Centros para el Control y la Prevención de Enfermedades sobre la

COVID-19 para grupos específicos de personas ( CDC 25 de marzo de 2022 )
RESUMEN
● DEL ESTUDIO
hipertensión, obesidad y diabetes reportadas como las comorbilidades más comunes en pacientes
hospitalizados con COVID-19 en Nueva York, Estados Unidos
ESTUDIO DE COHORTE : JAMA 2020 26 de mayo; 323 (20): 2052

Detalles
⚬ based on cohort study with noncomparative data

⚬ 5,700 patients (median age 63 years, 60% men) with COVID-19 admitted to 12 hospitals in New York
from March 1, 2020 to April 4, 2020 were assessed
⚬ comorbidities included
– hypertension in 57%
– obesity (body mass index ≥ 30 kg/m2) in 42%
– diabetes in 34%
– coronary artery disease in 11%
– asthma in 9%
– heart failure in 6.9%
– cancer in 6%
– chronic obstructive pulmonary disease in 5.4%
– chronic kidney disease in 5%
⚬ at triage or admission
– fever in 31%
– oxygen saturation < 90% in 20%
– respiratory rate > 24 breaths/minute in 17%
– corrected QT interval > 500 milliseconds in 6.1%
– respiratory viral panel positive for non-COVID-19 respiratory virus in 2.1%
⚬ supplemental oxygen given to 28% at triage

⚬ Reference - JAMA 2020 May 26;323(20):2052
Historia social
● pregunte sobre la exposición potencial a personas con COVID-19 confirmado o sospechado 1
● Pregunte sobre el tabaquismo, el trastorno por uso de sustancias y la inactividad física que pueden
estar asociados con un mayor riesgo de enfermedad grave ( CDC 2022 Mar 25 )
Físico
General
● buscar fiebre 1
Piel
● buscar manifestaciones cutáneas 2
● patrones clínicos de manifestaciones cutáneas asociadas con COVID-19 informados en una revisión
sistemática de estudios observacionales (en su mayoría informes de casos)
⚬ Se han observado erupciones inflamatorias/exantemáticas típicas de infecciones virales y/o lesiones
vasculopáticas/vasculíticas que pueden deberse a la oclusión de pequeños vasos sanguíneos.
⚬ las lesiones y erupciones de un patrón inflamatorio/exantematoso pueden incluir cualquiera de los
siguientes patrones
– erupciones de urticaria
– erupciones confluentes eritematosas/maculopapulares/morbiliformes
– exantemas papulovesiculares
⚬ las lesiones de un patrón vasculopático/vasculítico pueden incluir cualquiera de los siguientes

patrones
– lesiones acrales similares a sabañones
– patrón livedo reticularis/racemosa
– patrón vasculítico purpúrico
⚬ Referencia - Br J Dermatol 2020 Sep;183(3):431 texto completo
Imagen 2 de 5
COVID-19
Erupción en la mano asociada con la infección por COVID-19.
Imagen cortesía de DermNet NZ.
Imagen 3 de 5
COVID-19
Erupción a pie asociada con la infección por COVID-19.
Imagen 4 de 5
Hallazgos cutáneos de COVID-19
Erupción eritematosa en los dedos de los pies bilateralmente.
RESUMEN
● DEL ESTUDIO
manifestaciones cutáneas de erupción eritematosa, urticaria o vesículas notificadas en
aproximadamente el 20 % de los pacientes hospitalizados con COVID-19 en Italia
COHORT STUDY: J Eur Acad Dermatol Venereol 2020 May;34(5):e212

Details

⚬ 88 patients hospitalized with COVID-19 in the Lecco Hospital, Lombardy, Italy were evaluated for skin
manifestations by dermatologists (patients with new drug exposure within 15 days prior to
hospitalization were excluded)
⚬ 18 patients (20.4%) had cutaneous manifestations (8 patients had skin symptoms at onset of illness
and 10 patients developed skin symptoms during hospitalization)
– erythematous rash in 14 patients (16%)
– widespread urticaria in 3 patients
– chickenpox-like vesicles in 1 patient
⚬ most skin symptoms were found on the trunk and associated with minimal pruritus
⚬ Reference - J Eur Acad Dermatol Venereol 2020 May;34(5):e212
STUDY
● SUMMARY
maculopapular lesions most common skin manifestation in patients with COVID-19 in Spain
COHORT STUDY: Br J Dermatol 2020 Jul;183(1):71 | Full Text

Details

⚬ 375 patients with suspected or confirmed COVID-19 and cutaneous lesions within previous 2 weeks
in Spain were evaluated
⚬ common cutaneous manifestations included
– maculopapules in 47%
– acral areas of erythema-edema with vesicles or pustules (pseudo-chilblain) in 19%
– urticarial lesions in 19%
– vesicular eruptions in 9%
– livedo or necrosis in 6%
⚬ other manifestations such an enanthem or purpuric flexural lesions less commonly reported
⚬ Reference - Br J Dermatol 2020 Jul;183(1):71 full-text
STUDY
● SUMMARY
varicella-like exanthem, characterized by papulovesicular lesions of the trunk, reported in patients
with COVID-19
COHORT STUDY: J Am Acad Dermatol 2020 Jul;83(1):280 | Full Text

Details

⚬ 22 patients with COVID-19 and a papulovesicular exanthem who were evaluated in Dermatology
Units in Italy were reviewed
⚬ patients with history of any new medication in ≤ 15 days prior to rash were excluded
⚬ clinical characteristics of rash
– lesion onset at mean of 3 days after systemic symptoms (range of onset from 2 days prior to 12
after systemic symptoms)
– scattered or diffuse papulovesicular lesions on the trunk in 22 patients (100%)
– scattered or diffuse papulovesicular lesions on extremities in 4 patients (18%)
– no facial or mucosal involvement
– associated pruritus (generally mild) in 9 patients (41%)
– median duration of rash of 8 days (range 4-15 days)
⚬ systemic symptoms included fever in 96%, cough in 73%, headache in 50%, weakness in 50%, coryza
in 46%, dyspnea in 41%, hyposmia in 18%, hypogeusia in 18%, pharyngodynia in 5%, and diarrhea in
5%
⚬ mortality 14%
⚬ Reference - J Am Acad Dermatol 2020 Jul;83(1):280 full-text
● acro-ischemia, characterized by cyanosis of the fingers and/or toe, skin bulla and dry gangrene reported
in 7 patients hospitalized with critical COVID-19 in Wuhan, China from Feb 4 to Feb 15, 2020 (Zhonghua
Xue Ye Xue Za Zhi 2020 Mar 28;41(0):E006 )
STUDY
● SUMMARY
no hay evidencia de laboratorio de infección por SARS-CoV-2 en niños y adultos que presentan
lesiones de sabañones durante la pandemia de COVID-19
ESTUDIO DE COHORTE : JAMA Dermatol 2020 Sep 1;156(9):998 | Texto completo

Detalles

⚬ 31 children and adults aged 6-72 years presenting with purplish red chilblain lesions on toes (29
patients) and/or fingers (3 patients) at Belgian hospital between April 10 and April 17, 2020 were
assessed
⚬ lesions were erythematous or purplish erythematous macules that in some cases included central
vesicular or bullous lesions or lesions with necrotic areas
⚬ reported symptoms included pain, burning and/or itching
⚬ history of chilblains in 29% and Raynaud syndrome in 13%
⚬ diagnosis of chilblains confirmed by histopathology in 22 patients with skin biopsy
⚬ minimal evidence for SARS-CoV-2 infection
– SARS-CoV-2 not detected by RT-PCR of nasopharyngeal swabs in any patient or from any skin
lesion in 22 patients with biopsy
– negative antibody titers (IgM and IgG) for SARS-CoV-2 in all patients
– 64% reported possible symptoms of COVID-19 including diarrhea, dyspnea, fever, and sore throat
– 10% reported close contact with person with possible or confirmed COVID-19
⚬ Reference - JAMA Dermatol 2020 Sep 1;156(9):998 full-text
● la revisión de las manifestaciones cutáneas específicas de la infección por SARS-CoV-2 confirmada por
laboratorio en 11 546 personas que autoinformaron síntomas utilizando la aplicación COVID Symptom
Study entre el 7 de mayo y el 22 de junio de 2020 en el Reino Unido se puede encontrar en Br J
Dermatol 2021 mayo; 184(5):880 texto completo ; El catálogo de imágenes de las manifestaciones
cutáneas más comunes recopiladas por la Asociación Británica de Dermatólogos se puede encontrar en
Patrones de piel COVID-19
Diagnóstico
A quién probar
● Definiciones de caso de la Organización Mundial de la Salud (OMS) para la vigilancia de la salud pública
⚬ caso sospechoso
– paciente con enfermedad respiratoria aguda grave (fiebre, tos, inicio dentro de los 10 días y que
requiere hospitalización), O
– individuo asintomático con prueba de antígeno SARS-CoV-2 positiva, O
– paciente que cumple criterios clínicos o epidemiológicos
● criterios clínicos ya sea
⚬ inicio agudo de fiebre y tos O

⚬ ≥ 3 de
– fiebre
– tos
– debilidad general o fatiga
– dolor de cabeza
– mialgia
– dolor de garganta
– rinitis
– disnea
– anorexia, náuseas o diarrea
● Los criterios epidemiológicos incluyen
⚬ contacto con un caso probable o confirmado, O

⚬ vinculado a un grupo de COVID-19
– grupo de individuos sintomáticos vinculados por tiempo, ubicación y exposición común

con ≥ 1 caso confirmado mediante prueba de amplificación de ácido nucleico (NAAT), O
– ≥ 2 casos sintomáticos vinculados epidemiológicamente con prueba de antígeno
positiva
⚬ caso probable si alguno de
– paciente que cumple criterios clínicos y es contacto de un caso probable o confirmado o

epidemiológicamente vinculado a un conglomerado
– muerte no explicada de otro modo en un adulto con dificultad respiratoria anterior a la muerte y
que es un contacto de un caso probable o confirmado o está epidemiológicamente relacionado
con un grupo
⚬ caso confirmado cualquiera de
– prueba de amplificación de ácido nucleico SARS-CoV-2 positiva

– paciente que cumple criterios clínicos o epidemiológicos con prueba de antígeno positiva
⚬ Referencia - Definición de caso de COVID-19 de la OMS 2022 22 de julio
● Directrices de la Sociedad de Enfermedades Infecciosas de América (IDSA) sobre el diagnóstico de

COVID-19
⚬ Se recomiendan pruebas de ácido nucleico de SARS-CoV-2 para personas sintomáticas en la
comunidad que se sospecha que tienen COVID-19, incluso cuando la sospecha clínica es baja (
Recomendación fuerte de IDSA, evidencia de certeza muy baja )
⚬ in asymptomatic individuals
– SARS-CoV-2 nucleic acid testing recommended for asymptomatic persons
● with immunocompromise admitted to hospital regardless of exposure (IDSA Strong

recommendation, Very low certainty of evidence)
● prior to hematopoietic stem cell or solid organ transplantation regardless of exposure (IDSA
Strong recommendation, Very low certainty of evidence)
– SARS-CoV-2 nucleic acid testing suggested for asymptomatic persons
● known or suspected to have been exposed to SARS-CoV-2 (IDSA Conditional recommendation,

Very low certainty of evidence)
● with no history of contact with COVID-19 hospitalized in areas with high prevalence of COVID-
19 in the community (IDSA Conditional recommendation, Very low certainty of evidence)
● without known exposure who are undergoing
⚬ major time-sensitive surgery (IDSA Conditional recommendation, Very low certainty of

evidence)
⚬ time-sensitive aerosol-generating procedure such as bronchoscopy when personal
protective equipment (PPE) is limited and testing is available (IDSA Conditional
– SARS-CoV-2 nucleic acid testing suggested against for asymptomatic individuals
● with no known contact who are hospitalized in areas with low prevalence of COVID-19 in the
community (IDSA Conditional recommendation, Very low certainty of evidence)
● without known exposure to COVID-19 who are undergoing a time-sensitive aerosol-generating
procedure such as bronchoscopy when PPE is available (IDSA Conditional recommendation,
Very low certainty of evidence)
– no recommendation for or against SARS-CoV-2 nucleic acid testing for asymptomatic individuals
with cancer or autoimmune disease prior to initiating immunosuppressive therapy (IDSA
Knowledge gap)
⚬ Reference - IDSA guideline on diagnosis of COVID-19: Molecular diagnostic testing (IDSA 2020 Dec 23
)
● fully vaccinated persons (≥ 2 weeks after receiving second dose in a 2-dose series or single dose
vaccine) should get tested if experiencing COVID-19 symptoms (CDC Interim Public Health
Recommendations for Fully Vaccinated People 2021 Sep 1 )
STUDY
● SUMMARY
most signs and symptoms may have insufficient sensitivity to screen persons for further testing, but
anosmia and ageusia may each help diagnose COVID-19 DynaMed Level 2
COCHRANE REVIEW: Cochrane Database Syst Rev 2022 May 20;5:CD013665 | Full Text
Details
⚬ based on Cochrane review limited by clinical heterogeneity and selection bias

⚬ systematic review of 90 diagnostic studies evaluating diagnostic accuracy of signs and symptoms for
diagnosing COVID-19 in persons receiving testing in primary care or hospital settings
⚬ 42 prospective diagnostic studies with 52,608 persons were included in meta-analysis
– settings included emergency departments or outpatient test centers (35 studies), primary care (3
studies), pediatric hospital outpatients or inpatients (2 studies), and nursing homes (2 studies)
– prevalence of COVID-19 ranged from 3.7% to 60.6% (median 27.4%)
⚬ reference standard was polymerase chain reaction (PCR) test in 40 studies

⚬ criteria determining who was allowed testing varied across studies and inclusion of persons based
on prespecified symptoms, such as fever or cough, may lead to selection bias
Table 3. Pooled Performance of Signs and Symptoms for Diagnosis of COVID-19
Symptom Sensitivity Specificity Number of

Studies and
Patients
Cough 62% (95% CI 45% (95% CI 11 studies with

51%-73%) 34%-58%) 18,702 patients
Fever 38% (95% CI 75% (95% CI 12 studies with

23%-54%) 56%-88%) 28,495
Anosmia or 39% (95% CI 92% (95% CI 6 studies with

ageusia 27%-54%) 85%-96%) 6,142 patients
Fatigue 40% (95% CI 74% (95% CI 8 studies with

19%-65%) 48%-89%) 7,967 patients
Anosmia 26% (95% CI 94% (95% CI 7 studies with

14%-45%) 91%-97%) 9,456 patients
Symptom Sensitivity Specificity Number of
Studies and
Patients
Myalgia 38% (95% CI 75% (95% CI 6 studies with

21%-58%) 58%-87%) 2,684 patients
Ageusia 23% (95% CI 93% (95% CI 5 studies with

11%-43%) 83%-97%) 8,644 patients
Dyspnea 23% (95% CI 76% (95% CI 12 studies with

16%-32%) 65%-84%) 19,545 patients
Headache 36% (95% CI 73% (95% CI 7 studies with

17%-60%) 53%-86%) 10,899 patients
Sore throat 31% (95% CI 62% (95% CI 10 studies with

20%-45%) 47%-75%) 14,548 patients
Diarrhea 19% (95% CI 84% (95% CI 11 studies with

16%-22%) 79%-88%) 13,669 patients
Chills or shivers 25% (95% CI 85% (95% CI 5 studies with

15%-39%) 72%-93%) 14,472 patients
⚬ combination of different signs and symptoms were evaluated in 24 studies (29 combinations), of
which 3 studies included prediction rules
– Clinical Symptom-Based Scoring System (CSBSS) based on body temperature, cough, headache,
myalgia, and anosmia with cutoff of 41.7 points had sensitivity 65% and specificity 62% in 1 study
with 378 persons
– SARS-CoV-2 Risk Prediction Score (SCRiPS) based on gender, healthcare worker status, recent
contact with COVID-19 case, recent travel, local case detection rate, presence of rhinorrhea,
cough, or dyspnea, and combination of age and presence of fever using 0.5 times recent local
case detection rate had sensitivity 90% and specificity 31% in 1 study with 9,172 persons
– prediction rule based on combined age (> 56.5 years) with presence of chest pain, sore throat, dry
cough, or fever, with lowest cutoff point having sensitivity 67% and specificity 66% in 1 study with
2,152 persons
⚬ meta-analysis was not performed for subgroup of children or older adults due to limited number of
studies for each age group
⚬ Reference - Cochrane Database Syst Rev 2022 May 20;5:CD013665 full-text
STUDY
● SUMMARY
presence of symptoms appears to have low specificity for predicting positive COVID-19 test in
healthcare workers DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Acad Emerg Med 2020 Jun;27(6):469
Details
⚬ based on diagnostic cohort study without independent validation

⚬ 961 healthcare workers were assessed for symptoms of COVID-19 and had real-time PCR (RT-PCR) of
sample from nasopharyngeal or oropharyngeal swab (reference standard)
⚬ symptoms assessed included fever, shortness of breath, dry cough, and loss of taste or smell
⚬ 23% had COVID-19 by RT-PCR
⚬ for prediction of positive COVID-19 test
– presence of ≥ 1 of fever, shortness of breath, dry cough, or loss of taste or smell had
● sensitivity 98%
● specificity 8%
● positive predictive value 24%
● negative predictive value 92%
– presence of fever or loss of taste or smell had
● sensitivity 89%
● specificity 48%
⚬ Reference - Acad Emerg Med 2020 Jun;27(6):469
STUDY
● SUMMARY
el modelo de regresión logística que utiliza exposición conocida a COVID-19, temperatura elevada,
recuento reducido de glóbulos blancos y resultado positivo de radiografía de tórax puede tener una
alta sensibilidad y una especificidad moderada para predecir los resultados de la prueba PCR de
COVID-19 Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Acad Emerg Med 2020 28 de noviembre temprano en línea
| Texto completo
Detalles

⚬ 1,026 adults (mean age 52 years, 56% women) presenting to emergency department between March
and April 2020 were tested for COVID-19 with PCR of sample from nasopharyngeal swab (reference
standard)
– 770 patients were included in derivation cohort and 256 patients were included in internal
validation cohort
– 66% had respiratory symptoms and 36% had fever
⚬ 9.6% had COVID-19 by PCR

⚬ logistic regression model was derived using 4 factors associated with SARS-CoV-2 PCR testing results
– exposure history
– temperature
– white blood cell count
– chest X-ray results
⚬ performance of logistic regression model for predicting PCR test result in internal validation cohort
– sensitivity 97%
– specificity 69%
– positive predictive value 29%
– negative predictive value 99%
⚬ similar performance of 2 additional models developed (random forest model and gradient-boosted
decision tree model)
⚬ Reference - Acad Emerg Med 2020 Nov 28 early online full-text
Recolección de muestras y pruebas para SARS-CoV-2

Recomendaciones de Organizaciones Profesionales
Directrices de la Organización Mundial de la Salud (OMS)
● Directrices provisionales de la OMS sobre las pruebas de diagnóstico de la COVID-19
⚬ recogida y envío de muestras
– garantizar prácticas de bioseguridad adecuadas para la recolección y las pruebas

– como mínimo, se debe recolectar material respiratorio
● especímenes respiratorios superiores
⚬ adecuado para probar infecciones en etapa temprana, especialmente en casos

asintomáticos o leves
⚬ combined nasopharyngeal and oropharyngeal swabs increase sensitivity
⚬ individual nasopharyngeal swabs may be more reliable than oropharyngeal swabs
● lower respiratory specimens
⚬ recommended if collected later in disease course or in patients with negative upper

respiratory sample with strong clinical suspicion for infection
⚬ specimens include sputum (if spontaneously produced) and/or endotracheal aspirate or
bronchoalveolar lavage in patients with more severe disease
⚬ induced sputum not recommended
– stool specimens may be considered for nucleic acid amplification testing (NAAT) in patients with
negative respiratory samples and clinical suspicion of COVID-19
– post-mortem swab, needle biopsy, or tissue specimens may be considered for pathologic and
microbiologic testing
– Se pueden recolectar muestras de suero pareadas con 2 a 4 semanas de diferencia para
pacientes con NAAT negativo y sospecha fuerte de infección por SARS-CoV-2
– las muestras deben llegar al laboratorio lo antes posible
– la comunicación con el laboratorio fomenta el procesamiento y la notificación adecuados y
oportunos
⚬ prueba para SARS-CoV-2
– NAAT para SARS-CoV-2 actualmente prueba de elección
● NAAT positivo único confirma el diagnóstico

● ≥ 1 NAAT negativa no descarta infección por SARS-CoV-2
⚬ en pacientes con NAAT negativa, volver a muestrear y repetir NAAT

⚬ en pacientes con múltiples NAAT negativos, considere la recolección de suero en serie para
la prueba de anticuerpos en la fase aguda y 2-4 semanas después
● la combinación de muestras de varias personas puede aumentar la capacidad de diagnóstico

cuando la tasa de análisis no satisface la demanda
– pruebas rápidas de detección de antígeno SARS-CoV-2 en desarrollo
● en general, menos sensible que la NAAT, pero se informó una alta especificidad
● cuando sea aceptable, se puede considerar para reducir el número de NAAT y apoyar la
identificación rápida
– ensayos serológicos
● no debe utilizarse como prueba de diagnóstico independiente para casos agudos en la

atención clínica o para el rastreo de contactos
● Se puede considerar la recolección de suero en serie para la prueba de anticuerpos en la fase
aguda y 2-4 semanas después en pacientes con NAAT negativos pero sospecha clínica de
COVID-19
● puede usarse en estudios de vigilancia serológica
– la secuenciación del genoma completo puede contribuir a los estudios de epidemiología

molecular
– no se recomienda el cultivo viral como procedimiento diagnóstico
⚬ los laboratorios deben cumplir con los requisitos nacionales de información

⚬ Referencia: orientación provisional de la OMS para las pruebas de diagnóstico del SARS-CoV-2 ( OMS,
11 de septiembre de 2020 )
● Directrices provisionales de la OMS para la detección de antígenos mediante inmunoensayos rápidos
⚬ las pruebas detectan proteínas virales en muestras de las vías respiratorias superiores o en saliva
⚬ variable de sensibilidad y rendimiento afectado por el entorno y las poblaciones analizadas, aunque
se informó una especificidad alta
⚬ recomendaciones generales de uso
– requisito mínimo de rendimiento ≥ 80 % de sensibilidad y ≥ 97 % de especificidad

– considerar la prueba rápida de antígenos para
● individuos sintomáticos dentro de los 5 a 7 días del inicio de los síntomas

● personas asintomáticas con exposición conocida o probable o con alto riesgo de exposición,
como trabajadores de la salud (pero no recomendado para otras personas asintomáticas)
● en apoyo de las investigaciones de brotes, incluso en entornos remotos, instituciones y
comunidades semicerradas y especialmente donde NAAT no está disponible de inmediato
– se puede considerar repetir la prueba de antígeno o NAAT en pacientes sintomáticos con alta
sospecha clínica
– results of rapid antigen testing will be most reliable in areas with ongoing community
transmission (≥ 5% test positivity rate)
⚬ Reference - WHO interim guidance for antigen-detection in the diagnosis of SARS-CoV-2 infection
(WHO 2021 Oct 6 )
United States Guidelines
● Centers for Disease Control and Prevention (CDC) interim guidance for collecting and handling of
clinical specimens for COVID-19 testing
⚬ sample collection
– collect samples as soon as possible regardless of time since symptom onset

– maintain proper infection control and use personal protective equipment (PPE) during collection
⚬ specimen types for initial diagnostic testing for COVID-19
– acceptable upper respiratory specimens include
● nasopharyngeal swab collected by a healthcare professional

● oropharyngeal swab collected by healthcare professional
● nasal mid-turbinate (NMT) swab collected by healthcare professional or by patient after
reviewing and following collection instructions
● anterior nares specimen collected by healthcare professional or by patient after reviewing and
following collection instructions
● nasopharyngeal wash/aspirate or nasal wash/aspirate specimen collected by healthcare
professional
● saliva specimen collected by patient with or without supervision
● breath collected by a qualified and trained operator under supervision of healthcare provider
licensed or authorized to prescribe tests
– lower respiratory specimens can also be tested, if available, including
● sputum from patients with productive cough (sputum induction is not recommended)
● bronchoalveolar lavage, tracheal aspirate, pleural fluid, or lung biopsy, generally performed by
physician in hospital setting
⚬ storage
– store specimens at 2-8 degrees C (35.6-46.4 degrees F) for up to 72 hours

– store at ≤ -70 degrees C (-94 degrees F) if a delay in testing or shipping is expected
⚬ Reference - CDC Interim guidelines for collecting and handling of clinical specimens for COVID-19
testing (CDC 2022 Jul 15 )
● Infectious Disease Society of America (IDSA) guideline on diagnosis of COVID-19
⚬ specimens for SARS-CoV-2 nucleic acid testing
– for symptomatic individuals with upper respiratory tract infection or influenza-like illness
suspected of having COVID-19
● nasopharyngeal swab, mid-turbinate swab, anterior nasal swab, saliva, or combined anterior
nasal/oropharyngeal swab preferred over oropharyngeal swab alone (IDSA Conditional
● anterior nasal and mid-turbinate swab specimens may be collected by healthcare providers or
patients (IDSA Conditional recommendation, Low certainty of evidence)
– for hospitalized patients with suspected COVID-19 lower respiratory tract infection (IDSA
Conditional recommendation, Very low certainty of evidence)
● upper respiratory tract sample is preferred over lower respiratory tract sample
● if initial upper respiratory tract sample is negative and suspicion remains high, lower
respiratory tract sample preferred over another upper respiratory tract sample
⚬ test for diagnosis
– SARS-CoV-2 nucleic acid amplification test (NAAT) recommended for diagnosis of COVID-19
– rapid reverse transcriptase polymerase chain reaction (RT-PCR) or standard laboratory-based
NAATs recommended over rapid isothermal NAAT in symptomatic individuals with suspected
COVID-19 (IDSA Conditional recommendation, Low certainty of evidence)
⚬ repeat testing
– single viral nucleic acid test preferred over repeat testing in symptomatic individuals with low
clinical suspicion of COVID-19 (IDSA Conditional recommendation, Low certainty of evidence)
– repeat testing may be considered for patients with negative first test with intermediate or high
clinical suspicion of COVID-19 (IDSA Conditional recommendation, Low certainty of evidence)
⚬ Referencia - Pauta IDSA sobre el diagnóstico de COVID-19: Pruebas de diagnóstico molecular ( IDSA
2020 23 de diciembre )
● Directrices de los Institutos Nacionales de Salud (NIH) sobre el tratamiento de las recomendaciones de
COVID-19 para el diagnóstico de laboratorio
⚬ la prueba de amplificación de ácido nucleico (NAAT, por sus siglas en inglés) con una muestra
recolectada del tracto respiratorio superior (muestra nasofaríngea, del cornete medio nasal, nasal
anterior u orofaríngea) debe usarse para diagnosticar la COVID-19 aguda; se pueden usar pruebas
de antígeno si NAAT no es práctico o no está disponible ( NIH Grado AIII )
⚬ para adultos intubados y ventilados mecánicamente con sospecha de COVID-19
– Se recomienda obtener muestras de las vías respiratorias inferiores si la muestra inicial de las
vías respiratorias superiores es negativa ( NIH Grade BII )
– al obtener muestras de las vías respiratorias inferiores, se recomiendan aspirados
endotraqueales en lugar de muestras de lavado bronquial o lavado broncoalveolar ( NIH Grado
BII )
⚬ en personas asintomáticas con infección previa por SARS-CoV-2, NAAT no debe usarse dentro de los
90 días posteriores a la infección previa, excepto en trabajadores de la salud ( NIH Grado AIII )
⚬ Se puede considerar NAAT para personas recuperadas de una infección previa por SARS-CoV-2 que
presentan síntomas compatibles en ausencia de un diagnóstico alternativo ( NIH Grado BIII )
⚬ No se recomiendan las pruebas serológicas solas para diagnosticar la infección aguda por SARS-CoV-
2 ( NIH Grado AIII )
⚬ evidencia insuficiente para recomendar a favor o en contra de las pruebas serológicas para
determinar el estado inmunitario o guiar las decisiones sobre la vacunación o el uso de anticuerpos
monoclonales
⚬ Referencia - Pauta de tratamiento NIH COVID-19 ( NIH 2022 Mar 24 )
● Recomendaciones de la Campaña Sobrevivir a la Sepsis de la Sociedad de Medicina de Cuidados

Críticos (SCCM) para la recolección de muestras en adultos intubados y ventilados mecánicamente con
sospecha de COVID-19
⚬ Se prefiere la muestra de las vías respiratorias inferiores a la muestra de las vías respiratorias
superiores para las pruebas de diagnóstico ( recomendación débil de SCCM )
⚬ Se prefiere el aspirado endotraqueal a las muestras de lavado bronquial o lavado broncoalveolar (
recomendación débil SCCM )
⚬ Referencia: Directrices de la campaña SCCM Surviving Sepsis Campaign sobre el manejo de adultos
con enfermedad por coronavirus 2019 (COVID-19) en la UCI: Primera actualización ( Crit Care Med 28
de enero de 2021 )
Coleccion de muestra
● método de recolección de muestras de hisopos nasofaríngeos y orofaríngeos para la prueba de COVID-

19
⚬ para la recogida de hisopos nasofaríngeos
– eleve la punta de la nariz para reducir el riesgo de contaminación del vestíbulo nasal
– permita que el hisopo fluya sobre el piso de la cavidad nasal paralelo al paladar duro para llegar a
la nasofaringe
– Deje la punta en su lugar durante unos segundos, luego gírela para lograr la mayor absorción de
las secreciones nasofaríngeas y luego retírela.
⚬ para la recolección de hisopos orofaríngeos, aplique una suave depresión anterior de la lengua para
evitar la contaminación del hisopo de la cavidad oral y recolectar secreciones de la pared faríngea
posterior
⚬ Se puede encontrar un video que muestra los métodos de recolección de hisopos nasofaríngeos y
orofaríngeos y la autorecolección de saliva profunda como suplemento al texto completo del
artículo.
⚬ Referencia - Head Neck 2020 Jul;42(7):1552 texto completo
● La FDA recomienda a los proveedores de atención médica que brinden instrucciones paso a paso
claras, visuales y verbales, para la autoevaluación del SARS-CoV-2 a través de la recolección de muestras
de las narinas anteriores (nasales) en entornos de atención médica para evitar muestras inadecuadas
⚬ la recolección inadecuada de muestras puede resultar en una prueba falsa negativa
⚬ instrucciones escritas, animadas o electrónicas deben incluir la siguiente información
– coloque toda la punta del hisopo dentro de la nariz y frótela con una presión moderada contra la
mayor parte posible de la pared de la región nasal anterior usando un movimiento circular
dentro de la nariz
– realice ≥ 4 círculos de barrido (10-15 segundos por fosa nasal) en cada fosa nasal con el mismo
hisopo
– no gire el hisopo contra una parte de la nariz o solo coloque el hisopo en la nariz durante 10-15
segundos sin girar, ya que esto puede resultar en una muestra insuficiente
⚬ Referencia - Carta de la FDA a los proveedores de atención médica 7 de octubre de 2020
● Alerta De Medicamento/Dispositivo • Actualizado El 23 De Noviembre De 2022
La FDA revisa la EUA del antígeno COVID-19 para incluir recomendaciones de repetición de pruebas en
personas que inicialmente dan negativo
⚬ los datos disponibles muestran que repetir la prueba después de una prueba negativa de antígeno
de COVID-19 aumenta la probabilidad de obtener un resultado preciso tanto en personas con o sin
síntomas de COVID-19, lo que puede ayudar a prevenir la transmisión del SARS-CoV-2
⚬ repetir las recomendaciones de prueba
– en personas con síntomas de COVID-19, se debe repetir la prueba ≥ 2 veces durante 3 días con ≥
48 horas entre pruebas
– en personas sin síntomas de COVID-19, se debe repetir la prueba ≥ 3 veces durante ≥ 5 días con ≥
48 horas entre pruebas
⚬ Referencias: Comunicado de prensa de la FDA del 1 de noviembre de 2022 , Comunicado de

seguridad de la FDA del 11 de agosto de 2022
● Puede encontrar información detallada sobre las autorizaciones de uso de emergencia de la FDA de los
Estados Unidos para productos de diagnóstico de autodiagnóstico para COVID-19 en FDA 2021
RESUMEN
● DEL ESTUDIO
los hisopos nasales y faríngeos combinados pueden tener una mayor sensibilidad en comparación
con los hisopos faríngeos para detectar la infección por SARS-CoV-2 mediante RT-PCR en pacientes
ambulatorios Nivel DynaMed 2
REVISIÓN SISTEMÁTICA : Lancet Infect Dis 2021 12 de abril temprano en línea | Texto completo
Detalles
⚬ based on systematic review of diagnostic cohort studies limited by clinical heterogeneity

⚬ systematic review of 23 diagnostic cohort studies evaluating different sample collection methods for
detecting SARS-CoV-2 infection by RT-PCR in 7,973 outpatients
– specimens evaluated included nasal swabs (1,662 samples), saliva (6,110 samples), throat swabs
(338 samples), and pooled nasal and throat swabs (719 samples)
– reference standard was nasopharyngeal swab collected by healthcare workers (7,973 swabs)
⚬ prevalence of SARS-CoV-2 infection ranged from 4.3% to 84.1% across studies

⚬ studies varied in disease prevalence, study location, symptom status of patients, and number of
candidate genes tested
⚬ 3 studies evaluated pooled nasal and throat swabs, and 2 studies evaluated throat swabs
⚬ for detection of SARS-CoV-2 infection by RT-PCR
– pooled performance of pooled nasal and throat swabs in analysis of 3 studies
● sensitivity 97% (95% CI 93%-100%)

● specificity 99% (95% CI 98%‐100%)
– pooled performance of throat swabs in analysis of 2 studies
● sensitivity 68% (95% CI 35%-94%)

● specificity 97% (95% CI 95%‐99%)
⚬ pooled nasal and throat swabs associated with higher sensitivity compared to throat swabs for
detecting SARS-CoV-2 infection by RT-PCR (p = 0.017)
⚬ Reference - Lancet Infect Dis 2021 Apr 12 early online full-text
RESUMEN
● DEL ESTUDIO
las muestras de saliva y nasales tienen una alta sensibilidad y especificidad para la detección de la
infección por SARS-CoV-2 mediante RT-PCR Nivel DynaMed 2
REVISIÓN SISTEMÁTICA : Lancet Infect Dis 2021 12 de abril temprano en línea | Texto completo
Detalles
⚬ based on systematic review of diagnostic cohort studies limited by heterogeneity

⚬ systematic review of 23 diagnostic cohort studies evaluating different sample collection methods for
detecting SARS-CoV-2 infection by RT-PCR in 7,973 outpatients
– specimens evaluated included nasal swabs (1,662 samples), saliva (6,110 samples), throat swabs
(338 samples), and pooled nasal and throat swabs (719 samples)
– reference standard was nasopharyngeal swab collected by healthcare workers (7,973 swabs)
⚬ prevalence of SARS-CoV-2 infection ranged from 4.3% to 84.1% across studies

⚬ studies varied in disease prevalence, study location, symptom status of patients, and number of
candidate genes tested
⚬ 13 studies evaluated self-collected saliva samples, and 7 studies evaluated nasal swabs
⚬ for detection of SARS-CoV-2 infection by RT-PCR
– pooled performance of saliva samples in analysis of 13 studies
● sensitivity 85% (95% CI 75%-93%)

● specificity 99% (95% CI 98%‐99%)
– pooled performance of nasal swabs in analysis of 7 studies
● sensitivity 86% (95% CI 77%-93%)

● specificity 99% (95% CI 96%‐100%)
– all results limited by significant heterogeneity
⚬ Reference - Lancet Infect Dis 2021 Apr 12 early online full-text
RESUMEN
● DEL ESTUDIO
Las pruebas de saliva y frotis nasofaríngeo pueden tener una sensibilidad similar para detectar el
SARS-CoV-2 Nivel DynaMed 2
REVISIÓN SISTEMÁTICA : Ann Intern Med 2021 12 de enero temprano en línea | Texto completo
Detalles
⚬ based on systematic review of diagnostic studies without independent reference standard

⚬ systematic review of 35 cohort studies and 2 case-control studies comparing saliva vs.
nasopharyngeal swab samples for detecting SARS-CoV-2 in 7,169 adults and children (7,332 paired
samples)
⚬ most common methods for detecting SARS-CoV-2 were laboratory-based RT-PCR (34 studies) and
point-of-care RT-PCR (2 studies)
⚬ prevalence of SARS-CoV-2 infection was 32% by reference standard (positive test result using either
saliva or nasopharyngeal swab)
⚬ 23 studies enrolled only adults, 1 study enrolled adults and children, and 13 studies enrolled persons
of mixed or unspecified age
⚬ pooled sensitivity of saliva samples for detecting SARS-CoV-2 was 86.9% (95% CI 82.3%-90.4%) in
analysis of all studies, results limited by significant heterogeneity
⚬ no significant difference in sensitivity for detecting SARS-CoV-2 comparing saliva samples to
nasopharyngeal swabs (all results limited by significant heterogeneity)
– overall (difference -3.4%, 95% CI -9.9% to 3.1%) in analysis of all studies
– in persons without confirmed SARS-CoV-2 infection (difference -7.9%, 95% CI -16.7% to 0.8%) in
analysis of 22 studies with 5,599 paired samples
– in persons with previously confirmed SARS-CoV-2 infection (difference 1.5%, 95% CI -7.3% to
10.3%) in analysis of 17 studies with 1,158 paired samples
– in adults (difference 3.1%, 95% CI -5.1% to 11.3%) in analysis of 24 studies with 3,843 paired
samples
– in symptomatic persons (difference -4.9%, 95% CI -10.2% to 0.4%) in analysis of 24 studies with
3,605 paired samples
– in asymptomatic persons (difference -1.6%, 95% CI -37.4% to 34.1%) in analysis of 8 studies with
800 paired samples
⚬ Reference - Ann Intern Med 2021 Jan 12 early online full-text
RESUMEN
● DEL ESTUDIO
Las pruebas de amplificación de ácido nucleico (NAAT, por sus siglas en inglés) en saliva y frotis
nasofaríngeo parecen tener una sensibilidad y especificidad similares para detectar el SARS-CoV-2
Nivel DynaMed 2
REVISIÓN SISTEMÁTICA : JAMA Intern Med 2021 Jan 15 temprano en línea

Detalles
⚬ based on systematic review of diagnostic studies without independent reference standard

⚬ systematic review of 16 diagnostic cohort studies evaluating saliva and nasopharyngeal swab NAAT
for detecting SARS-CoV-2 in 5,922 persons
⚬ studies varied in setting, patient population, and timing of testing
– 10 studies enrolled persons in ambulatory setting (drive-through clinics, screening campaigns), 1

study enrolled patients and healthcare workers, and 1 study enrolled hospitalized patients
– 7 studies enrolled symptomatic persons or persons with known exposure to contact case
– few studies obtained paired samples on first day of presentation
⚬ reference standard was positive test result using nasopharyngeal swab, combination of
nasopharyngeal and oropharyngeal or oral swabs, or saliva sample
⚬ prevalence of SARS-CoV-2 infection was 16% by reference standard
⚬ for detecting SARS-CoV-2
– saliva NAAT had
● pooled sensitivity 83.2% (95% credible interval [CrI] 74.7%-91.4%) in analysis of all studies
● pooled specificity 99.2% (95% CrI 98.2%-99.8%) in analysis of all studies
– nasopharyngeal swab NAAT had
● pooled sensitivity 84.8% (95% CrI 76.8%-92.4%) in analysis of all studies

● pooled specificity 98.9% (95% CrI 97.4%-99.8%) in analysis of all studies
⚬ Reference - JAMA Intern Med 2021 Jan 15 early online
RESUMEN
● DEL ESTUDIO
Las muestras de hisopos nasofaríngeos y faríngeos para RT-PCR en tiempo real pueden tener una
mayor sensibilidad para la infección por SARS-CoV-2 que las muestras de saliva y de cornete medio
Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Open Forum Infect Dis 2020 Sep;7(9):ofaa335 | Texto
completo
Detalles
⚬ based on cohort study without independent reference standard and with selection bias
⚬ convenience sample of 105 patients (median age 44 years, 54% male) admitted to hospital with
suspected or confirmed COVID-19 in Singapore had simultaneous samples from multiple sites
collected for real-time RT-PCR test for SARS-CoV-2 infection
– samples included unilateral nasopharyngeal, mid-turbinate, throat swabs, and saliva
– real-time RT-PCR repeated each day in patients with initial positive test
– standard bilateral nasopharyngeal swab also performed in patients with suspected COVID-19 and
repeated after 24 hours if initial testing was negative
– patients discharged after 2 negative real-time RT-PCR tests 24 hours apart
⚬ median duration from specimen collection to onset of COVID-19 symptoms was 7 days
⚬ SARS-CoV-2 infection defined as at least 1 positive test from any specimen site during initial testing
or follow-up (all positive tests were considered true positives, so specificity cannot be estimated)
⚬ 69.5% had SARS-CoV-2 infection
⚬ sensitivity of real-time RT-PCR for detection of SARS-CoV-2 infection
– 84.9% (95% CI 74%-92%) for unilateral nasopharyngeal samples

– 79.5% (95% CI 68%-88%) for throat samples
– 61.6% (95% CI 49%-73%) for unilateral mid-turbinate samples
– 37.5% (95% CI 27%-50%) for saliva samples
⚬ for all sample types, detection rates were higher in samples collected within 7 days of symptom
onset compared to later collection
⚬ Reference - Open Forum Infect Dis 2020 Sep;7(9):ofaa335 full-text
Pruebas moleculares
● Administración Federal de Drogas de los Estados Unidos (FDA)
⚬ Puede encontrar información detallada sobre las autorizaciones de uso de emergencia de la

Administración Federal de Medicamentos (FDA) de los Estados Unidos para productos de
diagnóstico in vitro para COVID-19 en FDA 2021
⚬ La actualización de la política sobre el desarrollo y la autorización de pruebas para COVID-19 se
puede encontrar en el comunicado de prensa de la FDA del 16 de marzo de 2020
⚬ Mutaciones virales del SARS-CoV-2 y su impacto en las pruebas de COVID-19
– posibilidad de resultados falsos negativos con cualquier prueba molecular que detecte el SARS-
CoV-2 si se produce una mutación en la parte del genoma del virus evaluada por esa prueba
– los cambios en el genoma viral pueden provocar cambios en las proteínas virales, lo que puede
afectar el rendimiento de una prueba de antígeno o serología
– todos los proveedores de atención médica que usan pruebas de SARS-CoV-2 deben tener en
cuenta lo siguiente
● las variantes genéticas del SARS-CoV-2 son comunes y pueden dar como resultado pruebas
negativas falsas
● las pruebas moleculares que utilizan múltiples objetivos genéticos para obtener resultados
tienen menos probabilidades de verse afectadas por variantes genéticas
● los resultados negativos deben considerarse junto con las observaciones clínicas, el historial
del paciente y la información epidemiológica
● si se sospecha de COVID-19 a pesar de una prueba negativa, puede considerar repetir la
prueba con diferentes pruebas aprobadas por la FDA o autorizadas para uso de emergencia
con diferentes objetivos genéticos
– Referencia - Declaración de la FDA 2021 3 de junio
RESUMEN
● DEL ESTUDIO
Se informó que las tasas de falsos negativos asociadas con las pruebas de RT-PCR en tiempo real son
del 100 % en el día 1, del 67 % en el día 4 y del 20 % en el día 8 después de la exposición en pacientes
con infección por SARS-CoV-2 Nivel DynaMed 3
ESTUDIO DE MODELADO : Ann Intern Med 2020 13 de mayo temprano en línea | Texto completo
Detalles
⚬ based on modeling study

⚬ statistical model based on systematic review of 7 diagnostic studies evaluating real-test RT-PCR
performance by time since symptom onset or exposure in 1,330 nasal or throat swab samples from
inpatients and outpatients with SARS-CoV-2 infection
– analysis included patients with confirmed infection (≥ 1 positive real-test RT-PCR) and probable
infection (121 patients positive for IgM or IgG SARS-CoV-2 antibodies and 22 patients based only
on clinical criteria) from studies
– most studies tested samples at time of symptom onset
⚬ model assumptions included 5-day incubation period and 100% specificity of real-test RT-PCR test
⚬ median estimated false-negative rates for real-test RT-PCR tests conducted on different days since
exposure
– 100% for 1 day
– 67% for 4 days
– 38% for 5 days (symptom onset)
– 20% for 8 days
– 21% for 9 days
– 66% for 21 days
⚬ Reference - Ann Intern Med 2020 May 13 early online full-text
RESUMEN
● DEL ESTUDIO
la conversión de resultados de RT-PCR negativos a positivos para la infección por SARS-CoV-2
parece muy rara en pacientes hospitalizados y ambulatorios en áreas de baja prevalencia
ESTUDIO DE COHORTE : Open Forum Infect Dis 2020 Sep;7(9):ofaa388 | Texto completo
Detalles

⚬ 660 adult and pediatric inpatients and outpatients (12% patients < 18 years old, 64% outpatients) in
Dane County, Wisconsin had repeat RT-PCR testing for SARS-CoV-2 infection from March 2020 to May
2020
– RT-PCR tests were performed on nasopharyngeal samples
– tested patients included both patients suspected of having COVID-19 and asymptomatic patients
having procedures who were at risk of exposure to oral or respiratory secretions
⚬ SARS-CoV-2 prevalence in Dane County 4-6 per 100,000 persons

⚬ average number of repeat RT-PCR test was 1.2 per patient
⚬ overall RT-PCR testing results
– 638 patients (96.7%) had negative result on initial test
● 6 patients (0.9%) converted to positive on repeat test at 5-17 days after initial test
● all 6 patients with positive test were outpatients, no conversions to positive test in inpatients
– 22 patients (3.3%) had positive result on initial test, and 12 patients (1.8%) converted to negative
on repeat test at 7-43 days (median of 20 days) after initial test
RESUMEN
● DEL ESTUDIO
Las pruebas rápidas de base molecular en el punto de atención pueden tener una alta sensibilidad y
especificidad para la detección de la infección por SARS-CoV-2 Nivel DynaMed 2
REVISIÓN SISTEMÁTICA : Cochrane Database Syst Rev 2021 Mar 24;3:CD013705

Detalles
⚬ based on Cochrane review of studies with tests under investigation not representative of how it
would be conducted in clinical practice
⚬ systematic review of 78 diagnostic cohort and case-control studies evaluating rapid point-of-care
tests for SARS-CoV-2 infection
⚬ point of care defined as decentralized testing performed by minimally trained healthcare provider
near patient and outside central laboratory testing
⚬ 77 studies evaluated 24,418 respiratory tract samples
– 29 studies evaluated 5 commercial rapid molecular tests using automated RT-PCR or isothermal
PCR (32 evaluations)
– 48 studies evaluated 16 commercial antigen tests using colloidal gold immunoassay, fluorescent
immunoassay, or lateral flow assay (58 evaluations)
⚬ tests were not assessed in standard point-of-care settings
– 21% of studies performed by trained laboratory staff and 40% of studies likely conducted in
centralized laboratory setting
– residual or remnant samples used in some studies
– 50% of studies were enriched for positive samples
– results were based on per-sample analyses; number of patients and patient demographics not
reported
⚬ reference standard was laboratory-confirmed RT-PCR for SARS-CoV-2 infection

⚬ pooled diagnostic performance of molecular tests for detection of SARS-CoV-2 infection in per-
sample analyses
– overall, in analysis of 26 studies (29 evaluations) with 4,351 samples
● sensitivity 95% (95% CI 90.5%-98%)

● specificity 99% (95% CI 98%-99%)
– for Abbott ID NOW test in analysis of 4 evaluations with 812 samples
● sensitivity 73% (95% CI 67%-78%)

● specificity 99.7% (95% CI 98.7%-99.9%)
● assuming prevalence of SARS-CoV-2 infection of 10%, positive predictive value 96% and
negative predictive value 97%
– for Cepheid Xpert Xpress test in analysis of 2 evaluations with 100 samples
● sensitivity 100% (95% CI 88%-100%)

● specificity 97% (95% CI 89%-99%)
● assuming prevalence of SARS-CoV-2 infection of 10%, positive predictive value 80% and
negative predictive value 100%
⚬ Reference - Cochrane Database Syst Rev 2021 Mar 24;3:CD013705
● diagnostic performance of specific tests
⚬ FDA issues alert about early data suggesting potentially inaccurate results from Abbott ID NOW
point-of-care test to diagnose COVID-19
– FDA's concerns based on 15 adverse event reports suggesting some users are receiving false-
negative results in addition to some studies that have identified inaccuracies, which may be due
to the types of swabs used or the type of viral transport media used
– Abbott to conduct further post-marketing studies while FDA continues ongoing review of data
– although most positive cases of COVID-19 are likely to be correctly identified, negative results
may need to be confirmed with high-sensitivity authorized molecular test
– Reference - FDA press release 2020 May 14
STUDY
⚬ SUMMARY
SARS-CoV-2 Nucleic Acid Diagnostic Kit (Sansure) may have moderate sensitivity and high
specificity to detect SARS-CoV-2 in saliva samples in analysis using respiratory samples as
reference standard in symptomatic patients with history of potential exposure to SARS-CoV-2
DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Clin Microbiol Infect 2020 May 15 early online | Full Text
Details
– based on diagnostic cohort study without independent validation and wide confidence interval for
sensitivity
– 200 adults (median age 36 years, 65% women) presenting to acute respiratory infection clinic in
Thailand between March 27 and April 4, 2020, were assessed for SARS-CoV-2 using saliva and
nasopharyngeal or oropharyngeal swab samples
● all patients had fever or acute respiratory symptoms and had traveled from COVID-19 endemic
area ≤ 14 days previously or had contact with confirmed or suspected case of COVID-19
● saliva samples were collected first while patient was void of coughing, and respiratory samples
collected with Copan FLOQSwabs (COPAN)
● all samples stored in Copan’s Universal Transport Medium 95 (COPAN)
● all samples analyzed by SARS-CoV-2 Nucleic Acid Diagnostic Kit (Sansure)
– positive detection defined as ≤ 38 cycles for both target genes (retesting performed in samples
with discordance, and samples that remained discordant considered negative)
– 9.5% had COVID-19 by nasopharyngeal or oropharyngeal swab sample (reference)
– 100% included in analysis
– for detection of SARS-CoV-2 at cutoff ≤ 38 cycles for both target genes, saliva samples had
● sensitivity 84.2% (95% CI 60.4%-96.6%)

● specificity 98.9% (95% CI 96.1%-99.9%)
● positive predictive value 88.9% (95% CI 65.3%-98.6%)
● negative predictive value 98.4% (95% CI 95.3%-99.7%)
– Reference - Clin Microbiol Infect 2020 May 15 early online full-text
⚬ diagnostic cohort study evaluating sensitivity and specificity of single-tube reverse transcription
recombinase-aided amplification assay for rapid detection (30 minutes) of SARS-CoV-2 RNA can be
found in Clin Microbiol Infect 2020 May 15 early online full text
● pooling samples
⚬ El estudio de cohortes que evalúa la combinación de muestras nasofaríngeas para las pruebas de
ARN del SARS-CoV-2 se puede encontrar en Clin Microbiol Infect 2020 Sep 9 temprano en línea
⚬ El estudio de cohortes que evalúa las estrategias para combinar la extracción de ARN y la RT-PCR
para la detección de SARS-CoV-2 para aumentar el rendimiento se puede encontrar en Clin Microbiol
Infect 2020 Jun 23 texto completo en línea temprano
Pruebas de antígeno
● recomendaciones
⚬ Directrices provisionales de la OMS para la detección de antígenos mediante inmunoensayos

rápidos
– las pruebas detectan proteínas virales en muestras de las vías respiratorias superiores o en saliva
– variable de sensibilidad y rendimiento afectado por el entorno y las poblaciones analizadas,
aunque se informó una especificidad alta
– recomendaciones generales de uso
● requisito mínimo de rendimiento ≥ 80 % de sensibilidad y ≥ 97 % de especificidad

● considerar la prueba rápida de antígenos para
⚬ individuos sintomáticos dentro de los 5 a 7 días del inicio de los síntomas

⚬ personas asintomáticas con exposición conocida o probable o con alto riesgo de
exposición, como trabajadores de la salud (pero no recomendado para otras personas
asintomáticas)
⚬ en apoyo de las investigaciones de brotes, incluso en entornos remotos, instituciones y
comunidades semicerradas y especialmente donde NAAT no está disponible de inmediato
● se puede considerar repetir la prueba de antígeno o NAAT en pacientes sintomáticos con alta
sospecha clínica
● los resultados de la prueba rápida de antígeno serán más confiables en áreas con transmisión
comunitaria en curso (tasa de positividad de la prueba ≥ 5 %)
– Referencia: orientación provisional de la OMS para la detección de antígenos en el diagnóstico de

la infección por SARS-CoV-2 ( OMS, 6 de octubre de 2021 )
⚬ Guía provisional de los Centros para el Control y la Prevención de Enfermedades (CDC) para la
prueba de antígeno para SARS-CoV-2
– Las pruebas de antígenos son inmunoensayos que detectan antígenos de proteínas virales en
muestras nasales, nasofaríngeas y de saliva.
– la prueba de antígeno es relativamente económica y se puede usar en el hogar o en el punto de
atención con resultados en aproximadamente 15 a 30 minutos
– generalmente, menos sensible que la prueba de amplificación de ácido nucleico (NAAT)
– la Administración de Drogas y Alimentos de los Estados Unidos (FDA, por sus siglas en inglés)
autorizó el uso de varias pruebas de antígenos para el SARS-CoV-2 bajo autorización de uso de
emergencia
– la implementación de pruebas de antígenos en serie (detección) puede ser útil en entornos
congregados para identificar y aislar a las personas con infección por SARS-CoV-2 y prevenir una
mayor transmisión
– uso de pruebas de antígenos en entornos comunitarios
● en pacientes sintomáticos
⚬ la prueba de antígeno positiva probablemente indica infección por SARS-CoV-2
– el paciente debe seguir los requisitos de aislamiento

– Por lo general, no se requiere NAAT confirmatoria, pero se puede considerar para
pacientes con baja probabilidad previa a la prueba (como personas que residen en un
área donde el nivel comunitario es bajo y sin exposición conocida o sospechada)
⚬ la prueba de antígeno negativa generalmente debe ser confirmada por NAAT lo antes
posible (dentro de las 48 horas) o la prueba de antígeno en serie cada 2-3 días mientras
esté sintomático
– las pruebas de confirmación pueden no ser necesarias para pacientes con baja
probabilidad previa a la prueba
– los pacientes con prueba de antígeno negativa seguida de prueba de confirmación
positiva deben seguir los requisitos de aislamiento
– las personas con una prueba de antígeno negativa seguida de una prueba de
confirmación negativa deben ser consideradas para un diagnóstico alternativo y
aquellas con exposición conocida deben seguir los requisitos de cuarentena
● en personas asintomáticas
⚬ la prueba de antígeno positiva probablemente indica infección por SARS-CoV-2 y el

paciente debe aislarse (se puede considerar la NAAT confirmatoria para personas con baja
probabilidad previa a la prueba)
⚬ la prueba de antígeno negativa indica que no hay evidencia de infección actual
– Se puede considerar NAAT confirmatoria para personas con alta probabilidad previa a la
prueba (por ejemplo, personas con exposición a COVID-19)
– las personas con exposición conocida y prueba de antígeno negativa deben seguir los
requisitos de cuarentena
– Referencia: Guía provisional de los CDC para la prueba de antígenos para el SARS-CoV-2 ( CDC 4
de marzo de 2022 )
⚬ Directrices de la Sociedad de Enfermedades Infecciosas de América (IDSA) sobre el diagnóstico de

COVID-19
– NAAT preferible a la prueba rápida de antígenos para personas sintomáticas con sospecha de
COVID-19 ( Recomendación condicional de IDSA, evidencia de certeza muy baja )
– para personas asintomáticas con riesgo de exposición al SARS-CoV-2
● Se prefiere NAAT simple a la prueba de antígeno rápido simple ( recomendación condicional

de IDSA, certeza moderada de la evidencia )
● Se prefiere una NAAT única a dos pruebas rápidas de antígenos consecutivas ( recomendación
condicional de IDSA, certeza moderada de la evidencia )
● ninguna recomendación a favor o en contra de la prueba rápida de antígeno único frente a
ninguna prueba ( brecha de evidencia de IDSA )
● ninguna recomendación a favor o en contra de repetir la prueba rápida de antígeno frente a
ninguna prueba ( brecha de evidencia de IDSA )
– Referencia - Pauta IDSA sobre el diagnóstico de COVID-19: prueba de antígeno ( IDSA 2021 27 de
mayo )
● Evidencia • Actualizado El 7 De Septiembre De 2022
RESUMEN DEL ESTUDIO

las pruebas rápidas de antígenos en el punto de atención pueden tener una alta especificidad pero
una baja sensibilidad para la detección de la infección por SARS-CoV-2 Nivel DynaMed 2
REVISIÓN COCHRANE : Cochrane Database Syst Rev 2022 Jul 22;7:CD013705 | Texto completo
Detalles
⚬ based on Cochrane review of studies with samples collected by personnel; tests conducted in
manner not expected to be representative of clinical practice
⚬ systematic review of 155 diagnostic cohort and case-control studies (reported in 166 articles)
evaluating rapid point-of-care antigen tests for SARS-CoV-2 infection
⚬ point-of-care testing defined as decentralized testing performed by minimally trained healthcare
provider and outside central laboratory testing with test results available within 2 hours of sample
collection
⚬ among 210 test evaluations from 152 studies used in main analyses
– 49 commercial assays were assessed (74% of evaluations were of colloidal gold-based

immunoassays, 14.3% were of lateral flow assays, and 9.5% were of fluorescent immunoassays)
– 51% of studies conducted at COVID-19 test center, emergency department, or urgent care center,
13.8% in other hospital setting, and 3.9% in school or university setting
– sample collection by laboratory scientist (31%), healthcare worker (24%), trained personnel or
nonhealthcare worker (4%), and not specified (37%)
– reference standard was RT-PCR for SARS-CoV-2 in all but 2 studies
⚬ 16.7% of 100,462 unique samples were positive for SARS-CoV-2 by reference standard
⚬ pooled diagnostic performance of antigen tests for detection of SARS-CoV-2 infection in per-sample
analyses
– overall, in analysis of 184 evaluations of 117,372 samples
● sensitivity 69% (95% CI 66%-72%)

● specificity 99.3% (95% CI 99.2%-99.3%)
– for symptomatic patients, in analysis of 109 evaluations with 50,574 samples
● sensitivity 73% (95% CI 69%-76%)

● specificity 99% (95% CI 99%-99.2%)
– for asymptomatic patients, in analysis of 50 evaluations with 40,956 samples
● sensitivity 55% (95% CI 48%-62%)

● specificity 99.5% (95% CI 99.4%-99.6%)
– in analysis based on time from symptom onset
● sensitivity 82% (95% CI 79%-85%) in analysis of 72 evaluations with 18,555 samples collected
during first week after symptom onset
● sensitivity 54% (95% CI 48%-60%) in analysis of 40 evaluations with 1,798 samples collected
during second week of symptoms
⚬ in analyses with > 1,000 samples, commercial tests with sensitivity ≥ 70% in patients with symptoms
included
– 85% (95% CI 62%-95%) for AAZ - COVID-VIRO in analysis of 3 evaluations with 1,204 samples
(prevalence 44%)
– 84% (95% CI 66%-94%) for Denka Co - QuickNavi COVID-19 Ag in analysis of 2 evaluations with
1,633 samples (prevalence 7.5%)
– 84% (95% CI 72%-92%) for Shenzhen Bioeasy Biotech - 2019- nCoV Ag in analysis of 4 evaluations
with 1,093 samples (prevalence 18.5%)
– 81% (95% CI 68%-90%) for Abbott - BinaxNOW COVID-19 Ag card in analysis of 4 evaluations with
2,108 samples (17.7%)
– 80% (95% CI 72%-86%) for Quidel - SOFIA SARS Antigen FIA in analysis of 4 evaluations with 1,064
samples (prevalence 16.5%)
– 79% (95% CI 72%-84%) for SD Biosensor/Roche - Standard Q COVID-Ag in analysis of 28
evaluations with 10,798 samples (prevalence 24.6%)
– 78% (95% CI 64%-88%) for Becton Dickinson - BD Veritor in analysis of 7 evaluations with 2,655
samples (prevalence 12%)
– 75% (95% CI 68%-81%) for Abbott - Panbio COVID-19 Ag in analysis of 24 evaluations with 14,509
samples (prevalence 21.8%)
– 74% (95% CI 62%-84%) for SD Biosensor - Standard F COVID-19 Ag in analysis of 4 evaluations with
– 71% (95% CI 58%-81%) for Innova Medical Group - SARS-CoV-2 Ag in analysis of 5 evaluations with
⚬ Reference - Cochrane Database Syst Rev 2022 Jul 22;7:CD013705 full-text

⚬ consistent findings in systematic review of 194 diagnostic cohort and case-control studies (333
datasets) evaluating commercial rapid point-of-care antigen tests for detecting SARS-CoV-2 infection
(PLoS Med 2022 May 26;19(5):e1004011 full-text )
● Evidencia • Actualizado 19 Oct 2022
RESUMEN DEL ESTUDIO

la sensibilidad de las pruebas rápidas de antígenos para la detección de la variante Omicron puede ser
similar a la detección de la variante Delta; la sensibilidad para la variante de Omicron osciló entre el
22 % y el 60 % en general según el momento de la prueba, pero osciló entre el 34 % y el 90 % en
personas que tuvieron 2 pruebas de PCR positivas en un intervalo de 48 horas Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Ann Intern Med 11 de octubre de 2022 temprano en línea
| Texto completo
Detalles
⚬ based on post hoc secondary analysis of diagnostic cohort study without calculation of necessary
sample size
⚬ 5,779 asymptomatic persons > 2 years old from TUAH study in the United States who had negative
SARS-CoV-2 test at baseline performed rapid antigen tests at home and submitted self-collected
nasal samples for RT-PCR testing for SARS-CoV-2 every 48 hours for 15 day between October 2021
and February 2022
– antigen tests were BD Veritor At-Home COVID-19 Test, Quidel QuickVue At-Home OTC COVID-19
Test, and Abbott BinaxNOW COVID-19 Antigen Self Test
– reference standard was RT-PCR testing
⚬ total of 45,958 person-days of testing included in analysis

⚬ 207 persons had positive RT-PCR test overall (28% Delta variant, 72% Omicron variant), 109 persons
had positive RT-PCR test sustained for 48 hours (25% Delta variant, 75% Omicron variant), and 29 did
not repeat RT-PCR test within 48 hours
⚬ comparing sensitivity of rapid antigen test for detection of SARS-CoV-2 for Delta vs. Omicron
– overall
● 15.5% vs. 22% on same day as first positive RT-PCR result (not significant)
● 45% vs. 50% at 48 hours after first positive RT-PCR result (not significant)
● 50% vs. 60% at 1 week after first positive RT-PCR result (not significant)
– in 109 persons with sustained positive RT-PCR test 48 hours later
● 26% vs. 34% on same day as first positive RT-PCR result (not significant)
● 81.5% vs. 78% at 48 hours after first positive RT-PCR result (not significant)
● 93% vs. 93% at 1 week after first positive RT-PCR result (not significant)
⚬ Reference - Ann Intern Med 2022 Oct 11 early online full-text
RESUMEN
● DEL ESTUDIO
La prueba rápida de antígeno Veritor tiene una alta especificidad pero una baja sensibilidad para la
detección de la infección por SARS-CoV-2 en contactos cercanos asintomáticos o presintomáticos
analizados el día 5 en adelante después de la exposición Nivel DynaMed 1
ESTUDIO DE COHORTE DE DIAGNÓSTICO : BMJ 2021 27 de julio; 374: n1676

Detalles
⚬ based on diagnostic cohort study

⚬ 4,295 persons ≥ 16 years old in the Netherlands identified through contact tracing between
December 14, 2020 and February 6, 2021 were assessed with rapid antigen test (Veritor or
Biosensor) on day ≥ 5 after exposure
– all persons were asymptomatic for COVID-19 when testing was requested
– all persons completed questionnaire at time of sample collection reporting any new symptom
onset since requesting testing
– paired swabs (oropharyngeal-nasal or oronasopharyngeal) were collected for each person; 1 swab
was used for rapid antigen test and 1 swab was used for RT-PCR test (reference standard)
⚬ 2,692 persons (mean age 45 years, 51% women) had Veritor rapid antigen test
– 67% had sample collected ≥ 5 days after last contact with index case
– 219 persons (8.1%) persons developed COVID-19 symptoms (including cough, shortness of
breath, myalgia, and fever) at time of testing
⚬ among persons who had Veritor test, 2,678 persons (99.5%) had RT-PCR test and were included in
analysis
⚬ 8.7% had SARS-CoV-2 infection by RT-PCR overall
⚬ performance of Veritor rapid antigen test for detection of SARS-CoV-2 infection
– in all persons
● sensitivity 63.9%
● specificity 99.6%
● positive predictive value 94.3%
● negative predictive value 96.7%
– in persons who developed symptoms between test request and sampling (prevalence of SARS-
CoV-2 infection 17.4%)
⚬ Reference - BMJ 2021 Jul 27;374:n1676
RESUMEN
● DEL ESTUDIO
La prueba rápida de antígeno con biosensor tiene una alta especificidad pero una baja sensibilidad
para la detección de la infección por SARS-CoV-2 en contactos cercanos asintomáticos o
presintomáticos analizados el día 5 en adelante después de la exposición Nivel DynaMed 1
ESTUDIO DE COHORTE DE DIAGNÓSTICO : BMJ 2021 27 de julio; 374: n1676

Detalles

⚬ 4,295 persons ≥ 16 years old in the Netherlands identified through contact tracing between
December 14, 2020 and February 6, 2021 were assessed with rapid antigen test (Veritor or
Biosensor) on day ≥ 5 after exposure
– all persons were asymptomatic for COVID-19 when testing was requested
– all persons completed questionnaire at time of sample collection reporting any new symptom
onset since requesting testing
– paired swabs (oropharyngeal-nasal or oronasopharyngeal) were collected for each person; 1 swab
was used for rapid antigen test and 1 swab was used for RT-PCR test (reference standard)
⚬ 1,603 persons (mean age 40 years, 53% male) had Biosensor rapid antigen test
– 78% had sample collected ≥ 5 days after last contact with index case
– 158 persons (9.8%) developed COVID-19 symptoms (including cough, shortness of breath,
myalgia, and fever) at time of testing
⚬ among persons who had Biosensor test, 1,596 persons (99.5%) had RT-PCR test and were included in
analysis
⚬ 8.3% had SARS-CoV-2 infection by RT-PCR overall
⚬ performance of Biosensor rapid antigen test for detection of SARS-CoV-2 infection
– in all persons
– in persons who developed symptoms between test request and sampling (prevalence of SARS-
CoV-2 infection 19%)
⚬ Reference - BMJ 2021 Jul 27;374:n1676 full text

RESUMEN
● DEL ESTUDIO
La prueba rápida de detección de antígenos de Panbio puede tener una alta sensibilidad y
especificidad para detectar la infección por SARS-CoV-2 en adultos Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Clin Microbiol Infect 2021 16 de febrero temprano en línea
| Texto completo
Detalles
⚬ based on diagnostic cohort study with blinding not stated

⚬ 958 patients (median age 40 years, 61.3% female) with ≥ 1 COVID-19 symptom or close contact to
patient with confirmed COVID-19 during September and October 2020 were tested with Panbio
COVID-19 Ag Rapid Test Device and RT-PCR (reference standard) using paired nasopharyngeal swabs
⚬ all patients were within 7 days of symptom onset or exposure to patient with COVID-19
⚬ 6% (58 patients) were ≤ 14 years old
⚬ 37.5% positive for SARS-CoV-2 infection by reference standard
⚬ for detection of SARS-CoV-2 infection, Panbio rapid antigen-detection test had
– sensitivity 90.5% (95% CI 87.5%-93.6%)
– specificity 98.8% (95% CI 98%-99.7%)
– positive predictive value 97.8% (95% CI 96.3%-99.4%)
– negative predictive value 94.6% (95% CI 92.8%-96.3%)
⚬ Reference - Clin Microbiol Infect 2021 Feb 16 early online full-text
RESUMEN
● DEL ESTUDIO
La prueba rápida de detección de antígenos de Panbio puede tener una sensibilidad moderada y una
alta especificidad para detectar la infección por SARS-CoV-2 en niños sintomáticos ≤ 15 años
Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Pediatr Infect Dis J 2021 17 de febrero temprano en línea
Detalles
⚬ based on diagnostic cohort study with blinding not stated

⚬ 440 children ≤ 15 years old (median age 3 years, 59% boys) presenting to pediatric emergency
department with COVID-19 symptoms between September 25 and October 14, 2020, were tested
with Panbio COVID-19 Ag Rapid Test Device and RT-PCR (reference standard) using paired
nasopharyngeal swabs
⚬ 4.1% had SARS-CoV-2 infection by reference standard
⚬ for detection of SARS-CoV-2 infection, Panbio rapid antigen-detection test had
– sensitivity 77.8% (95% CI 51.9%-92.6%)

– specificity 100% (95% CI 98.9%-100%)
– positive predictive value 100% (95% CI 73.2%-100%)
⚬ Reference - Pediatr Infect Dis J 2021 Feb 17 early online
RESUMEN
● DEL ESTUDIO
La prueba rápida de antígeno BinaxNOW ayuda a detectar la infección por SARS-CoV-2, pero la
sensibilidad es demasiado baja para descartar la infección en pacientes ≥ 10 años Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : MMWR Morb Mortal Wkly Rep 2021 Jan 22;70(3):100
Detalles
⚬ 3,419 patients ≥ 10 years old (median age 41 years) with or without COVID-19 symptoms were
assessed with rapid antigen test (BinaxNOW) and RT-PCR (reference standard)
– paired swabs were collected for each patient
● rapid antigen testing was performed using bilateral anterior nasal swabs and analyzed
immediately following sample collection
● RT-PCR was performed using bilateral nasopharyngeal swabs and analyzed within 24-48 hours
of collection
– all patients completed questionnaire reporting any symptoms within previous 14 days
⚬ 24% were symptomatic at time of testing

⚬ 8.7% had SARS-CoV-2 infection by RT-PCR
⚬ performance of rapid antigen test (BinaxNOW) for detection of SARS-CoV-2
– overall
● sensitivity of 52.5%
– in symptomatic patients
● specificity 100%
– in asymptomatic patients
⚬ Reference - MMWR Morb Mortal Wkly Rep 2021 Jan 22;70(3):100
RESUMEN
● DEL ESTUDIO
en la primera semana después del inicio de los síntomas de COVID-19, la prueba basada en antígenos
de flujo lateral parece tener una tasa de falsos positivos más baja que la RT-PCR en tiempo real para
predecir la presencia de virus infecciosos según el cultivo Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Clin Infect Dis 2021 20 de enero temprano en línea |
Texto completo
Detalles
⚬ based on diagnostic cohort study with confidence interval including differences that are not clinically
important
⚬ 251 adults with ≥ 1 COVID-19 symptom were tested within 7 days of symptom onset with lateral flow
antigen test (BD Veritor Antigen Test) and real-time (RT-PCR)
⚬ reference standard was SARS-CoV-2 TMPRSS2 culture assay (using VeroE6TMPRSS2 cell line); positive
culture was considered surrogate measure for presence of infectious virus
⚬ 11.2% had positive culture
⚬ comparing lateral flow antigen test vs. real-time RT-PCR for prediction of positive culture within 8
days after symptom onset
– sensitivity 96.4% vs. 100%
– specificity 98.7% vs. 95.5%
– positive predictive value 90% vs. 73.7%
– negative predictive value 99.5% vs. 100%
⚬ lateral flow antigen test associated with nonsignificant reduction in false-positive rate (defined as 1 -
positive predictive value) (difference 16.32%, 95% CI -1.33% to 33.96%), CI includes differences that
are not clinically important
⚬ Reference - Clin Infect Dis 2021 Jan 20 early online full-text
⚬
DynaMed Commentary
Confidence interval for difference in false-positive rates based on post hoc calculation by
DynaMed Editors.
RESUMEN
● DEL ESTUDIO
La prueba de antígeno casera QuickVue parece tener baja sensibilidad para descartar la infección por
SARS-CoV-2 en adultos y niños Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : JAMA Intern Med 2022 29 de abril temprano en línea
Detalles
⚬ based on diagnostic cohort study without diagnostic uncertainty

⚬ 552 adults and children from 151 households with recent RT-PCR-confirmed SARS-CoV-2 infection in
January-April 2021 in California and Colorado were enrolled within 10 days of illness onset of earliest
case in household
⚬ 225 persons (median age 29 years, 52% female, 64% White, 22% Hispanic or Latino, 4% Asian, 3%
Black) from 107 households with RT-PCR-confirmed SARS-CoV-2 infection who completed ≥ 1 home
antigen test (QuickVue At-Home COVID-19 Test) were followed for 15 days and included in analysis
– 91% were symptomatic, 86% were unvaccinated for COVID-19
– SARS-CoV-2 lineages detected included Alpha (B.1.1.7) in 56%, Epsilon (B.1.427 or B.1.429) in 16%,
and Gamma (P.1) in 4%
– 3,044 antigen tests and 642 nasopharyngeal swabs were performed, including 593 pairs of
antigen tests and nasopharyngeal swabs performed on same day
⚬ reference standards were same-day RT-PCR test, positive case status, or positive same-day viral
culture
⚬ sensitivity of home antigen test for detecting SARS-CoV-2 infection during infection period (defined as
2 days before symptom onset date or sample collection date of first positive RT-PCR test if
asymptomatic through 10 days afterward)
– 64% (95% CI 56%-70%) using same-day RT-PCR test as reference standard
– 50% (95% CI 45%-55%) using positive case status as reference standard
– 84% (95% CI 75%-90%) using positive same-day viral culture as reference standard
⚬ sensitivity of home antigen test peaked 4 days after illness onset at 77% (80% for symptomatic
persons at day 3 and 50% for asymptomatic persons at day 2)
⚬ Reference - JAMA Intern Med 2022 Apr 29 early online
● La FDA alerta a los proveedores de atención médica sobre los resultados falsos positivos con las
pruebas de antígenos utilizadas para la detección rápida del SARS-CoV-2 y emite recomendaciones para
limitar los resultados falsos positivos o falsos negativos ( Carta de la FDA a los proveedores de atención
médica, 3 de noviembre de 2020 )
Análisis de sangre
Pruebas serológicas
● Consideraciones para las pruebas serológicas
⚬ Directrices de la Sociedad de Enfermedades Infecciosas de América (IDSA) sobre el diagnóstico de

COVID-19
– No se recomiendan pruebas serológicas para el diagnóstico de infección por SARS-CoV-2 durante
las primeras 2 semanas después del inicio de los síntomas ( Recomendación condicional de IDSA,
certeza de evidencia muy baja )
– detección de infección previa
● cuando la infección por SARS-CoV-2 requiera confirmación de laboratorio con fines clínicos o
epidemiológicos, considere pruebas que detecten inmunoglobulina (Ig)G o anticuerpos totales
3-4 semanas después del inicio de los síntomas ( Recomendación condicional de IDSA, certeza
de evidencia muy baja )
⚬ la prueba 3-4 semanas después del inicio de los síntomas maximiza la sensibilidad y la
especificidad para detectar infecciones pasadas cuando se usan pruebas serológicas
además de la prueba de amplificación de ácido nucleico (NAAT)
⚬ los estudios de serovigilancia deben utilizar pruebas con alta especificidad (≥ 99,5%),
especialmente cuando la prevalencia comunitaria es baja
● ninguna recomendación a favor o en contra de las pruebas serológicas que detectan IgM
específica de SARS-CoV-2 ( Recomendación condicional de IDSA, evidencia de certeza muy baja
)
● No se recomiendan las pruebas serológicas que detectan IgA (Recomendación condicional de
IDSA, certeza de evidencia muy baja )
● No se recomiendan las pruebas combinadas de IgM o IgG (donde la detección de cualquiera
de los subtipos de anticuerpos se considera positiva) (Recomendación condicional de IDSA,
evidencia de certeza muy baja )
– Se puede considerar la prueba de anticuerpos IgG en pacientes sintomáticos con alta sospecha
clínica a pesar de NAAT negativa repetida ( Recomendación débil de IDSA, evidencia de certeza
muy baja )
– Se recomienda la prueba de anticuerpos IgG más NAAT para niños con síndrome inflamatorio
multisistémico (MIS-C) para proporcionar evidencia de infección pasada o actual (
Recomendación fuerte de IDSA, evidencia de certeza muy baja )
– ninguna recomendación a favor o en contra de la sangre capilar frente a la sangre venosa para
las pruebas serológicas ( brecha de conocimiento de IDSA )
– Referencia - Directrices de IDSA sobre el diagnóstico de COVID-19: Pruebas serológicas ( IDSA
2020 18 de agosto )
⚬ Directrices provisionales de los Centros para el Control y la Prevención de Enfermedades (CDC) para
las pruebas de anticuerpos contra el COVID-19
– Indicaciones para pruebas serológicas.
● la serología no debe usarse para diagnosticar una infección aguda

● situaciones en las que la serología puede ser útil para el diagnóstico
⚬ la prueba de anticuerpos positiva puede usarse para respaldar un diagnóstico en pacientes
que presentan complicaciones de COVID-19, como el síndrome inflamatorio multisistémico
y otras secuelas post-agudas
⚬ prueba de anticuerpos positiva ≥ 7 días después del inicio de la enfermedad aguda en
personas con prueba de anticuerpos negativa previa puede indicar infección entre las
fechas de pruebas positivas y negativas incluso si la persona no tiene una prueba viral
positiva
● las pruebas serológicas se pueden usar con fines clínicos, de salud ocupacional y de salud
pública para diferenciar la infección natural de la vacunación
⚬ en personas que nunca fueron vacunadas, una prueba positiva de IgG contra la
nucleocápside (N), la espiga (S) o el dominio de unión al receptor (RBD) indica una infección
natural previa
⚬ en personas vacunadas
– Prueba IgG positiva contra
– solo S indica que no hay infección previa

– cualquier antígeno no S indica una infección previa que puede haber ocurrido antes
o después de la vacunación
– actualmente no se recomienda la prueba de anticuerpos para evaluar la inmunidad

después de la vacunación
● las pruebas serológicas pueden usarse en estudios de seroprevalencia para estimar la

incidencia acumulada de infección o vacunación en una comunidad
● prueba serológica negativa no descarta infección previa
– elección de prueba y estrategia de prueba
● Se recomiendan ensayos serológicos con autorización de uso de emergencia (EUA) de la FDA

para uso clínico o de salud pública (la lista se puede encontrar en FDA 2020 )
● Se prefieren las pruebas serológicas con una sensibilidad y especificidad muy altas.
– consideraciones adicionales
● las personas con COVID-19 deben seguir la guía sobre la interrupción del aislamiento
independientemente de la serología
● Las pruebas de anticuerpos no deben usarse para determinar la necesidad de cuarentena
después de la exposición.
● todos deben seguir las recomendaciones para prevenir la infección por SARS-CoV-2
independientemente de la serología
● las personas que anteriormente dieron positivo en la prueba de anticuerpos pero que
actualmente tienen evidencia de infección deben seguir las pautas de aislamiento
● no se recomienda la prueba de anticuerpos para evaluar la inmunidad o evaluar la necesidad
de vacunación en personas no vacunadas
– Referencia: Directrices provisionales de los CDC para las pruebas de anticuerpos contra la COVID-
19 ( CDC 2022 24 de enero )
⚬ limitaciones de las pruebas serológicas
– OMS publica informe científico sobre pruebas serológicas
● actualmente no hay evidencia de que las personas que se han recuperado de COVID-19 y
tienen anticuerpos estén protegidas de una segunda infección
● las pruebas serológicas necesitan más validación para distinguir con precisión los anticuerpos
contra el SARS-CoV-2 de los anticuerpos contra otros 6 coronavirus que se sabe que causan
enfermedades humanas, incluidas 4 especies que circulan ampliamente y causan infecciones
típicas del tracto respiratorio superior, SARS y MERS-CoV
● inaccurate serologic tests with high rates of false-positive and false-negative identification
could have significant impact on infection control measures
● Reference - WHO Scientific Brief 2020 Apr 24
– FDA issues letter to healthcare providers to reinforce limitations of serologic testing to detect
COVID-19
● no antibody test currently available for diagnosis of SARS-CoV-2 infection has been validated
(to the knowledge of the FDA)
● recommendations for clinicians
⚬ continue to use serologic tests as appropriate, with awareness of their limitations which
include
– antibody levels may not reach detectable levels, and duration for which antibodies (IgG
and IgM) remain detectable is unknown
– IgM antibodies do not always develop early (or at all) in active infection
– IgG antibodies may take time to develop (typically 7-10 days after infection), but may not
exclude patients with recent infection who are still contagious (especially with
concurrent detection of IgM antibodies)
⚬ consider serologic testing to determine potential exposure rather than as sole basis to
diagnose COVID-19
⚬ be aware that not all serologic tests on the market have been evaluated by the FDA
● Reference - FDA Letter to healthcare providers 2020 Apr 17 , Fact Sheet for healthcare
providers 2020 Apr
⚬ FDA emergency use authorization for SARS-CoV-2 antibody tests can be found in FDA 2020
⚬ FDA advises against use of SARS-CoV-2 antibody test results to evaluate immunity or protection from
COVID-19, particularly after COVID-19 vaccination; FDA will continue to monitor use of authorized
SARS-CoV-2 antibody tests for purposes other than identifying people with adaptive immune
response to SARS-CoV-2 from prior or recent infection (FDA Press Release 2021 May 19 )
STUDY
● SUMMARY
serologic tests appear to have limited utility for diagnosing COVID-19, especially in first 2 weeks
after symptom onset DynaMed Level 2
SYSTEMATIC REVIEW: BMJ 2020 Jul 1;370:m2516 | Full Text

SYSTEMATIC REVIEW: Cochrane Database Syst Rev 2020 Jun 25;6:CD013652
Details
⚬ based on 2 systematic reviews of diagnostic studies with methodologic limitations

⚬ systematic review of 40 studies evaluating performance of serologic tests to diagnosis COVID-19 by
detection of IgG and IgM antibodies against SARS-CoV-2
– tests for detection of IgM and IgG included enzyme-linked immunosorbent assay (ELISA), lateral
flow immunoassay (LFIA), and chemiluminescent immunoassays (CLIA)
– mean age ranged from 39 to 95 years
– review authors reported all studies to have high or unclear risk of bias in ≥ 1 quality domain
including patient selection, index test, reference standard, and flow and timing
● analyses included 29,842 tests, multiple samples from single patients were used in most
studies
● most studies had case-control design, with specificity based on pre-epidemic samples or
samples from patients without suspected infection
● reference standard was not blinded in most studies
● time of sample collection for serological tests ranged from 1 to 55 days after onset of
symptoms
– reference standard was real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 using
nasopharyngeal, sputum, saliva, oral, throat, or pharyngeal samples
– pooled performance of detection of IgM antibodies against SARS-CoV-2 for diagnosis of COVID-19
● using ELSA
⚬ sensitivity in first week after symptom onset
– in first week after symptom onset 26.7% (95% CI 15.6%-35.6%) in analysis of 4 study
arms
– in second week 57.6% (95% CI 15.9%-88.2%) in analysis of 5 study arms
– in third week or later 78.4% (95% CI 54.1%-91.9%) in analysis of 5 study arms
⚬ specificity 99.7% (95% CI 99%-100%) in analysis of 9 study arms
● using LFIA
⚬ sensitivity
arms
⚬ specificity 96.6% (95% CI 93.8%-98.4%) in analysis of 16 study arms
● using CLIA
⚬ sensitivity
arms
⚬ specificity 96.6% (95% CI 84.7%-99.5%) in analysis of 10 study arms
– consistent results for detection of IgG antibodies for all assays

– Reference - BMJ 2020 Jul 1;370:m2516 full-text
⚬ systematic review of 54 diagnostic studies evaluating performance of serologic tests to diagnose

COVID-19 in adults and children suspected of current or previous SARS-CoV-2 infection or during
population screening
– tests for detection of antibodies included ELISA, CLIA, indirect immunofluorescence tests, and
rapid LFIA
– mean or median age of patients with COVID-19 ranged from age 37 to 76 years
– review authors reported all studies to have high or unclear risk of bias in ≥ 1 quality domain
including patient selection, index test, reference standard, and flow and timing
● most studies (48) had case-control design
● index test and/or reference standard were not blinded in most studies
● multiple samples from same patient used in some studies
– analysis included 15,976 serum samples

– reference standards included reverse transcriptase polymerase chain reaction (RT-PCR) and
clinical diagnostic criteria
– pooled diagnostic performance of antibody tests for detection of SARS-CoV-2 antibodies
● tests for IgG detection had
⚬ sensitivity
– 29.7% (95% CI 22.1%-38.6%) at days 1-7 in analysis of 23 studies

⚬ specificity 99.1% (95% CI 98.3%-99.6%) in analysis of 44 studies
● tests for IgM detection had
⚬ sensitivity

– 68.1% (95% CI 55%-78.9%) at days 22-35 in analysis of 11 studies
● test for IgA detection had
⚬ sensitivity

– 98.7% (95% CI 39%-100%) at days 15-21 in analysis of 3 studies
● tests for IgG/IgM detection had
⚬ sensitivity

– 91.4% (95% CI 87%-94.4%) at days 15-21 in analysis of 9 studies
– 96% (95% CI 90.6%-98.3%) at days 22-35 in analysis of 5 studies
– Reference - Cochrane Database Syst Rev 2020 Jun 25;6:CD013652 , results of Cochrane
summarized in Ann Intern Med 2020 Nov 17;173(10):JC57
– consistent findings in systematic review of 10 studies with 2,252 samples J Clin Med 2020 May
18;9(5):doi:10.3390/jcm9051515 full text , results summarized in Ann Intern Med 2020 Oct
20;173(8):JC47
STUDY
● SUMMARY
lateral flow assays may have high specificity and variable sensitivity to detect antibodies against
SARS-CoV-2 in nonhospitalized adults DynaMed Level 2
DIAGNOSTIC CASE-CONTROL STUDY: Thorax 2020 Aug 12 early online

Details
⚬ based on diagnostic case-control study

⚬ 276 nonhospitalized adults (median age 37 years, 71% women) with PCR-confirmed SARS-CoV-2
infection ≥ 21 days after symptom onset or positive swab and 500 serum samples collected before
August 2019 were analyzed by lateral flow immunoassays (LFIAs) to detect antibodies against SARS-
CoV-2
⚬ 5 LFIAs were evaluated using fingerprick self-testing (clinic) and serum samples interpreted in
laboratory and 6 LFIAs were evaluated with serum samples only
⚬ reference standards were PCR and 2 ELISAs (spike protein ELISA [S-ELISA] and hybrid spike protein
receptor binding domain double antigen bridging assay [hybrid DABA])
⚬ samples were assessed median 44 days from symptom onset or positive test (range 21-100 days)
⚬ positives on serum samples collected before August 2019 were considered to be false
⚬ 95% tested positive for antibodies against SARS-CoV-2 on ≥ 1 ELISA
⚬ sensitivity of 5 LFIAs using clinic (fingerprick) and laboratory (serum) samples to detect IgG or IgM
against SARS-CoV-2 and ≥ 1 ELISA as reference standard
Test Number of Median Sensitivity

Samples Days Since
Symptom
Onset
Serum Fingerprick
Sample Sample
MENARINI 47 41 95.6% 95.6%
FORTRESS 48 59 93.3% 84.4%
BIOPANDA I 68 44 76.9% 67.7%
BIOSURE/M 44 40 85% 60%

OLOGIC I
WONDFO 76 37 76.7% 21.9%
⚬ analysis of 5 LFIAs assessed in clinic (fingerprick) and laboratory (serum) samples using ≥ 1 ELISA as
reference standard
– specificity to detect IgG or IgM against SARS-CoV-2 ranged from 97.2% to 99.8%
– concordance between fingerprick and serum samples ranged from moderate (kappa 0.56) to
slight (kappa 0.13)
⚬ diagnostic performance of 6 LFIAs using serum to detect IgG or IgM against SARS-CoV-2 and ≥ 1 ELISA
as reference standard
– ABBOTT (184 samples for sensitivity) had
● sensitivity 91%
– SURESCREEN (184 samples for sensitivity) had
● sensitivity 88%
– BIOPANDA II (184 samples for sensitivity) had
● sensitivity 82%
– BIOMERICA (184 samples for sensitivity) had
● sensitivity 81%
– SURE-BIOTECH (93 samples for sensitivity) had
● sensitivity 68%
● specificity not reported
– BIOSURE/MOLOGIC II assay was not performed according to manufacturer's instructions
⚬ Reference - Thorax 2020 Aug 12 early online
STUDY
● SUMMARY
AbC-19 Rapid Test LFIA may have moderate sensitivity and high specificity to detect antibodies
against SARS-CoV-2 in essential workers DynaMed Level 2
DIAGNOSTIC COHORT STUDY: BMJ 2020 Nov 11;371:m4262 | Full Text

Details
⚬ based on diagnostic cohort study with possible selection bias

⚬ 4,842 adults in United Kingdom had blood samples assessed using AbC-19 Rapid Test LFIA to detect
antibodies against SARS-CoV-2
– 2,847 adults were essential workers including healthcare staff, fire and rescue officers, and police
officers from Evaluating Detection of SARS-CoV-2 AntiBodies at HOME (EDSAB-HOME) study
● 2,579 adults had unknown previous infection status
● 286 adults had PCR-confirmed SARS-CoV-2 infection
– 1,995 adults were from COMPARE study whose blood samples were collected in 2016-2017 prior
to COVID-19 pandemic (controls)
⚬ AbC-19 Rapid Test LFIA was designed to detect IgG antibodies against SARS-CoV-2 spike protein
⚬ reference standards were Roche Elecsys assay that detects antibodies to SARS-CoV-2 nucleoprotein
and/or EUROIMMUN assay that detects antibodies to SARS-CoV-2 spike protein
⚬ prevalence of SARS-CoV-2 infection ranged from 13.4% to 14.4% by reference standards
⚬ of 354 adults with unknown previous infection status who had positive result on Roche Elecsys assay,
62% reported symptoms compatible with COVID-19 and were more likely to enroll in study
⚬ diagnostic performance of AbC-19 Rapid Test LFIA to detect SARS-CoV-2 antibodies
– in adults with unknown previous infection status
● using Roche Elecsys assay as reference standard
⚬ sensitivity 84.7%
⚬ specificity 98.9%
⚬ positive predictive value 92.6%
⚬ negative predictive value 97.6%
● using EUROIMMUN assay as reference standard
● using composite of Roche Elecsys and EUROIMMUN assays as reference standard
⚬ specificity 99%
– in adults with PCR-confirmed SARS-CoV-2 infection
● sensitivity 94.2% using Roche Elecsys assay as reference standard

● sensitivity 96% using EUROIMMUN assay as reference standard
● sensitivity 93.9% using composite of Roche Elecsys and EUROIMMUN assays as reference
standard
– in controls, specificity 97.9%
⚬ Reference - BMJ 2020 Nov 11;371:m4262 full-text

⚬ consistent performance for 2 additional lateral flow assays (Onsite and Encode) in case-control and
cohort analyses of healthcare workers in United Kingdom using PCR as reference standard (Lancet
Respir Med 2020 Sep;8(9):885 full-text )
STUDY
● SUMMARY
results of lateral flow serological assays may change or become unreadable from 15 minutes to 24
hours after sampling
DIAGNOSTIC CASE-CONTROL STUDY: Lancet Respir Med 2020 Sep;8(9):885 | Full Text
Details

⚬ 400 healthcare workers (mean age 39 years, 73% women) with mild-to-moderate symptoms in
United Kingdom meeting Public Health England case definition for COVID-19 and 100 historic pre-
COVID-19-negative control samples (mean age 38 years, 79% women) were assessed with 2 point-of-
care lateral flow serological assays and IgG ELISA immunoassay
⚬ all symptomatic patients had delivered care to patients hospitalized with SARS-CoV-2 infection and
had lateral flow assays within 7 days of symptom onset
⚬ lateral flow serological assays included Encode and Onsite rapid tests
– both used visual scoring with scale ranging from 0 (absent) to 4 (strong positive)
– results were read at 15 minutes (initial reading), 2 hours, and 24 hours after sampling
⚬ no changes from initial readings occurred at 2 hours for either assay

⚬ changes in results at 24 hours
– 8.8% of Encode assay results changed from initial readings (35 tests)
● 29 changed from negative to positive

● 6 changed from positive to negative
● ELISA results were concordant with initial assay readings
– 9.8% of Onsite assay results changed from initial readings (39 tests)
● 15 changed from negative to positive (7 confirmed as positive and 8 as negative by ELISA)

● 24 became unreadable
⚬ Reference - Lancet Respir Med 2020 Sep;8(9):885 full-text

STUDY
● SUMMARY
immunofluorescent antibody (IFA) test may have high sensitivity and specificity for COVID-19
DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Open Forum Infect Dis 2020 Sep;7(9):ofaa387 | Full Text
Details
⚬ based on retrospective diagnostic cohort study with possible selection bias

⚬ 2,753 patients (median age 38 years, 61% women) with suspected COVID-19 who were tested with
both IFA assay and nucleic acid amplification testing (NAAT) in Australia from January 2020 to May
2020 were assessed
– IFA assay designed to detect IgG, IgA, and IgM antibodies against SARS-CoV-2 performed on
serum samples
– NAAT (reference standard) performed on respiratory tract samples
⚬ most potentially eligible patients seen during study period were excluded due to lack of serologic
testing; a small number of patients with positive NAAT and negative IFA results were also excluded
⚬ positive IFA results defined as titer ≥ 10 for SARS-CoV-2-specific antibody (IgG, IgA, or IgM)
⚬ mean time from symptom onset to seroconversion was 10.2 days (maximum 14.4 days)
⚬ 4.6% had SARS-CoV-2 infection by reference standard
⚬ diagnostic performance of IFA for detection of COVID-19
– detection of any antibodies (IgG, IgA, or IgM) had
– IgG detection had
– IgA detection had
– IgM detection had
STUDY
● SUMMARY
ELISA for serum IgG and IgA against SARS-CoV-2 performed ≥ 14 days after symptom onset may
have high sensitivity for diagnosis of SARS-CoV-2 infection DynaMed Level 2
DIAGNOSTIC CASE-CONTROL STUDY: Ann Intern Med 2020 Jul 6 early online | Full Text
Details

⚬ 628 persons (876 serum samples) were assessed using ELISA for serum antibodies against SARS-CoV-
2 spike protein
– cases were 60 hospitalized adults (308 samples) with COVID-19 confirmed by nucleic acid
amplification test (NAAT) and clinical assessment
– controls were 568 persons (568 samples) who had either tested negative for SARS-CoV-2 by NAAT
(9.7%) or had not been tested by NAAT but were not suspected of having COVID-19 (healthy
laboratory employees and patients with polyclonal activation of antibody response)
⚬ diagnostic performance of ELISA for diagnosis of SARS-CoV-2 infection in per-sample analyses
– for IgG with cutoff 1.1 units
● sensitivity
⚬ 97.6% at ≥ 14 days of symptom onset

⚬ 0%-51% at 0-13 days after symptom onset
– for IgA with cutoff 1.1 units
● sensitivity
⚬ 98.4% at ≥ 14 days of symptom onset

⚬ 13.3%-77% at 0-13 days after symptom onset
● specificity 88%
⚬ Reference - Ann Intern Med 2020 Jul 6 early online full-text
STUDY
● SUMMARY
384-well ELISA and Total immunoassays may have at least 96% sensitivity and 98% specificity to
diagnose COVID-19 ≥ 20 days after symptom onset in adults DynaMed Level 2
DIAGNOSTIC CASE-CONTROL STUDY: Lancet Infect Dis 2020 Dec;20(12):1390 | Full Text
Details

⚬ 536 blood samples from adults with laboratory-confirmed SARS-CoV-2 infection and 976
prepandemic (September 2014 to October 2016) samples from healthy adults were evaluated by 5
immunoassays for SARS-CoV-2
– immunoassays tested included IgG assay (Abbott), LIAISON S1/S2 IgG assay (DiaSorin), Elecsys
assay (Roche), Total assay (Siemens), and 384-well ELISA (Oxford immunoassay)
– blood samples from patients with confirmed SARS-CoV-2 were collected ≥ 20 days after symptom
onset
⚬ for diagnosis of SARS-CoV-2 infection using cutoffs specified by manufacturer (June 8, 2020)
– 384-well ELISA (Oxford immunoassay) had
● sensitivity 99.1% (95% CI 97.8%-99.7%)

● specificity 99% (95% CI 98.1%-99.5%)
– Total assay (Siemens) had
● sensitivity 98.1% (95% CI 96.6%-99.1%)

● specificity 99.9% (95% CI 99.4%-100%)
– Elecsys assay (Roche) had
● sensitivity 97.2% (95% CI 95.4%-98.4%)

● specificity 99.8% (95% CI 99.3%-100%)
– LIAISON S1/S2 IgG assay (DiaSorin) excluding 9 samples in equivocal zone of 12 to < 15 arbitrary
units (AU)/mL had
● sensitivity 96.2% (95% CI 94.2%-97.7%)
● specificity 98.9% (95% CI 98%-99.4%)
– IgG assay (Abbott) had
● sensitivity 92.7% (95% CI 90.2%-94.8%)

● specificity 99.9% (95% CI 99.4%-100%)
⚬ using manufacturer-defined cutoffs in additional analyses including samples taken < 20 days after
symptom onset
– 384-well ELISA immunoassay (Oxford) had point estimates for sensitivity and specificity ≥ 98% at
≥14 and ≥ 30 days after symptom onset
– Total assay had point estimates for sensitivity and specificity ≥ 98% at ≥ 30 days after symptom
onset
– Elecsys assay (Roche) had ≥ 98% sensitivity and specificity at ≥ 30 days after symptom onset
⚬ Reference - Lancet Infect Dis 2020 Dec;20(12):1390 full-text
STUDY
● SUMMARY
seroconversion rates appear high about 10 days after symptom onset in adults with COVID-19
ESTUDIO DE COHORTE : Eur Respir J 2020 19 de mayo temprano en línea

Detalles

⚬ 80 adults (median age 55 years) admitted to hospital with laboratory-confirmed COVID-19, fever
and/or respiratory symptoms, and abnormal lung imaging findings between January 19 and February
9, 2020 in China were evaluated for antibodies (total antibody, IgM, and IgG) against SARS-CoV-2
– tests included ELISA, colloidal-gold lateral-flow immunoassays, and chemiluminescence
microparticle immunoassays
– samples collected at days 0 to 7, 8 to 14, and 15 to 29 with median 4 samples collected for each
patient
⚬ seroconversion rates by ELISA in patients with COVID-19
– 97.5% for total antibodies

– 92.5% for IgM
– 88.8% for IgG
⚬ consistent results for seroconversion by other tests

⚬ time to seroconversion assessed in subgroup analysis of 45 patients with unambiguous close contact
with patient with confirmed COVID-19 to determine date of exposure (33% classified as having
critical illness)
– median time from symptom onset to seroconversion for total antibodies by ELISA
● 9 days in patients with critical illness

● 10 days in patients without critical illness
– median time from exposure to seroconversion for total antibodies by ELISA
● 14 days in patients with critical illness

● 15 days in patients without critical illness
⚬ no false-positive results on ELISA reported in additional cohort of 300 healthy controls without
known close contact with confirmed COVID-19 cases, false-positive rate for total antibodies by any
test was 5.3%
⚬ Reference - Eur Respir J 2020 May 19 early online
RESUMEN
● DEL ESTUDIO
El ensayo Abbott Architect IgG puede tener una alta especificidad pero una baja sensibilidad < 14 días
después del inicio de los síntomas para detectar una infección más temprana con SARS-CoV-2
Nivel DynaMed 2
ESTUDIO DE DIAGNÓSTICO DE CASOS Y CONTROLES : Clin Microbiol Infect 2020 9 de junio temprano en
línea | Texto completo
Detalles

⚬ 177 symptomatic patients with polymerase chain reaction (PCR)-confirmed COVID-19 and 163
patients with serum samples taken before December 2019 (controls) in Singapore had residual sera
assessed with Abbott Architect SARS-CoV-2 IgG assay
⚬ patients who were asymptomatic at time of PCR testing (reference standard) were excluded from
analysis (46% had symptoms for ≤ 6 days, 22% had symptoms for 7-13 days, and 32% had symptoms
for ≥ 14 days)
⚬ controls were assumed to not have had COVID-19
⚬ for detection of SARS-CoV-2 IgG, Abbott Architect IgG assay with signal/cutoff ratio ≥ 1.4 had
– sensitivity
● 40.7% overall
● 8.6% (95% CI 3.8%-17.5%) with symptom onset ≤ 6 days
● 43.6% (95% CI 28.2%-60.2%) with symptom onset 7-13 days
● 84.2% (95% CI 71.6%-92.1%) with symptom onset ≥ 14 days
– specificity 100% (95% CI 97.1%-100%)
⚬ Reference - Clin Microbiol Infect 2020 Jun 9 early online full-text
RESUMEN
● DEL ESTUDIO
se informó que los anticuerpos contra el SARS-CoV-2 medidos por el ensayo de anticuerpos pan-
inmunoglobulina permanecen detectables hasta 4 meses después de la confirmación de COVID-19
por PCR
ESTUDIO DE DIAGNÓSTICO DE CASOS Y CONTROLES : N Engl J Med 1 de septiembre de 2020

Detalles

⚬ 30,576 persons in Iceland had serum samples assessed for SARS-CoV-2-specific antibodies
⚬ 1,215 persons with positive quantitative polymerase chain reaction (qPCR) SARS-CoV-2 test who had
recovered from infection had serum samples tested for antibodies against SARS-CoV-2 up to 4
months after diagnosis
– antibodies were quantified by
● 2 pan-immunoglobulin (IgM, IgG, and IgA) antibody assays targeting viral nucleoprotein or
receptor binding domain in S1 subunit of spike protein
● 4 antibody-specific assays targeting IgG or IgM against nucleoprotein or IgG or IgA against S1
subunit of spike protein
– 91.1% of serum samples from recovered patients collected 25 days after diagnosis by qPCR were
positive for SARS-CoV-2 antibodies on 2 pan-immunoglobulin assays
– antibody levels measured by
● both pan-immunoglobulin antibody assays increased over first 2 months and then remained at
plateau over next 2 months
● IgM targeting nucleoprotein increased after diagnosis but were generally not detected after 2
months
● IgA targeting S1 subunit decreased 1 month after diagnosis and remained detectable
● IgG targeting nucleoprotein or IgG targeting S1 subunit increased for 6 weeks and then
decreased slightly
– increasing body mass index associated with significantly increased SARS-CoV-2-specific antibodies
– use of anti-inflammatory medication and smoking each associated with significantly decreased
SARS-CoV-2-specific antibodies
⚬ in analysis of entire cohort, estimated prevalence of SARS-CoV-2 infection in Iceland was 0.9% (95% CI
0.8%-0.9%)
– 56% of infections were diagnosed by qPCR
– 14% of infections were in quarantined persons (undiagnosed)
– 30% of infections were in nonquarantined persons (undiagnosed)
⚬ Reference - N Engl J Med 2020 Sep 1
● El estudio que evalúa el uso de muestras de gotas de sangre seca para la detección de anticuerpos
específicos contra el SARS-CoV-2 se puede encontrar en Emerg Infect Dis 2020 Dec;26(12):2970 texto
completo
Análisis de sangre generales
RESUMEN
● DEL ESTUDIO
La linfopenia puede ser común en pacientes con neumonía por COVID-19
ESTUDIO DE COHORTE : JAMA 2020 17 de marzo; 323 (11): 1061 | Texto completo
ESTUDIO DE COHORTE : Lancet 2020 15 de febrero; 395 (10223): 497
ESTUDIO DE COHORTE : Lancet 2020 15 de febrero; 395 (10223): 507
ESTUDIO DE COHORTE : Alergia 2020 19 de febrero temprano en línea
Detalles
⚬ based on 4 cohort studies

⚬ cohort admitted January 1-28, 2020
– 138 adults aged 22-92 years (median age 56 years, 54% men) with confirmed COVID-19
pneumonia consecutively admitted to Zhongnan Hospital in Wuhan, China, between January 1-28,
2020, were evaluated through February 3, 2020
– laboratory testing revealed
● lymphopenia (lymphocyte count < 1.1 × 109 cells/L) in 70.3%

● prolonged prothrombin time (> 12.5 seconds) in 58%
● elevated lactate dehydrogenase (> 243 units/L) in 39.9%
– Reference - JAMA 2020 Mar 17;323(11):1061 full-text , editorial can be found in JAMA 2020
Mar 17;323(11):1039
⚬ cohort admitted by January 2, 2020
– 41 patients (mean age 49 years, 73% male) with confirmed COVID-19 pneumonia admitted to
● lymphopenia (lymphocyte count < 1 × 109 cells/L) in 63%

● elevated aspartate aminotransferase levels in 37%
● leukopenia (white blood cell count < 4 × 109 cells/L) in 25%
● viremia in 15%
– Reference - Lancet 2020 Feb 15;395(10223):497 , correction can be found in Lancet 2020 Feb
15;395(10223):496
⚬ cohort admitted January 1-20, 2020
– 99 adults aged 21-82 years (mean age 55 years, 68% men) with confirmed COVID-19 pneumonia
admitted to Jinyintan Hospital in Wuhan, China, from January 1 to 20, 2020, were evaluated up to
January 25, 2020
● increased lactate dehydrogenase (> 250 units/L) in 76%

● decreased hemoglobin (< 130 g/L) in 51%
● neutrophilia (neutrophil count > 6.3 × 109 cells/L) in 38%
● lymphopenia (lymphocyte count < 1.1 × 109 cells/L) in 35%
● leukocytosis (white blood cell count > 9.5 × 109 cells/L) in 24%
● thrombocytopenia (platelet count < 125 × 109 platelets/L) in 12%
● leukopenia (white blood cell count < 3.5 × 109 cells/L) in 9%
● thrombocytosis (platelet count > 350 × 109 platelets/L) in 4%
– Reference - Lancet 2020 Feb 15;395(10223):507
⚬ cohort admitted January 16-February 3, 2020
– 140 adults (median age 57 years, range 25-87 years) with confirmed COVID-19 admitted to No. 7
Hospital of Wuhan from January 16 to February 3, 2020, were evaluated
● elevated C-reactive protein in 91.9%

● elevated serum amyloid A in 90.2%
● lymphopenia in 75.4%
● eosinopenia in 52.9%
● elevated D-dimer in 43.2%
● elevated procalcitonin in 34.7%
– comparing patients with severe disease vs. nonsevere disease
● median lymphocyte percentage 12.7% vs. 20% (p < 0.001)

● median D-dimer 0.4 mcg/mL vs. 0.2 mcg/mL (p < 0.001)
● median C-reactive protein 47.6 mg/L vs. 28.7 mg/L (p < 0.001)
● median procalcitonin 0.1 ng/mL vs. 0.05 ng/mL (p < 0.001)
● median leukocyte count 5.3 × 109 cells/L vs. 4.5 × 109 cells/L (p = 0.014)
– Reference - Allergy 2020 Feb 19 early online
RESUMEN
● DEL ESTUDIO
el patrón de reloj de arena en el diagrama de dispersión de fluorescencia diferencial de glóbulos
blancos (WDF) puede tener una alta sensibilidad y especificidad para la detección de COVID-19 en
adultos hospitalizados Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Br J Haematol 2020 15 de junio temprano en línea | PDF
Detalles
⚬ based on retrospective diagnostic cohort study without independent validation

⚬ 381 adults (median age 61 years) hospitalized in France between March 16 and April 5, 2020 with
suspected COVID-19 and symptoms for ≥ 3 days had complete blood count with WDF scattergram at
time of admission
⚬ reference standard was diagnosis by RT-PCR and chest computed tomography (CT)
– patients defined as having COVID-19 if positive on ≥ 1 RT-PCR and/or chest CT

– patients considered negative for COVID-19 if negative results of RT-PCR and chest CT
⚬ WDF scattergrams were assessed by optical microscopy
– discontinuous sandglass pattern of lymphocytes found to be associated with COVID-19

– optimal cutoff derived for COVID-19 diagnosis was sandglass lymphocyte pattern with ≥ 4 dots in
upper graduation of scattergram
⚬ 76% had COVID-19 by reference standard

⚬ 57% of patients were hospitalized, 9% admitted to intensive care unit for acute respiratory distress
syndrome
⚬ for detection of COVID-19, complete blood count with WDF scattergram had
– sensitivity 85.9%
– specificity 83.5%
– positive predictive value 94.3%
⚬ additional case-control analysis of 117 patients with confirmed pathogen was performed
– 85 patients had confirmed infection with SARS-CoV-2, 54 patients had influenza virus infection, 19
patients had Epstein-Barr virus infection, 8 patients had Mycoplasma pneumoniae infection, and 4
patients had parvovirus infection
– performance of pattern of ≥ 4 dots on WDF scattergram to differentiate patients with COVID-19
from patients with other pathogens
⚬ Reference - Br J Haematol 2020 Jun 15 early online PDF
RESUMEN
● DEL ESTUDIO
La prueba de sangre rápida FebriDx en el punto de atención tiene alta sensibilidad y especificidad
para identificar pacientes con COVID-19 Nivel DynaMed 1
ESTUDIO DE COHORTE DE DIAGNÓSTICO : J Infect 2020 Oct;81(4):607

Detalles

⚬ 251 adults (mean age 70 years) hospitalized with suspected COVID-19 between March 20 and April
12, 2020 were evaluated using FebriDx rapid point-of-care blood test for SARS-CoV-2
⚬ FebriDx detects antiviral host response using blood from fingerprick with result in ≤ 10 minutes
– myxovirus resistance protein A and C-reactive protein can be detected using 5 mcL blood
– myxovirus resistance protein A is marker of antiviral host response and not specific for COVID-19
⚬ 99% had valid FebriDx results and were included in analysis
⚬ reference standard was RT-PCR detection of SARS-CoV-2 RNA in combined nose and throat swabs
⚬ 48% of patients were positive for COVID-19 by RT-PCR
⚬ other viral infections detected included rhino/enterovirus (4%), metapneumovirus (2%), coronavirus
OC43 (2%), coronavirus HKU1 (1%) and coronavirus NL65 (1%)
⚬ performance of FebriDx for identifying patients with COVID-19
– sensitivity 93%
– specificity 86%
⚬ Reference - J Infect 2020 Oct;81(4):607 full text
Estudios de imagen
● hallazgos radiográficos pueden incluir 1
⚬ Infiltrados bilaterales en la radiografía de tórax con predominio en el lóbulo inferior

⚬ Opacidades en vidrio esmerilado periféricas, difusas, bilaterales o consolidación en la tomografía
computarizada (TC) de tórax
● los hallazgos de imágenes pueden ser normales en pacientes con COVID durante la enfermedad
temprana, incluido aproximadamente el 40% por radiografía de tórax y el 15% por TC de tórax, pero las
anomalías se desarrollarán rápidamente durante las primeras 2 semanas después del inicio de los
síntomas antes de desaparecer gradualmente 1
Imagen 5 de 5
Radiografía de tórax y tomografía computarizada COVID-19
Desai S, Baghal A, Wongsurawat T, et al. (2020). Datos de imágenes de tórax con correlatos clínicos y genómicos que
representan una población rural positiva para COVID-19 [Conjunto de datos]. El archivo de imágenes del cáncer. DOI:
https://doi.org/10.7937/tcia.2020.py71-5978. Reproducido con permiso bajo licencia Creative Commons Attribution 4.0
International.
RESUMEN
● DEL ESTUDIO
La TC de tórax puede tener una sensibilidad de moderada a buena para diagnosticar COVID-19 en
pacientes con sospecha de COVID-19 Nivel DynaMed 2
REVISIÓN COCHRANE : Cochrane Database Syst Rev 2022 16 de mayo;5:CD013639 | Texto completo
Detalles
⚬ based on Cochrane review of diagnostic studies limited by heterogeneity

⚬ systematic review of 98 diagnostic cohort studies evaluating performance of thoracic imaging (chest
CT, chest x-ray, or lung ultrasound) for diagnosing COVID-19 in children and adults
⚬ 94 studies evaluated 37,631 children and adults with suspected COVID-19
– 70 studies included only symptomatic patients, 20 studies included both symptomatic and
asymptomatic patients, and 4 studies did not report symptom status
– 57 studies included adults and adolescents ≥ 16 years old, 32 studies included patients of all ages,
1 study included only children, 1 study included only adults ≥ 70 years old, and patient age
unclear in 3 studies
– studies conducted in Europe (65 studies), Asia (19 studies), North America (7 studies), and South
America (3 studies)
⚬ reference standard was reverse transcriptase polymerase chain reaction (RT-PCR) with or without
other criteria including laboratory tests, clinical signs, and follow-up
⚬ 69 studies evaluated chest CT in 28,285 patients with suspected COVID-19
– chest CT parameters not reported in 31 studies; where reported, protocols included noncontrast
CT (25 studies), low-dose CT with or without contrast (11 studies), high-resolution chest CT (8
studies), and CT with IV contrast (5 studies)
– 11 studies evaluating chest CT used COVID-19 Reporting and Data System (CO-RADS) thresholds
to define test positivity
⚬ prevalence of COVID-19 was 51%

⚬ heterogeneity for diagnostic performance inferred from distribution of sensitivities and specificities
in receiver operating characteristics curve (see ranges below), as review did not report results of
formal statistical tests of heterogeneity
⚬ pooled performance of chest CT for diagnosis of COVID-19 in analysis of 69 studies with 28,285
patients with suspected COVID-19
– sensitivity 86.9% (95% CI 83.6%-89.6%); sensitivity across studies ranged from 34% to 100%
– specificity 78.3% (95% CI 73.7%-82.3%); specificity across studies ranged from 0% to 99%
⚬ performance of chest CT using CO-RADS thresholds for diagnosing COVID-19 in patients with
suspected COVID-19
– at CO-RADS cutoff of 4 points in analysis of 9 studies with 4,169 patients
● sensitivity 83.3% (95% CI 76.1%-88.7%)

● specificity 84% (95% CI 81.3%-86.4%)
– at CO-RADS cutoff of 5 points in analysis of 9 studies with 4,169 patients
● sensitivity 67.3% (95% CI 57.9%-75.6%)

● specificity 92.2% (95% CI 89.3%-94.3%)
⚬ Reference - Cochrane Database Syst Rev 2022 May 16;5:CD013639 full-text
RESUMEN
● DEL ESTUDIO
La TC de tórax podría ayudar a detectar COVID-19 en áreas epidémicas, pero la alta tasa de falsos
positivos puede limitar su utilidad Nivel DynaMed 2
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Radiología 2020 26 de febrero;:200642 | Texto completo
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Open Forum Infect Dis 2020 Jun;7(6):ofaa171

Detalles
⚬ based on 2 retrospective diagnostic cohort studies with possible selection bias

⚬ 1,014 children and adults aged 2-95 years (mean age 51 years, 99% > 20 years old) with suspected
COVID-19 in Wuhan, China, from January 6 to February 6, 2020, who had both chest CT and RT-PCR
from swab samples (reference standard) were assessed
– time interval between PCR and chest CT ≤ 7 days (median interval 1 day)
– prevalence of COVID-19 was 59%
– main positive chest CT findings were ground-glass opacity in 46% and consolidations in 50%;
other findings included reticulation/thickened interlobular septa and nodular lesions
– 90% had bilateral chest CT findings
– diagnostic performance of chest CT for detection of COVID-19
● sensitivity 97% (95% CI 95%-98%)

● specificity 25% (95% CI 22%-30%)
● positive predictive value 65% (95% CI 62%-68%)
● negative predictive value 83% (95% CI 76%-89%)
– Reference - Radiology 2020 Feb 26;:200642 full-text
⚬ 211 adults (median age 51 years) with suspected COVID-19 in Wuhan, China, from January 29 to
February 4, 2020, who had both chest CT and RT-PCR test for SARS-CoV-2 from nasopharyngeal or
oropharyngeal swabs (reference standard) were assessed
– time interval between RT-PCR and chest CT was ≤ 3 days
– among 64 patients with negative RT-PCR assay and CT scan suggestive of viral pneumonia, 41 had
repeat RT-PCR assay (9 with positive results) and 23 were lost to follow-up
– prevalence of COVID-19 was 52.6%
– CT diagnosis of viral pneumonia based on imaging reported in patients with COVID-19: findings
consistent with viral pneumonia were multiple, bilateral, ill-defined ground-glass opacities or
mixed consolidation with diffuse peripheral distribution (bilateral pulmonary consolidation may
be present in patients with severe disease)
– diagnostic performance of chest CT to diagnose COVID-19
● overall
⚬ specificity 45%
● in 141 patients with fever
⚬ sensitivity 100%
● in 70 patients without fever
– Reference - Open Forum Infect Dis 2020 Jun;7(6):ofaa171 full text
RESUMEN
● DEL ESTUDIO
opacidades en vidrio esmerilado bilaterales, hallazgo común en la TC de tórax en pacientes con
neumonía por COVID-19
REVISIÓN SISTEMÁTICA : J Med Virol 2020 21 de abril temprano en línea

REVISIÓN SISTEMÁTICA : AJR Am J Roentgenol 2020 14 de marzo temprano en línea
Detalles
⚬ based on 2 systematic reviews

⚬ systematic review of 34 retrospective studies evaluating 4,121 patients with COVID-19 in China

– distribution of lesions
● bilateral lesions in 73.8% (95% CI 65.9%-81.1%) in analysis of 28 studies with 2,628 patients
● multilobar lesions in 67.3% (95% CI 54.8%-78.8%) in analysis of 10 studies with 846 patients
● single lesion in 18.7% (95% CI 14.7%-23.1%) in analysis of 22 studies with 1,977 patients
● single lobe lesions in 14.9% (95% CI 9.2%-21.7%) in analysis of 9 studies with 629 patients
● normal findings in 8.4% (95% CI 4.2%-13.9%) in analysis of 13 studies with 2,195 patients
– lesion density
● ground-glass opacities in 68.1% (95% CI 56.9%-78.2%) in analysis of 26 studies with 3,574

patients
● air bronchogram sign in 44.7% (95% CI 32.9%-56.8%) in analysis of 15 studies with 1,075
patients
● crazy paving pattern in 35.6% (95% CI 11.3%-64.8%) in analysis of 4 studies with 264 patients
● consolidation in 32% (95% CI 21.5%-43.4%) in analysis of 14 studies with 1,637 patients
– lesion shape
● patchy in 40.3% (95% CI 29.8%-51.4%) in analysis of 8 studies with 2,009 patients

● spider web sign in 39.5% (95% CI 27.2%-52.6%) in analysis of 11 studies with 806 patients
● cord-like in 36.8% (95% CI 21.7%-53.4%) in analysis of 6 studies with 267 patients
● nodular in 20.5% (95% CI 6.8%-39.1%) in analysis of 8 studies with 739 patients
– accompanying signs
● pleural thickening in 27.1% (95% CI 15.6%-40.5%) in analysis of 9 studies with 1,077 patients
● lymphadenopathy in 5.4% (95% CI 2.2%-9.8%) in analysis of 8 studies with 622 patients
● pleural effusion in 5.3% (95% CI 3.7%-7.3%) in analysis of 17 studies with 1,627 patients
– Reference - J Med Virol 2020 Apr 21 early online
⚬ systematic review of 30 studies (19 cohort studies and 11 case reports) including 919 patients with
COVID-19 were evaluated
– common patterns and distribution on initial CT
● ground-glass opacities in 88% in analysis of 22 studies with 393 patients

● bilateral involvement in 87.5% in analysis of 12 studies with 497 patients
● posterior involvement in 80.4% in 1 study with 51 patients
● multilobar involvement in 78.8% in analysis of 5 studies with 137 patients
● peripheral distribution in 76% in analysis of 12 studies with 121 patients
● consolidation in 31.8% in analysis of 10 studies with 204 patients
– Reference - AJR Am J Roentgenol 2020 Mar 14 early online
RESUMEN
● DEL ESTUDIO
La puntuación CO-RADS basada en la presencia de opacidades en vidrio esmerilado en la TC de tórax
ayuda a estratificar el riesgo de infección por SARS-CoV-2 en pacientes sintomáticos y
asintomáticos Nivel DynaMed 1
REGLA DE PREDICCIÓN : Radiología 2020 10 de agosto temprano en línea | Texto completo

Detalles

⚬ 1,997 consecutive patients ≥ 14 years old admitted to hospital were assessed with chest CT and had
RT-PCR for SARS-CoV-2 infection (reference standard)
– 859 patients (median age 70 years, 52% male) had COVID-19 symptoms
– 1,138 patients (median age 68 years, 52% male) were asymptomatic for COVID-19
⚬ CT findings were classified using CO-RADS (range 1-5 points with higher score indicating greater
suspicion of SARS-CoV-2 infection)
– 1 point for normal findings
– 2 points for absence of ground glass opacities and presence of tree-in-bud signs, endobronchial
spread, or bronchiolitis
– 3 points for presence of unifocal ground glass opacities
– 4 points for presence of unilateral multifocal ground glass opacities
– 5 points for presence of multifocal bilateral ground glass opacities
⚬ prevalence of SARS-CoV-2 infection by PCR was 41.7% in symptomatic patients and 5.3% in
asymptomatic patients
Table 4. Rates of SARS-CoV-2 Infection by CO-RADs score
CO-RADS Symptomatic Patients Asymptomatic Patients

Score
Infection Total Infection Total
Rate Number of Rate Number of
Patients Patients
1 point 8.6% 313 3% 929
2 points 13.5% 89 8.2% 61
3 points 19.5% 77 11.6% 69
4 points 36.8% 68 17.8% 45
5 points 89.4% 312 32.3% 34
Abbreviation: CO-RADS, COVID-19 Reporting and Data System.
⚬ Reference - Radiology 2020 Aug 10 early online full-text

⚬ derivation of CO-RADS score can be found in Radiology 2020 Aug;296(2):E97 full-text
RESUMEN
● DEL ESTUDIO
CO-RADS en el punto de corte ≥ 4 puntos puede tener alta sensibilidad y especificidad para el
diagnóstico de COVID-19 Nivel DynaMed 2
DIAGNOSTIC COHORT STUDY: Chest 2020 Nov 30 early online | Full Text
Details

⚬ 741 adults (mean age 62 years, 56% men) presenting to emergency department with suspected
COVID-19 had chest CT and PCR for SARS-CoV-2 infection
⚬ 78.3% of patients were admitted to hospital, 11.3% were admitted to intensive care unit
⚬ comorbidities included hypertension (39%), chronic cardiovascular disease (26.6%), diabetes mellitus
(25.5%), chronic obstructive pulmonary disease (17.3%), and asthma (6.6%)
⚬ 31.7% had SARS-CoV-2 infection confirmed by PCR (reference standard)
⚬ CT findings were classified using CO-RADS (range 1-5 points with higher score indicating greater
suspicion of SARS-CoV-2 infection)
⚬ optimal cutoff derived for COVID-19 diagnosis was ≥ 4 points on CO-RADS
⚬ performance of CO-RADS with cutoff ≥ 4 points for diagnosis of COVID-19
– sensitivity 89.4% (95% CI 84.7%-93%)

– specificity 87.2% (95% CI 83.9%-89.92%)
– positive predictive value 76.4% (95% CI 71.9%-80.3%)
⚬ Reference - Chest 2020 Nov 30 early online full-text
STUDY
● SUMMARY
ground-glass opacities evident on chest CT in about one-third of children with SARS-CoV-2
infection
COHORT STUDY: N Engl J Med 2020 Apr 23;382(17):1663

Details

⚬ 171 children (median age 6 years, 61% male) with SARS-CoV-2 infection at Wuhan Children's Hospital
between January 28 and February 26, 2020 were evaluated
⚬ spectrum of illness
– pneumonia in 64.9% (111 children, of whom 12 had radiologic features of pneumonia without
symptoms)
– upper respiratory tract infection in 19.3% (33 children)
– asymptomatic infection without radiologic features of pneumonia in 15.8% (27 children)
⚬ chest CT findings included
– ground-glass opacity in 32.7%

– local patchy shadowing in 18.7%
– bilateral patchy shadowing in 12.3%
– interstitial abnormalities in 1.2%
⚬ Reference - N Engl J Med 2020 Apr 23;382(17):1663
● cohort study describing features of chest CT for diagnosis of COVID-19 in 21 adults with COVID-19
pneumonia can be found in AJR Am J Roentgenol 2021 Jan;216(1):66 full text
● CT features by severity and stage of disease
STUDY
⚬ SUMMARY
CT features may vary based on severity of disease in patients with COVID-19 pneumonia
COHORT STUDY: Eur Radiol 2020 Apr 11 early online

Details

– 120 patients (mean age 45 years, 64% female) with COVID-19 pneumonia admitted to single
hospital in Wuhan, China, between January 10 and February 10, 2020, were evaluated
● 16 patients were asymptomatic
● 74 patients had mild-moderate disease
● 30 patients had severe disease
– comparing CT features in patients with mild-moderate disease vs. severe disease
● bilateral involvement in 44% vs. 93% (p < 0.001)

● ground-glass opacities in 87% vs. 97% (not significant)
● nodules in 59% vs. 40% (p = 0.072)
● linear densities in 56% vs. 83% (p = 0.007)
● consolidation in 41% vs. 83% (p < 0.001)
● crazy paving pattern in 10% vs. 70% (p < 0.001)
● bronchiectasis in 7% vs. 27% (p = 0.007)
● effusion in 0% vs. 30% (p < 0.001)
● air bronchograms in 6% vs. 63% (p < 0.001)
● white lung in 0% vs. 67% (p < 0.001)
● involvement of all 5 lobes in 7% vs. 80% (p < 0.001)
● tree-in-bud sign in 4% vs. 17% (p = 0.042)
– comparing CT findings in patients with asymptomatic disease vs. findings in patients with
symptoms, no significant difference in individual signs, patterns, zonal predominance, or extent of
abnormalities
– Reference - Eur Radiol 2020 Apr 11 early online
STUDY
⚬ SUMMARY
CT features may vary between early and advanced phases of COVID-19 pneumonia
COHORT STUDY: AJR Am J Roentgenol 2020 Mar 5 early online

Details

– 62 adults aged 30-77 years with laboratory-confirmed COVID-19 pneumonia in Wuhan, China,
who had CT were evaluated
● 40 patients had CT ≤ 7 days after onset of symptoms (early phase)
● 22 patients had CT 8-14 days after onset of symptoms (advanced phase)
– 83.9% had multiple lesions on CT overall; peripheral distribution of lesions in 77%, peripheral and
central distribution in 23%
– CT features comparing early vs. advanced phase
● ground-glass opacities in 47.5% vs. 27.3% (p = 0.012)

● ground-glass opacities plus reticular pattern in 50% vs 86.4% (p = 0.005)
● vacuolar sign in 40% vs. 81.8% (p = 0.002)
● fibrotic streaks in 42.5% vs. 81.8% (p = 0.003)
● air bronchogram in 62.5% vs. 90.9% (p = 0.016)
– rates of subpleural line, subpleural transparent line, bronchus distortion, and pleural effusion
were significantly higher in advanced phase
– no significant differences between early and advanced phases in consolidation, microvascular
dilation sign
– Reference - AJR Am J Roentgenol 2020 Mar 5 early online
● lung ultrasound
⚬
STUDY SUMMARY
chest ultrasound may have good sensitivity and moderate specificity for diagnosing COVID-19 in
patients with suspected COVID-19 DynaMed Level 2
Details
– based on Cochrane review of diagnostic studies limited by heterogeneity

– systematic review of 98 diagnostic cohort studies evaluating performance of thoracic imaging
(chest CT, chest x-ray, or lung ultrasound) for diagnosing COVID-19 in children and adults
– 94 studies evaluated 37,631 children and adults with suspected COVID-19
● 70 studies included only symptomatic patients, 20 studies included both symptomatic and
● 57 studies included adults and adolescents ≥ 16 years old, 32 studies included patients of all
ages, 1 study included only children, 1 study included only adults ≥ 70 years old, and patient
age unclear in 3 studies
● studies conducted in Europe (65 studies), Asia (19 studies), North America (7 studies), and
South America (3 studies)
– reference standard was RT-PCR with or without other criteria including laboratory tests, clinical
signs, and follow-up
– 15 studies evaluated chest ultrasound in 2,410 patients with suspected COVID-19
– heterogeneity for diagnostic performance inferred from distribution of sensitivities and
specificities in receiver operating characteristics curve (see ranges below), as review did not report
results of formal statistical tests of heterogeneity
– pooled performance of chest ultrasound for diagnosing COVID-19 in analysis of 15 studies with
2,410 patients
● sensitivity 88.9% (95% CI 84.9%-92%); sensitivity across studies ranged from 73% to 94%
● specificity 72.2% (95% CI 58.8%-82.5%); specificity across studies ranged from 21% to 95%
– Reference - Cochrane Database Syst Rev 2022 May 16;5:CD013639 full-text
STUDY
⚬ SUMMARY
B-pattern on lung ultrasound reported in 97% of symptomatic adults with confirmed COVID-19
SYSTEMATIC REVIEW: Am J Trop Med Hyg 2020 Jun 2 early online

Details

– systematic review of 7 retrospective observational studies evaluating detection of lung
abnormalities by point-of-care lung ultrasound in 122 symptomatic adults with confirmed COVID-
19
– B-pattern defined as ≥ 3 B-lines in lung region, confluent B-lines, or white lung appearance
– pooled lung ultrasound findings
● B-pattern in 97% (95% CI 94%-100%) in analysis of all studies

● pleural line abnormalities in 70% (95% CI 13%-100%) in analysis of 5 studies
● pleural thickening in 54% (95% CI 11%-95%) in analysis of 5 studies
● subpleural or pulmonary consolidation in 39% (95% CI 21%-58%) in analysis of 6 studies
● pleural effusion in 14% (95% CI 0%-37%) in analysis of 5 studies
– Reference - Am J Trop Med Hyg 2020 Jun 2 early online

STUDY
⚬ SUMMARY
bilateral B lines on ultrasound may help diagnose COVID-19 in adults presenting to emergency
department DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Ann Emerg Med 2020 May 21 early online | Full Text
Details
– based on diagnostic cohort study with wide confidence intervals

– 391 adults (median age 62 years) presenting to emergency department with suspected COVID-19
at 1 center in France from March 9 to April 4, 2020 were assessed
● physicians rated clinical probability of COVID-19 as low, medium, or high based on history and
physical exam
● 88 patients (22.3%) had lung ultrasound
● 129 patients (33%) had chest x-ray
● reference standard for COVID-19 was RT-PCR
– COVID-19 diagnosed by RT-PCR in 57.6% overall and in 56% of patients having ultrasound
– diagnostic performance of bilateral B lines on ultrasound for diagnosis of COVID-19
● sensitivity 77% (95% CI 62%-88%)

● specificity 89% (95% CI 75%-97%)
● positive predictive value 90% (95% CI 76%-97%)
● negative predictive value 75% (95% CI 60%-87%)
– precision of diagnostic performance estimates limited by small sample size

– Reference - Ann Emerg Med 2020 May 21 early online full-text
STUDY
⚬ SUMMARY
lung ultrasound plus clinical evaluation may have high sensitivity and specificity for diagnosing
SARS-COV-2 pneumonia in adults presenting to emergency department with symptoms of SARS-
COV-2 infection DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Ann Emerg Med 2020 Oct 13 early online | Full Text
Details
– based on diagnostic cohort study with blinding of reference standard not stated
– 228 adults (median age 57 years, 51% women) presenting to emergency department with acute
symptoms of SARS-COV-2 infection (fever, dyspnea, new or worsening cough, sore throat,
diarrhea, ageusia, anosmia, and/or asthenia) were evaluated
● physician first rated probability of SARS-COV-2 pneumonia as yes or no based on clinical
evaluation (medical history, history of present illness, physical exam, and electrocardiogram)
● same physician then performed lung ultrasound and recorded SARS-COV-2 pneumonia status
as yes or no based on integrated assessment of both clinical and lung ultrasound findings
– median time from end of clinical evaluation to start of lung ultrasound was 10 minutes
– SARS-CoV-2 pneumonia defined as presence of focal or diffuse interstitial syndrome associated
with spared areas, subpleural consolidations, and irregular or thickened pleural line on lung
ultrasound
– reference standard for SARS-CoV-2 infection was RT-PCR test using nasopharyngeal swab
● patients with negative RT-PCR test but suspicious clinical, laboratory, or imaging evaluations
had RT-PCR test repeated using second nasopharyngeal swab or bronchoalveolar lavage within
72 hours from initial test
● patients with positive result on first or second RT-PCR test were considered positive for SARS-
CoV-2 infection
– 47% had SARS-CoV-2 infection by reference standard (38% were positive at first test, 9% were
positive at second test)
– diagnostic performance of clinical and lung ultrasound findings for diagnosing SARS-CoV-2
pneumonia
● specificity 95%
● positive likelihood ratio 19
● negative likelihood ratio 0.06
– integrated assessment of clinical and lung ultrasound findings correctly identified all 21 patients
with SARS-CoV-2 pneumonia and negative first nasopharyngeal RT-PCR test
– Reference - Ann Emerg Med 2020 Oct 13 early online , full-text
⚬ cohort study describing lung ultrasound risk score based on consolidations, B lines, and other
patterns for prediction of in-hospital death or intensive care unit admission in adults with COVID-19
without external validation can be found in Eur Respir J 2021 Feb 25 early online full-text
● chest x-ray
STUDY
⚬ SUMMARY
chest x-ray may have moderate sensitivity and specificity for diagnosing COVID-19 in patients
with suspected COVID-19 DynaMed Level 2
Details
– based on Cochrane review of diagnostic studies limited by heterogeneity

– systematic review of 98 diagnostic cohort studies evaluating performance of thoracic imaging
(chest CT, chest x-ray, or lung ultrasound) for diagnosing COVID-19 in children and adults
– 94 studies evaluated 37,631 children and adults with suspected COVID-19
● 70 studies included only symptomatic patients, 20 studies included both symptomatic and
● 57 studies included adults and adolescents ≥ 16 years old, 32 studies included patients of all
ages, 1 study included only children, 1 study included only adults ≥ 70 years old, and patient
age unclear in 3 studies
● studies conducted in Europe (65 studies), Asia (19 studies), North America (7 studies), and
South America (3 studies)
– reference standard was RT-PCR with or without other criteria including laboratory tests, clinical
signs, and follow-up
– 17 studies evaluated chest x-ray in 8,529 children and adults with suspected COVID-19
– heterogeneity for diagnostic performance inferred from distribution of sensitivities and
specificities in receiver operating characteristics curve (see ranges below), as review did not report
results of formal statistical tests of heterogeneity
– pooled performance of chest x-ray for diagnosis of COVID-19 in analysis of 17 studies with 8,529
patients
● sensitivity 73.1% (95% CI 64.1%-80.5%); sensitivity across studies ranged from 44% to 94%
● specificity 73.3% (95% CI 61.9%-82.2%); specificity across studies ranged from 24% to 93%
– Reference - Cochrane Database Syst Rev 2022 May 16;5:CD013639 full-text
Additional Testing
● National Institutes of Health (NIH) guideline on treatment of COVID-19 recommendations for diagnosis
of influenza and COVID-19 when influenza viruses and SARS-CoV-2 are cocirculating
⚬ only testing can distinguish between influenza virus and SARS-CoV-2 infections and identify
coinfection
⚬ when SARS-CoV-2 and influenza viruses are cocirculating, test for
– both viruses in hospitalized patients with acute respiratory illness (NIH Grade AIII)
– influenza virus in outpatients with acute respiratory illness if the results will change clinical
management (NIH Grade BIII)
⚬ testing for other pathogens should be considered on clinical circumstances

⚬ Reference - NIH COVID-19 Treatment Guideline (NIH 2021 Oct 27 )
● FDA issues Emergency Use Authorization for Quest Diagnostics RC COVID-19 + Flu RT-PCR Test (using
home-collected sample) to detect SARS-CoV-2 and influenza A and B in persons who are suspected of
respiratory viral infection consistent with COVID-19
⚬ Quest Diagnostic RC COVID-19 + Flu RT-PCR Test is first test authorized for prescription use to detect
both COVID-19 and influenza A and B with self-collected nasal swabs which are subsequently sent to
laboratory for analysis
⚬ positive test result indicates RNA from SARS-CoV-2 or influenza A and/or B was detected, and patient
is infected with SARS-CoV-2 or influenza and is presumed to be contagious
⚬ el resultado positivo de la prueba tanto para el SARS-CoV-2 como para el ARN de influenza A y/o B
indica coinfección con COVID-19 e influenza
⚬ el resultado negativo de la prueba indica que no se detectó SARS-CoV-2 y ARN de influenza A y/o B
en la muestra, pero no descarta COVID-19 o influenza
⚬ Referencia - Comunicado de prensa de la FDA 2020 4 de diciembre , Hoja de datos de la FDA para
proveedores de atención médica 2020 4 de diciembre
● Alerta De Medicamento/Dispositivo • Actualizado El 23 De Noviembre De 2022
La FDA emite una autorización de uso de emergencia para la prueba de alcoholímetro InspectIR COVID-
19 para detectar el SARS-CoV-2 en adultos con o sin síntomas u otras razones epidemiológicas para
sospechar de COVID-19
⚬ La prueba de alcoholímetro InspectIR COVID-19 es la primera prueba autorizada para detectar
compuestos químicos en muestras de aliento asociados con la infección por SARS-CoV2 mediante
cromatografía de gases-espectrometría de masas
⚬ la prueba es realizada por un operador calificado bajo la supervisión de un proveedor de atención
médica autorizado para prescribir pruebas
⚬ el resultado positivo debe tratarse como presuntivo y confirmarse con una prueba molecular
⚬ un resultado negativo no descarta la infección y debe considerarse en el contexto de los síntomas
clínicos y el historial de exposición
⚬ rendimiento basado en un estudio en 2409 adultos; para la detección de COVID-19, el alcoholímetro
InspectIR tenía
– sensibilidad 91,2%
– especificidad 99,3%
– valor predictivo negativo 99,6%
⚬ Referencias - Comunicado de prensa de la FDA 2022 14 de abril , Hoja de datos de la FDA para
proveedores de atención médica 2022 14 de abril
administración
Descripción general de la gestión
● la decisión de manejar al paciente en un entorno hospitalario o ambulatorio debe tomarse caso por
caso
⚬ los pacientes con enfermedad leve (ausencia de neumonía viral e hipoxia) a menudo no requieren
hospitalización
⚬ los pacientes con enfermedad moderada pueden requerir hospitalización según las comorbilidades
y el riesgo de progresión clínica
⚬ enfermedad grave que requiere hospitalización puede incluir síntomas de
– neumonía
– hipoxemia y síndrome de dificultad respiratoria aguda (SDRA)
– sepsis y shock séptico
– miocardiopatía
– arritmia
– Lesión renal aguda
● muchos pacientes requieren atención de apoyo, que puede incluir
⚬ tratamiento respiratorio de la hipoxemia y el síndrome de dificultad respiratoria aguda (SDRA)

⚬ soporte hemodinámico para sepsis y shock séptico
⚬ anticoagulación para tromboprofilaxis o manejo de coagulopatía
⚬ los antipiréticos son seguros para los pacientes con fiebre
● Las opciones para el manejo terapéutico incluyen:
⚬ corticosteroides
– recomendado para pacientes con COVID-19 grave o crítico

– generalmente no se recomienda para pacientes con COVID-19 no grave
– evidencia insuficiente para recomendar a favor o en contra de los corticosteroides inhalados
⚬ remdesivir
– único antiviral aprobado por la FDA para el tratamiento de COVID-19 en adultos y adolescentes
– puede ser considerado para
● pacientes no hospitalizados con COVID-19 leve-moderado con alto riesgo de progresión

● pacientes hospitalizados que no requieren oxígeno suplementario o que solo requieren
oxígeno convencional mínimo
– Se puede considerar remdesivir más dexametasona para pacientes hospitalizados que requieren
oxígeno convencional pero no un dispositivo de alto flujo, ventilación no invasiva, ventilación
mecánica o ECMO
– se puede considerar la adición de remdesivir a la dexametasona con o sin terapia
inmunomoduladora para pacientes inmunocomprometidos que requieren un dispositivo de alto
flujo o ventilación no invasiva
⚬ inmunomoduladores
– adición de baricitinib (inhibidor de la cinasa de Janus) a la dexametasona
● puede considerarse para pacientes seleccionados con oxígeno suplementario que tienen
evidencia de progresión clínica o aumento de los marcadores de inflamación, con o sin la
adición de remdesivir
● recomendado para pacientes hospitalizados que requieren oxígeno de alto flujo o ventilación
no invasiva
● puede considerarse para pacientes hospitalizados que requieren ventilación mecánica
invasiva o ECMO
– Se puede considerar la adición de tocilizmab (inhibidor de la interleucina-6) para pacientes

seleccionados con oxígeno suplementario que tienen evidencia de progresión clínica o aumento
de los marcadores de inflamación (con o sin la adición de remdesivir), pacientes hospitalizados
que requieren oxígeno de alto flujo o ventilación no invasiva, y pacientes hospitalizados que
requieren ventilación mecánica invasiva o ECMO
– se puede considerar tofacitinib si no se dispone de baricitinib o se puede considerar sarilumab si
no se dispone de tocilizumab
⚬ el nirmatrelvir/ritonavir iniciado dentro de los 5 días posteriores al inicio de los síntomas puede
considerarse para pacientes no hospitalizados con COVID-19 leve a moderado con alto riesgo de
progresión
⚬ otras opciones que se pueden considerar para pacientes ambulatorios con alto riesgo cuando
nirmatrelvir/ritonavir o remdesivir no están disponibles incluyen bebtelovimab o molnupiravir
⚬ Los medicamentos que generalmente no se recomiendan o que solo deben considerarse en el
contexto de un ensayo clínico incluyen
– plasma convaleciente
– hidroxicloroquina
– lopinavir/ritonavir
– interferones
– ivermectina
⚬ hay una variedad de medicamentos adicionales bajo investigación
● consulte Manejo de COVID-19 para obtener detalles completos sobre la atención de apoyo y el manejo
terapéutico de COVID-19
Complicaciones
coagulopatía
● anomalías en los marcadores de coagulación
⚬ la coagulopatía es uno de los factores pronósticos más significativos en pacientes con COVID-19 y se
asocia con una mayor mortalidad e ingreso a cuidados intensivos
⚬ La coagulopatía más comúnmente observada en pacientes hospitalizados con COVID-19
(coagulopatía asociada a COVID-19) se caracteriza por niveles elevados de dímero D y fibrinógeno
⚬ algunos pacientes con COVID-19 grave desarrollan coagulopatía que cumple con los criterios de la
Sociedad Internacional de Trombosis y Hemostasia (ISTH) para la coagulación intravascular
diseminada (DIC); El 71% de los pacientes que no sobrevivieron a la hospitalización reportaron haber
desarrollado CID en comparación con el 0,6% de los sobrevivientes.
● riesgo de tromboembolismo venoso asociado al hospital (TEV)
⚬ Los pacientes con COVID-19 tienen un alto riesgo de TEV, especialmente aquellos que están
inmovilizados, aquellos en cuidados intensivos y aquellos que tienen factores de riesgo adicionales
que los predisponen a TEV, como un estado inflamatorio agudo e hipoxia.
⚬ Las complicaciones trombóticas son comunes entre los pacientes ingresados en la unidad de
cuidados intensivos (UCI) por COVID-19 (reportado en 9.5%-47%), especialmente la embolia
pulmonar (EP)
● evaluación
⚬ evaluación de coagulopatía en pacientes con COVID-19
– las pruebas de laboratorio a realizar en pacientes con COVID-19 deben incluir pruebas de función
hemostásica y recuento de plaquetas; la evaluación de los marcadores de coagulación al ingreso
hospitalario puede ser útil para identificar a los pacientes que necesitan un seguimiento estrecho
– Los parámetros de coagulación anormales a buscar incluyen (en orden de importancia)
● nivel significativamente elevado de dímero D (por ejemplo, aumento de 3 a 4 veces en los

niveles de dímero D sobre el rango normal)
● tiempo de protrombina prolongado
● 9
recuento de plaquetas < 100 × 10 /L
● fibrinógeno < 2 g/L (parte de la evaluación para identificar el desarrollo de CID)
– considere evaluar a los pacientes para DIC utilizando la puntuación ISTH DIC; si la puntuación es <
5, la DIC es poco probable
– considerar la evaluación de los pacientes utilizando los criterios de coagulopatía inducida por
sepsis, lo que ayuda a identificar a los pacientes en la fase más temprana de la CID, porque estos
pacientes pueden beneficiarse de la terapia con heparina
⚬ consideraciones de evaluación para TEV
– considere la detección de trombosis venosa profunda por ultrasonido, si es posible, si los

marcadores hemostáticos son anormales
– la ecografía de las extremidades inferiores debe ser parte de la ecografía en el lugar de atención,
especialmente si el paciente presenta disfunción ventricular derecha inexplicable, hipoxemia
inexplicable o refractaria, o aquellos con sospecha de EP que no pueden someterse a pruebas de
diagnóstico; sin embargo, la ausencia de trombo en la ecografía de las extremidades inferiores
no excluye la presencia de EP
– deben adoptarse estrategias para reducir la necesidad de pruebas que generen aerosoles, como
la gammagrafía de ventilación/perfusión, para la detección de EP; esto incluye una rigurosa
evaluación de probabilidad previa a la prueba para ayudar a limitar los pacientes que son
referidos para diagnóstico por imágenes y el uso preferencial de otras modalidades de
diagnóstico por imágenes, como la angiografía pulmonar por TC (CTPA)
● tromboprofilaxis en pacientes hospitalizados por COVID-19
⚬ administrar tromboprofilaxis a todos los pacientes hospitalizados (heparina de bajo peso molecular
[HBPM], heparina no fraccionada [HNF] o fondaparinux); si la anticoagulación está contraindicada
9
(por ejemplo, recuento de plaquetas < 20-30 × 10 /L, fibrinógeno < 0,5 g/L o sangrado activo), los
pacientes deben tratarse con compresión de piernas.
⚬ se debe administrar tromboprofilaxis a todos los pacientes hospitalizados con COVID-19 incluso en
el contexto de pruebas de coagulación anormales en ausencia de sangrado; PT anormal o tiempo de
tromboplastina parcial activado no es una contraindicación para la tromboprofilaxis farmacológica
⚬ todos los pacientes completamente inmovilizados pueden beneficiarse de la compresión neumática
intermitente además de la profilaxis farmacológica
⚬ debido a las interacciones farmacológicas entre los tratamientos antivirales y los anticoagulantes
orales directos (DOAC) y la dificultad de monitorear y mantener estables los INR mientras reciben
antagonistas de la vitamina K (AVK), los pacientes que toman DOAC o AVK deben considerar
cambiar/pasar a HBPM o HNF con o sin profilaxis mecánica durante la enfermedad
⚬ dosificación de anticoagulantes
– en adultos no embarazadas hospitalizados que no requieren el nivel de cuidado de la UCI con un

nivel de dímero D que está por encima del límite superior de lo normal, requieren un flujo bajo
de oxígeno y no tienen un mayor riesgo de sangrado
● considere heparina en dosis terapéuticas (HBPM o UFH)
● si no se administra heparina en dosis terapéuticas, use heparina en dosis profiláctica, a menos
que esté contraindicado
● no use anticoagulantes orales en dosis terapéuticas excepto en un ensayo clínico
– en adultos no embarazadas hospitalizados en la UCI, incluidos los que reciben oxígeno de alto
flujo
● administrar heparina en dosis profiláctica a menos que esté contraindicado
● No se sugiere heparina en dosis intermedia (por ejemplo, enoxaparina 1 mg/kg/día) ni
anticoagulación en dosis terapéuticas, excepto en ensayos clínicos.
● si se inició la heparina en dosis terapéuticas mientras se recibía oxígeno de bajo flujo y luego
se transfirió a la UCI, considere cambiar de heparina en dosis terapéuticas a profilácticas a
menos que se haya confirmado TEV
⚬ duración de la tromboprofilaxis
– se debe administrar anticoagulación a dosis profiláctica durante toda la hospitalización; si está en

dosis terapéuticas de heparina (y no ha desarrollado TEV), el tratamiento debe continuar durante
14 días o hasta el alta del hospital, lo que ocurra primero
– Por lo general, no se sugiere la administración rutinaria de tromboprofilaxis prolongada posterior
al alta.
– considere la tromboprofilaxis extendida en pacientes con alto riesgo de TEV (por ejemplo,
pacientes con movilidad reducida, antecedentes de TEV, con condiciones coexistentes como
cáncer, nivel de dímero D > 2 veces el nivel superior de lo normal y edad ≥ 75 años) si el riesgo de
sangrado es bajo; considerar rivaroxabán durante 31-39 días
● manejo de pacientes con COVID-19 que desarrollan coagulopatía
⚬ considerar dosis profiláctica de HBPM

⚬ los resultados anormales de la coagulación (tiempo de protrombina prolongado o tiempo de
tromboplastina parcial activado) no requieren corrección en pacientes que no están sangrando
⚬ considere seguir la estrategia de terapia de transfusión de sangre para pacientes con coagulopatía
séptica
⚬ si la coagulopatía empeora, se deben administrar hemoderivados
– 9
en pacientes que no sangran, el objetivo es mantener el recuento de plaquetas > 25 × 10 /L
– en pacientes que están sangrando, el objetivo es mantener
● 9
recuento de plaquetas > 50 × 10 /L
● fibrinógeno > 1,5 g/L
● Relación PT < 1,5 (no igual que INR)
⚬ manejo de la coagulación intravascular diseminada (CID)
– El aspecto más importante del manejo de la CID es el tratamiento de la afección subyacente, lo

que hace que el manejo de la CID sea especialmente difícil en pacientes con COVID-19
– manejo del sangrado
● 9
si el recuento de plaquetas es < 50 × 10 /L, considere la transfusión de plaquetas (1 dosis
para adultos)
● si el INR es > 1,8, considerar plasma fresco congelado (4 unidades)
● si el sangrado continúa y el nivel de fibrinógeno es < 1,5 g/L, considere crioprecipitado (10
unidades) o concentrado de fibrinógeno (si está aprobado para su uso) generalmente
administrado en dosis de 4 g
– en pacientes con hemorragia grave, considere concentrado de complejo de protrombina de 4
factores (por ejemplo, 25 unidades/kg) en lugar de plasma para reducir el aumento del estado de
volumen, que puede estar asociado con compromiso respiratorio
● manejo de pacientes que desarrollan TEV
⚬ Por lo general, se prefieren los anticoagulantes parenterales (UFH o LMWH) debido a la falta de
interacciones farmacológicas conocidas (por ejemplo, con las terapias para la COVID-19)
⚬ Los DOAC tienen la ventaja de que no necesitan monitoreo y facilitan la planificación del alta y el
manejo ambulatorio; pero los riesgos incluyen deterioro clínico y dificultad con la reversión
oportuna de la anticoagulación en algunos hospitales
⚬ en pacientes que están listos para el alta o que no fueron hospitalizados, se pueden preferir ACOD,
HBPM o AVK debido a que se necesita un contacto más limitado con los pacientes en comparación
con otros anticoagulantes
⚬ in patients with PE, current guideline recommendations for the general population should be
followed for reperfusion strategies
⚬ recurrent VTE despite anticoagulation
– if on therapeutic weight-adjusted LMWH (with documented compliance), consider increasing dose

by 25%-30%
– if on DOACs (with documented compliance) or VKA (within therapeutic range), consider switching
to therapeutic weight-adjusted LMWH
● additional considerations in specific patient populations
⚬ patients already receiving antithrombotic therapy for pre-existing conditions (for example, VTE or
atrial fibrillation) should continue with these medications but may need to be held if platelet count is
< 30-50 × 109/L or if fibrinogen level is < 1 g/L
⚬ patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) or continuous
renal replacement therapy or who have thrombosis of catheters or extracorporeal filters should
have antithrombotic therapy per standard of care for patients without COVID-19
⚬ in pregnant women, administer VTE prophylaxis similarly to those who are not pregnant; continue
with antithrombotic therapy if already prescribed for another indication
● see COVID-19-associated Coagulopathy for details
Neurologic Complications
● serious neurologic complications are infrequent and diverse
● reported complications include
⚬ stroke (usually ischemic due to hypercoagulable state, hemorrhagic is less common)

⚬ encefalitis y/o meningitis con manifestaciones clínicas variadas que incluyen alteración del estado
mental, síntomas psicóticos, signos de irritación meníngea, respuesta plantar extensora, disfagia,
disartria y deterioro bulbar
⚬ mialgia/miositis incluyendo rabdomiolisis en algunos pacientes
⚬ Síndorme de Guillain-Barré
⚬ encefalomielitis diseminada aguda (ADEM)
⚬ encefalopatía necrotizante hemorrágica aguda
⚬ otras formas de debilidad de las extremidades
⚬ ataxias
● Referencias - 2 , J Neurovirol 2020 Apr;26(2):143 texto completo , J Neurol 2020 11 de junio

temprano en línea texto completo
RESUMEN
● DEL ESTUDIO
la hiposmia, la hipogeusia, la mialgia y el dolor de cabeza pueden ser las manifestaciones
neurológicas más comunes de COVID-19
REVISIÓN SISTEMÁTICA : Crit Care 2020 Jul 13;24(1):421 | Texto completo

Detalles

⚬ systematic review of 37 cohort studies, case reports, or case series evaluating neurological
manifestations of COVID-19
⚬ neurological manifestations included
– smell disorders in 59% of patients in 5 studies

– taste disorders in 56% of patients in 4 studies
– myalgia in 25% of patients in 7 studies
– headache in 20% of patients in 8 studies
– ischemic stroke in 2.8%-5% of patients in 2 studies
– encephalopathy/hypoxic encephalopathy in 2.6%-8.8% of patients in 2 studies
⚬ Reference - Crit Care 2020 Jul 13;24(1):421 full-text
RESUMEN
● DEL ESTUDIO
74 % de recuperación del sentido del olfato y 79 % de recuperación del sentido del gusto después de
30 días y 90 % de recuperación para ambos a los 90 días informados en adultos con disfunción del
olfato y el gusto relacionada con COVID-19
REVISIÓN SISTEMÁTICA : BMJ 2022 27 de julio; 378: e069503 | Texto completo

Detalles
⚬ based on noncomparative data in systematic review of observational studies

⚬ systematic review of 86 observational studies evaluating incidence and prognostic factors for COVID-
19-related persistent dysfunction of smell and taste in adults
– 18 studies (9 retrospective and 9 prospective cohorts) with 3,699 patients included in
reconstructed individual patient data meta-analyses
– 68 studies included in aggregate data meta-analyses
⚬ in individual patient data meta-analyses
– estimated incidence of persistent self-reported dysfunction
● 5.6% for sense of smell (95% CI 2.7%-11%, 95% prediction interval 0.7%-33.5%) in analysis of 10
studies
● 4.4% for sense of taste (95% CI 1.2%-14.6%, 95% prediction interval 0%-49%) in analysis of 5
studies
– median time to recovery
● 14.9 days for sense of smell (95% CI 12.7 to 20.3 days)

● 12.4 days for sense of taste (95% CI 10.3 to 16.3 days)
– sense of smell recovery in
● 74.1% at 30 days (95% Cl 64%-81.3%)

● 85.8% at 60 days (95% Cl 77.6%-90.9%)
● 90% at 90 days (95% Cl 83.3%-94%)
● 95.7% at 180 days (95% Cl 89.5%-98.3%)
– sense of taste recovery in
● 78.8% at 30 days (95% Cl 70.5%-84.7%)

● 87.7% at 60 days (95% Cl 82%-91.6%)
● 90.3% at 90 days (95% Cl 83.5%-94.3%)
● 92% at 120 days (95% CI 86%-96%)
● 97% at 150 days (95% CI 93%-99%)
● 98% at 180 days (95% Cl 92.2%-100%)
⚬ in aggregate data meta-analysis
– factors associated with decreased likelihood of smell recovery included
● female sex (odds ratio [OR] 0.52, 95% CI 0.37-0.72) in analysis of 7 studies
● higher severity of smell dysfunction (OR 0.48, 95% CI 0.31-0.73) in analysis of 5 studies
● nasal congestion (OR 0.42, 95% CI 0.18-0.97) in analysis of 3 studies
– female sex associated with decreased likelihood of taste recovery (OR 0.31, 95% CI 0.13-0.72) in
analysis of 7 studies
– no significant association of age and smoking with likelihood of smell recovery
⚬ Reference - BMJ 2022 Jul 27;378:e069503 full-text
RESUMEN
● DEL ESTUDIO
en comparación con otras infecciones respiratorias, infección por COVID-19 o SARS-CoV-2 asociada
con un mayor riesgo de diagnóstico neurológico o psiquiátrico dentro de los 6 meses
ESTUDIO DE COHORTE : Lancet Psychiatry 2021 1 de abril temprano en línea | Texto completo
Detalles

⚬ 236,379 patients > 10 years old (mean age 46 years, 56% women, 57% White) with COVID-19 or SARS-
CoV-2 infection were compared to 236,038 propensity score-matched control patients without
COVID-19 or SARS-CoV-2 infection who had a respiratory tract infection (control)
– all patients had index diagnosis on or after January 20, 2020, and were alive as of December 13,
2020
– patient data from electronic health records from 62 healthcare organizations, mostly in the
United States
– patients excluded if they were previously diagnosed with chronic neurologic disease such as
Parkinson disease or dementia
– propensity score based on factors associated with increased risks of COVID-19 and severe COVID-
19, including socioeconomic and demographic characteristics, cardiovascular risk factors, chronic
conditions, and altered immune function
⚬ neurologic or psychiatric diagnosis within 6 months in 33.6% of patients with COVID-19 or SARS-CoV-
2 infection (hazard ratio [HR] 1.16, 95% CI 1.14-1.17 vs. control patients), including
– mood, anxiety, or psychotic disorder in 23.98% (HR 1.2, 95% CI 1.18-1.23)
– substance use disorder in 6.58% (HR 1.09, 95% CI 1.05-1.12)
– insomnia in 5.42% (HR 1.15, 95% CI 1.1-1.2)
– nerve, nerve root, or plexus disorder in 2.85% (HR 1.27, 95% CI 1.19-1.35)
– ischemic stroke in 2.1% (HR 1.45, 95% CI 1.36-1.55)
– dementia, intracranial hemorrhage, myoneural junction or muscle disease, parkinsonism,
encephalitis, and Guillain-Barre syndrome (each in < 1% and with increased HR compared to
control patients)
⚬ COVID-19 or SARS-CoV-2 infection also associated with increased risks of first diagnoses of
– mood, anxiety, or psychotic disorder (in 8.63%; HR 1.48, 95% CI 1.42-1.55)

– insomnia (in 2.53%; HR 1.43, 95% CI 1.34-1.54)
– ischemic stroke (in 0.76%; HR 1.63, 95% CI 1.44-1.85)
– intracranial hemorrhage (in 0.28%; HR 1.56, 95% CI 1.27-1.92)
⚬ among patients with COVID-19 or SARS-CoV-2 infection, any and first neurologic or psychiatric
diagnosis is also more likely if hospital admission, intensive therapy unit admission, or
encephalopathy
⚬ Reference - Lancet Psychiatry 2021 Apr 1 early online full-text
RESUMEN
● DEL ESTUDIO
La infección por SARS-CoV-2 puede estar asociada con un mayor riesgo de parálisis de Bell,
encefalomielitis y síndrome de Guillain-Barre en adultos no vacunados contra COVID-19 en el Reino
Unido y España desde septiembre de 2020 hasta junio de 2021
ESTUDIO DE COHORTE : BMJ 2022 16 de marzo; 376: e068373

Detalles
⚬ based on 2 population-based cohort studies

⚬ adults who had positive polymerase chain reaction (PCR) or antigen test for SARS-CoV-2 before
COVID-19 vaccination in the United Kingdom and Spain were compared to adults from general
population to evaluate association between SARS-CoV-2 infection and risks of Bell palsy,
encephalomyelitis, Guillain-Barre syndrome, and transverse myelitis
⚬ analysis included
– the United Kingdom cohort: 447,233 unvaccinated adults (median age 41 years, 54% female) with
SARS-CoV-2 infection between September 1, 2020 and May 8, 2021 and 9,651,568 adults (median
age 48 years, 50% female) from general population in Clinical Practice Research Datalink AURUM
database enrolled since 2017
– Spain cohort: 288,637 unvaccinated adults (median age 46 years, 53% female) with SARS-CoV-2
infection between September 1, 2020 and June 23, 2021 and 4,678,512 adults (median age 47
years, 51% female) from general population in Information System for Research in Primary Care
database enrolled since 2017
⚬ standardized incidence ratio (SIR) estimated by comparing observed incident rate up to 90 days after
SARS-CoV-2 infection in unvaccinated adults to expected background incidence rate estimated from
general population cohort
⚬ incidence rates per 100,000 person-years comparing observed vs. expected in the United Kingdom
cohort
– 53 vs. 39.8 (SIR 1.33, 95% CI 1.02-1.74) for Bell palsy
– 11 vs. 1.6 (SIR 6.89, 95% CI 3.82-12.44) for encephalomyelitis
– 9 vs. 2.6 (SIR 3.53, 95% CI 1.83-6.77) for Guillain-Barre syndrome
– < 5 vs. 1.9 (SIR not estimated) for transverse myelitis
⚬ consistent results in Spain cohort

⚬ Reference - BMJ 2022 Mar 16;376:e068373 , editorial can be found in BMJ 2022 Mar 16;376:o522
RESUMEN
● DEL ESTUDIO
encefalopatía al inicio de la COVID-19 en el 1,8 % y en cualquier momento durante el curso de la
COVID-19 en el 32 % de los pacientes hospitalizados por la COVID-19 y se asocia con un mayor riesgo
de malos resultados
ESTUDIO DE COHORTE : Ann Clin Transl Neurol 2020 Nov;7(11):2221 | Texto completo
Detalles

⚬ 509 adults (mean age 58 years, 55% men, 53% White) hospitalized in Northwestern Medicine
Healthcare system in Chicago, Illinois, between March 5 and April 6, 2020, were evaluated
– severe COVID-19 requiring mechanical ventilation in 26.3% of patients
– favorable functional outcome at discharge (modified Rankin Score 0-2) in 71%
– 30-day mortality 9.1%
⚬ encephalopathy at COVID-19 onset in 1.8% and during any point of COVID-19 course in 31.8%
⚬ factors associated with increased risk of encephalopathy in multivariable analysis
– severe COVID-19 (adjusted OR 131, 95% CI 61.2-310)

– chronic kidney disease (adjusted OR 3.76, 95% CI 1.65-8.65)
– history of any neurologic disorder (adjusted OR 3.33, 95% CI 1.72-6.6)
– older age (adjusted OR 1.06, 95% CI 1.04-1.08/year)
– reduced time from COVID-19 symptoms to hospitalization (adjusted OR 0.91, 95% CI 0.85-0.97)
– reduced white blood cell count (adjusted OR 0.97, 95% CI 0.93-0.99)
⚬ encephalopathy associated with
– reduced likelihood of favorable functional outcome at discharge (modified Rankin Score 0-2) in
multivariable analysis
● adjusted OR 0.2 (95% CI 0.1-0.4)
● other factors associated with reduced risk were severe COVID-19, older age, male sex, pre-
existing neurologic disorders, and admission to non-academic medical center
– increased 30-day mortality (adjusted OR 2.9, 95% CI 1.2-7.6) in analysis adjusted for severe COVID-
19, age, and admission to academic medical center
⚬ Reference - Ann Clin Transl Neurol 2020 Nov;7(11):2221 full-text
RESUMEN
● DEL ESTUDIO
presencia de delirio al ingreso informado en el 24 % y delirio incidente durante la hospitalización
informado en el 32 % de los adultos hospitalizados con COVID-19, y el delirio asociado con una
mayor mortalidad
REVISIÓN SISTEMÁTICA : Edad Envejecimiento 2021 12 de mayo temprano en línea

Detalles

⚬ systematic review of 48 observational studies (37 retrospective and 11 prospective studies)
evaluating prevalence or incidence of delirium or delirium-related mortality in 11,553 adults with
COVID-19
– most studies conducted in hospitalized patients (setting was nursing home [3 studies] and unclear
[2 studies], and mixed hospital ward and outpatient, geriatric institute, and outpatient in 1 study
each)
– studies conducted in 13 countries (Spain, France, the United Kingdom, Italy, Scotland, Switzerland,
Belgium, Norway, Sweden, Tunisia, Brazil, China, and the United States)
⚬ presence of delirium at admission (all results limited by significant heterogeneity)
– 24% (95% CI 19%-30%) overall in analysis of 39 studies with 9,031 adults

● 28% (95% CI 24%-33%) in analysis of 25 studies with 5,490 adults ≥ 65 years old
● 16% (95% CI 9.2%-24%) in analysis of 12 studies with 3,293 adults < 65 years old
– 45% (95% CI 30%-61%) in analysis of 5 studies with 398 adults with dementia
⚬ incident delirium during hospitalization (all results limited by significant heterogeneity)
– 32% (95% CI 21%-45%) overall in analysis of 16 studies with 3,923 adults
● 25% (95% CI 16%-36%) in analysis of 13 studies with 3,505 adults ≥ 65 years old
● 71% (95% CI 58%-83%) in analysis of 3 studies with 418 adults < 65 years old
– 30% (95% CI 3.2%-69%) in analysis of 3 studies with 195 adults with dementia
⚬ delirium associated with increased mortality (odds ratio 3.2, 95% CI 2.1-4.8) in analysis of 19 studies
with 6,457 adults, results limited by significant heterogeneity
⚬ Reference - Age Ageing 2021 May 12 early online
● El COVID-19 grave puede estar asociado con miositis en pequeñas series de autopsias ( JAMA Neurol
2021 11 de junio temprano en línea )
● Se pueden encontrar revisiones de informes de casos de mielitis transversa después de COVID-19 en
⚬ Frente Immunol 2021;12:653786

⚬ Eur J Neurol 2021 1 de junio temprano en línea
Síndrome post-agudo de COVID-19 (PACS) (COVID largo)

Presentación clínica de COVID largo
● PACS también se conoce como COVID prolongado o secuelas post-agudas de COVID-19 (PASC) y los
pacientes se conocen comúnmente como transportistas prolongados en los medios de comunicación
generales.
⚬ Los síntomas persistentes informados después de la recuperación incluyen
– fatiga o debilidad muscular

– dolor en las articulaciones
– Dolor de pecho
– palpitaciones
– dificultad para respirar
– tos
– lesión cardiopulmonar incluyendo
● trastorno cerebrovascular
● arritmia
● enfermedad inflamatoria del corazón
● enfermedad isquémica del corazón
● insuficiencia cardiaca
● enfermedad tromboembólica
– síntomas neurológicos y psiquiátricos que incluyen
● dolor de cabeza
● cambios en la visión
● pérdida de la audición
● problemas de movilidad
● entumecimiento en las extremidades
● Sindrome de la pierna inquieta
● temblores
● pérdida de memoria
● deterioro cognitivo
● dificultades para dormir
● problemas con la concentracion
● cambios de humor
● pérdida del gusto o del olfato
● ansiedad
● depresión
– diabetes mellitus tipo 2 de nueva aparición
⚬ Se ha informado PACS en pacientes embarazadas, aunque no está claro si es más común durante el
embarazo o si hay efectos únicos a largo plazo.
⚬ Referencia - Pauta de tratamiento NIH COVID-19 ( NIH 2022 Sep 26 )
● Definición de caso clínico de la Organización Mundial de la Salud (OMS) de condición post COVID-19
⚬ La condición posterior a COVID-19 ocurre en personas con antecedentes de infección por SARS-CoV-
2 probable o confirmada, generalmente 3 meses después del inicio de COVID-19
⚬ los síntomas pueden
– últimos ≥ 2 meses
– afectan el funcionamiento diario e incluyen fatiga, dificultad para respirar y función cognitiva
– persistir desde el inicio de la enfermedad o tener un nuevo inicio después de la recuperación
inicial
– fluctuar o recaer con el tiempo
⚬ los síntomas no pueden ser explicados por un diagnóstico alternativo

⚬ Referencia - Definición de caso clínico de la OMS de condición post COVID-19 por un consenso de
Delphi ( OMS 6 de octubre de 2021 )
RESUMEN
● DEL ESTUDIO
COVID-19 asociado con una mayor persistencia de síntomas somáticos que incluyen ageusia o
anosmia y músculos dolorosos entre 90 y 150 días después del diagnóstico en adultos en los Países
Bajos
ESTUDIO DE COHORTE : Lancet 2022 6 de agosto; 400 (10350): 452 | Texto completo
Detalles
⚬ based on prospective population-based cohort study

⚬ 76,422 adults (mean age 53 years, 61% female) in Lifelines COVID-19 prospective cohort study in
northern region of the Netherlands who completed 883,973 digital questionnaires at 24 time points
between March 2020 and August 2021 were evaluated
⚬ 4,231 persons (mean age 52 years, 66% female) who had first-time COVID-19 were matched to 8,462
controls without COVID-19
– median follow-up was 101 days after diagnosis in persons with COVID-19 and 104 days after
matched time point in controls
– median number of questionnaires completed was 17 for female persons and 18 for male persons
among COVID-19 cases and 20 for controls
– COVID-19 diagnosis method was positive SARS-CoV-2 test (78.8%) or diagnosis made by physician
(21.2%)
⚬ during each survey, severity of 23 somatic symptoms in prior 1-2 weeks was assessed using ordinal
Likert scale (range 1-5 points, with higher scores indicating greater severity and 3 points indicating
moderate severity)
⚬ for each person, mean severity scores per symptom were calculated before and after COVID-19
diagnosis or matched time point (excluding week before diagnosis)
⚬ persistence of symptoms was assessed by calculating relative increase in incidence of symptoms at
90-150 days after COVID-19 diagnosis (or matched time point) compared to period preceding
diagnosis
⚬ substantial increase in symptom severity was defined as increase of ≥ 1 point in severity score
⚬ ≥ 1 symptom of at least moderate severity (score ≥ 3 points) at 90-150 days reported in 40.7% of
patients with COVID-19 vs. 29.3% of controls (p < 0.001); painful muscles was the most common
symptom in both groups
⚬ adjusted rates of substantial increase in symptom severity to at least moderate severity at 90-150
days comparing patients with COVID-19 vs. controls (p < 0.001 for all)
– ≥ 1 symptom in 29.6% vs. 18.1%
– ageusia or anosmia in 7.6% vs. 0.4%
– painful muscles in 7.3% vs. 3.2%
– general tiredness in 4.9% vs. 2.1%
– heavy arms or legs in 4.2% vs. 1.6%
– tingling extremities in 2.9% vs. 1.6%
– feeling hot and cold alternately in 2.5% vs. 1.7%
– lump in throat in 2.4% vs. 0.6%
– difficulties with breathing in 2.4% vs. 0.5%
– chest pain in 2.4% vs. 0.6%
– pain when breathing in 0.9% vs. < 0.2%
⚬ no significant difference between groups at 90-150 days in substantial increase in severity of

symptoms to at least moderate severity for headache, dizziness, back pain, nausea, runny nose, sore
throat, dry cough, wet cough, fever, diarrhea, stomach pain, sneezing, or itchy eyes
⚬ Reference - Lancet 2022 Aug 6;400(10350):452 full-text , editorial can be found in Lancet 2022
Aug 6;400(10350):411
RESUMEN
● DEL ESTUDIO
fatiga informada en 23%-28% a las 16-20 semanas después del inicio de los síntomas en pacientes
hospitalizados por COVID-19
REVISIÓN SISTEMÁTICA : Open Forum Infect Dis 2021 Oct;8(10):ofab440 | Texto completo
Detalles

⚬ systematic review of 21 observational studies reporting on prevalence of fatigue for ≥ 21 days after
symptom onset in 7,639 patients with COVID-19
⚬ 15 studies included patients who had been admitted to the hospital, 6 included both hospitalized
and nonhospitalized patients, and 10 studies included patients who were admitted to intensive care
unit (ICU)
⚬ median rates of patients with fatigue in analysis of patients who completed follow-up
– 50% at 4-7 weeks in analysis of 4 studies

– 28% at 16-20 weeks in analysis of 5 studies (4 studies included hospitalized patients and 1 study
included both hospitalized and nonhospitalized patients)
– 34% at 28 weeks in 1 study
⚬ median rate of patients with fatigue in analysis of all patients (including those who refused, were lost
to follow-up, or died)
– 32% at 28 weeks in 1 study
⚬ rates of patients unable to return to work
– 40% at 2 months in 1 study

– 31% at 3 months in 1 study
– 9%-15% at 4 months in 1 study each
⚬ 15 observational studies reported on chronic fatigue after other acute infections

⚬ Reference - Open Forum Infect Dis 2021 Oct;8(10):ofab440 full-text
RESUMEN
● DEL ESTUDIO
1 año después del tratamiento de cuidados intensivos por COVID-19, el 67 % puede tener problemas
físicos nuevos o empeorados, el 26 % puede tener síntomas de salud mental y el 16 % puede tener
síntomas cognitivos
ESTUDIO DE COHORTE : JAMA 2022 24 de enero temprano en línea

Detalles

⚬ 246 patients (mean age 61 years, 71.5% male) who were admitted to ICU for COVID-19 in the
Netherlands from March 2020 to July 2020 and completed follow-up questionnaire at 1 year were
assessed
⚬ 74.3% reported ≥ 1 physical symptom
– new or worsened physical problems in 67.1%
● weakened condition in 38.9%

● joint stiffness in 26.3%
● joint pain in 25.5%
● muscle weakness in 24.8%
● myalgia in 21.3%
● dyspnea in 20.8%
– frailty (Clinical Frailty Scale score ≥ 5 points) in 6.1%

– fatigue (fatigue subscale score ≥ 27 points on Checklist Individual Strength) in 56.1%
⚬ 26.2% had ≥ 1 mental health symptom
– depression in 18.3%
– anxiety in 17.9%
– posttraumatic stress disorder in 9.8%
⚬ 16.2% had cognitive symptoms (Cognitive Failure Questionnaire-14 score ≥ 43 points)

⚬ 57.8% of patients who were employed prior to ICU admission reported work limitations (reduced
work time or still on sick leave)
⚬ Reference - JAMA 2022 Jan 24 early online
● Evidencia • Actualizado El 26 De Octubre De 2022
RESUMEN DEL ESTUDIO

3 meses después de la infección sintomática por SARS-CoV-2, se informaron grupos prolongados de
síntomas de COVID en un 6,2 % en general (problemas respiratorios continuos en un 3,7 %, fatiga
persistente en un 3,2 % y problemas cognitivos en un 2,2 %) y parecen ser más comunes en mujeres
adultos que en los adultos masculinos
ESTUDIO DE COHORTE : JAMA 2022 25 de octubre; 328 (16): 1604

Detalles
⚬ based on pooled analysis of cohort studies and medical record databases

⚬ pooled analysis of 44 published cohort studies, 10 collaborating cohorts with individual patient data,
and 2 United States medical record databases from 22 countries reporting occurrence of 3 selected
long COVID symptom clusters (persistent fatigue with bodily pain or mood swings, cognitive
problems [forgetfulness or difficulty concentrating], or ongoing respiratory problems [shortness of
breath and persistent cough as main symptoms]) at 3 months after symptomatic SARS-CoV-2
infection in 2020 and 2021
– 44 cohort studies included 10,501 hospitalized patients and 42,891 nonhospitalized patients
– 10 collaborating cohorts included 10,526 hospitalized patients and 1,906 nonhospitalized patients
– medical record databases included 250,928 hospitalized patients and 846,046 nonhospitalized
patients
⚬ mean age ranged from 4 to 66 years across data sources

⚬ estimated proportion of patients with ≥ 1 of 3 self-reported long COVID symptom clusters among
survivors at 3 months after symptom onset
– 6.2% overall (95% uncertainty interval [UI] 2.4%-13%)
● 3.7% for ongoing respiratory problems (95% UI 0.9%-9.6%)

● 3.2% for persistent fatigue with bodily pain or mood swings (95% UI 0.6%-10%)
● 2.2% for cognitive problems (95% UI 0.3%-7.6%)
– by sex or age
● 10.6% among female adults ≥ 20 years old (95% UI 4.3%-22%, p < 0.05 vs. male adults ≥ 20
years old, p < 0.05 vs. all patients < 20 years old)
● 5.4% among male adults ≥ 20 years old (95% UI 2.2%-11.7%, p < 0.05 vs. all patients < 20 years
old)
● 2.8% among all patients < 20 years old (95% UI 0.9%-7%)
⚬ estimated 15% of patients with long COVID 3 months after symptom onset (95% UI 10%-21%)
continued to experience symptoms at 12 months
⚬ Reference - JAMA 2022 Oct 25;328(16):1604
● Evidencia • Actualizado El 26 De Octubre De 2022
RESUMEN DEL ESTUDIO

3 meses después de la infección sintomática por SARS-CoV-2, se informaron grupos prolongados de
síntomas de COVID en el 27,5 % de los pacientes hospitalizados en la sala general, el 43 % de los
pacientes ingresados en la UCI y el 5,7 % de los pacientes no hospitalizados, con una duración media
prolongada de los síntomas de COVID de 9 meses para pacientes hospitalizados y 4 meses para
pacientes no hospitalizados

Detalles
⚬ based on pooled analysis of cohort studies and medical record databases

⚬ pooled analysis of 44 published cohort studies, 10 collaborating cohorts with individual patient data,
and 2 United States medical record databases from 22 countries reporting occurrence of 3 selected
long COVID symptom clusters (persistent fatigue with bodily pain or mood swings, cognitive
problems [forgetfulness or difficulty concentrating], or ongoing respiratory problems [shortness of
breath and persistent cough as main symptoms]) at 3 months after symptomatic SARS-CoV-2
infection in 2020 and 2021
– 44 cohort studies included 10,501 hospitalized patients and 42,891 nonhospitalized patients
– 10 collaborating cohorts included 10,526 hospitalized patients and 1,906 nonhospitalized patients
– medical record databases included 250,928 hospitalized patients and 846,046 nonhospitalized
patients
⚬ mean age ranged from 4 to 66 years across data sources

⚬ estimated proportion of patients with ≥ 1 of 3 self-reported long COVID symptom clusters among
survivors at 3 months after symptom onset 6.2% overall (95% UI 2.4%-13.3%)
– 27.5% in patients hospitalized in general ward (95% UI 12%-47.8%)
● 34.8% among female patients (95% UI 16.5%-57%)

● 21.6% among male patients (95% UI 8.9%-40%)
– 43% in patients admitted to ICU (95% UI 22.6%-65%)
● 51.9% among female patients (95% UI 29.7%-73.6%)

● 35.8% among male patients (95% UI 17%-58%)
– 5.7% in nonhospitalized patients (95% UI 1.9%-13.1%)
● 9.9% among female adults ≥ 20 years old (95% UI 3.4%-21%)

● 4.8% among male adults ≥ 20 years old (95% UI 1.5%-11%)
● 2.7% among all patients < 20 years old (95% UI 0.8%-6.7%)
⚬ estimated mean duration of long COVID symptom cluster
– 9 months (95% UI 7-12 months) in analysis of 6 studies with 8,660 hospitalized patients
– 4 months (95% UI 3.6-4.6 months) in analysis of 4 studies with 4,918 nonhospitalized patients
● systematic review of 24 observational studies evaluating post-COVID pain symptoms of musculoskeletal

origin in hospitalized or nonhospitalized patients who recovered from COVID can be found in Pain 2022
Jul 1;163(7):1220
STUDY
● SUMMARY
≥ 1 symptom consistent with PASC reported in 55% of adults at median 4.9 months after symptom
onset
COHORT STUDY: Ann Intern Med 2022 Jul;175(7):969

Details

⚬ 189 adults (median age 50 years, 78% White, 11% Black, 7% Asian) recovering from laboratory-
confirmed SARS-CoV-2 infection ≥ 6 weeks after onset of COVID-19 symptoms between June 30, 2020
and July 1, 2021 were assessed
– persons were enrolled regardless of presence of PASC, defined as any symptom or medical
condition that began or worsened after onset of COVID-19 illness (or first positive reverse
transcriptase polymerase chain reaction [RT-PCR] result in those with asymptomatic infection)
and was still present at study enrollment
– median time between acute COVID-19 symptom onset and enrollment was 4.9 months
– 12% were hospitalized during acute illness and 6% required supplemental oxygen
– 2.6% were asymptomatic (enrolled ≥ 4 weeks after first positive SARS-CoV-2 RT-PCR test)
– persons with fever in previous 7 days before enrollment and worsening respiratory symptoms
were excluded
⚬ all persons were recruited by self-referral through ClinicalTrials.gov, National Institutes of Health
(NIH) Clinical Center websites, and NIH Office of Patient Recruitment listserv
⚬ 104 persons (55%) reported ≥ 1 persistent postacute symptom at enrollment including
– fatigue (26%)
– dyspnea (19%)
– anosmia/parosmia (14%)
– concentration impairment (12%)
– headache (12%)
– memory impairment (10%)
– insomnia (9%)
– chest pain/discomfort (8%)
– anxiety (6%)
– myalgia (6%)
– tinnitus (6%)
⚬ symptoms reported in ≤ 5% of persons included palpitations, arthralgia, cough, taste disorder,

depression, alopecia, dizziness, dyspepsia, decreased appetite, nasal congestion, nausea, visual
impairment, and paresthesia
⚬ Reference - Ann Intern Med 2022 Jul;175(7):969 , editorial can be found in Ann Intern Med 2022
Jul;175(7):1041
STUDY
● SUMMARY
30% of patients with COVID-19 report persistent symptoms 3-9 months after illness onset
COHORT STUDY: JAMA Netw Open 2021 Feb 1;4(2):e210830 | Full Text
Details

⚬ 177 patients (mean age 48 years, 57% female) with COVID-19 completed self-reported symptom
survey 3-9 months after illness onset (median 169 days)
⚬ severity of acute illness
– asymptomatic infection in 6.2%

– mild illness in 84.7%
– moderate-to-severe disease requiring hospital admission in 9%
⚬ persistent symptoms after acute illness in 30%
– 1-2 symptoms in 16.4%

– ≥ 3 symptoms in 13.6%
⚬ most common persistent symptoms were
– fatigue in 13.6%
– loss of smell or taste in 13.6%
⚬ 13% reported other persistent symptoms including
– trouble breathing
– muscle or body aches
– headache
– cough
– sore throat
– sweats
– chills or shivering
– brain fog
⚬ Reference - JAMA Netw Open 2021 Feb 1;4(2):e210830 full-text
STUDY
● SUMMARY
51% of patients hospitalized with COVID-19 reported symptoms 4 months after discharge from
hospital or intensive care
COHORT STUDY: JAMA 2021 Apr 20;325(15):1525

Details

⚬ 478 adults (mean age 61 years, 58% women) hospitalized (30% in ICU) with laboratory-confirmed
(87%) COVID-19 between March 1 and May 29, 2020 were assessed by telephone 3-4 months after
discharge
– all patients formerly in ICU and patients reporting selected symptoms were invited for in-person
assessment
– patients without history of chronic kidney disease who had plasma creatinine levels > 1.47 mg/dL
(130 mcmol/L) or estimated glomerular filtration rate (GFR) < 60 mL/minute/1.73 m2 at discharge
had reassessment of serum creatinine
⚬ median duration of hospitalization or ICU stay 9 days

⚬ 244 (51%) patients reported ≥1 symptom that did not exist before COVID-19 including
– fatigue in 31%
– ≥ 1 cognitive symptom (memory difficulties, mental slowness, or concentration problems > once a
week) in 20.7%
– dyspnea in 16.3%
– paresthesia in 12.1%
⚬ out of 294 patients eligible for in-person assessment, 177 patients had in-person follow-up at median
125 days after discharge (55% formerly in ICU)
– insomnia based on Insomnia Severity Index in 53.6%
– cognitive impairment based on Montreal Cognitive Assessment or d2-R score in 38.4%
– anxiety based on Hospital Anxiety and Depression Scale in 31.4%
– depression based on Beck Depression Inventory in 20.6%
– symptoms of posttraumatic stress disorder based on Posttraumatic Stress Disorder Checklist
(PCL-5 scale) score in 14.2%
– persistent cough in 13.4%
– new onset chronic kidney disease in 2 patients formerly in ICU
– abnormal lung computed tomography in 63.2% (including persistent ground-glass opacities in
42.4% and fibrotic lesions in 19.4%)
– diffusion capacity for carbon monoxide < 70% in 22%
– right ventricle dilatation in 25%
– left ventricular ejection fraction 40%-50% in 12%
⚬ Reference - COMEBAC trial (JAMA 2021 Apr 20;325(15):1525 ), editorial can be found in JAMA 2021
Apr 20;325(15):1511
STUDY
● SUMMARY
persistence of symptoms 2-3 weeks after testing in 35% of patients with COVID-19 not admitted to
hospital
COHORT STUDY: MMWR Morb Mortal Wkly Rep 2020 Jul 31;69(30):993
Details

⚬ 274 adults with first positive RT-PCR test for SARS-CoV-2 between March 31 and June 4, 2020 were
evaluated
– patients were tested in outpatient clinics or presented to emergency department but were not
admitted to hospital
– 31% were aged 18-34 years, 36% were aged 35-49 years, and 33% were ≥ 50 years old
– 24% had hypertension, 19% had obesity, 13% had asthma, 10% had diabetes, and 5% had
immunosuppressive condition
⚬ 94% of patients reported ≥ 1 symptom at time of testing

⚬ patients were randomly selected for telephone interview 14-21 days after date of positive test
⚬ interview included patient reported comorbidities, symptoms present at time of test, resolution of
symptoms, and return to usual state of health
⚬ 98% included in analysis
⚬ patients were interviewed median 16 days post positive test
⚬ persistence of symptoms (including cough, fatigue, or dyspnea) and not returning to usual state of
health at 14-21 days post positive test reported in 35% of patients
– 26% of patients aged 18-34 years
– 32% of patients aged 35-49 years
– 47% of patients aged ≥ 50 years old
– 46% of patients with 2 chronic medical conditions
– 57% of patients with ≥ 3 chronic medical conditions
⚬ factors associated with not having returned to usual health
– age ≥ 50 years (adjusted odds ratio [OR] 2.29, 95% CI 1.14-4.58 vs. age 18-34 years)
– ≥ 3 chronic medical conditions (adjusted OR 2.29, 95% CI 1.07-4.9 vs. no chronic condition)
– obesity (adjusted OR 2.31, 95% CI 1.21-4.42)
– psychiatric condition (adjusted OR 2.32, 95% CI 1.17-4.58)
⚬ Reference - MMWR Morb Mortal Wkly Rep 2020 Jul 31;69(30):993 full text
⚬ persistence of symptoms at 7-9 months reported in 39% of 410 patients with COVID-19 who were not
admitted to hospital (Ann Intern Med 2021 Jul 6 early online full-text )
STUDY
● SUMMARY
in patients with COVID-19 discharged from hospital, symptoms persisting at 6 months include
fatigue or muscle weakness, reduced exercise capacity, problems sleeping, anxiety or depression,
and impaired pulmonary diffusion; at 12 months, prevalence of physical and functional symptoms
appears generally lower, but anxiety and depression may be more prevalent
COHORT STUDY: Lancet 2021 Jan 16;397(10270):220

COHORT STUDY: Lancet 2021 Aug 28;398(10302):747 | Full Text
Details
⚬ based on cohort study and follow-up study

⚬ 2,469 patients with laboratory-confirmed COVID-19 discharged from hospital in Wuhan, China
between January 7 and May 29, 2020 were assessed
– exclusion criteria included death, psychotic disorders, dementia, readmission to hospital,
restricted movement due to osteoarthropathy, immobility due to stroke or pulmonary embolism,
living outside Wuhan, or living in nursing or welfare homes
– 1,733 patients (median age 57 years, 52% men) with median follow-up of 186 days after symptom
onset were included in analysis
– highest disease severity during hospital stay assessed on 7-point scale
● 122 patients had 5 points (needing high-flow nasal cannula, noninvasive mechanical
ventilation, or both) or 6 points (needing extracorporeal membrane oxygenation, invasive
mechanical ventilation, or both)
● 1,172 patients had 4 points (needing supplemental oxygen)
● 439 patients had 3 points (not needing supplemental oxygen)
– most common symptoms overall at 6 months included fatigue or muscle weakness in 63%, sleep
difficulties in 26%, hair loss in 22%, smell disorder in 11%, palpitations in 9%, joint pain in 9%,
decreased appetite in 8%, taste disorder in 7%, dizziness in 6%, diarrhea or vomiting in 5%, and
chest pain in 5%
– rates of outcomes at 6 months by highest severity scale score (comparisons vs. 3 points)
● fatigue or muscle weakness
⚬ 81% with 5-6 points (adjusted odds ratio [OR] 2.69, 95% CI 1.46-4.96)
⚬ 59% with 4 points (adjusted OR 0.74, 95% CI 0.58-0.96)
⚬ 66% with 3 points
● pain or discomfort on EuroQol 5-dimension 5-level (EQ-5D-5L) questionnaire
⚬ 41% with 5-6 points (adjusted OR 1.94, 95% CI 1.19-3.16)

⚬ 25% with 4 points (not significant)
● anxiety or depression assessed by EQ-5D-5L questionnaire

● less than lower limit of normal range on 6-minute walking distance test

● score ≥ 1 point on modified British Medical Research Council questionnaire (score range 0-4
points, with higher scores indicating increased dyspnea)
● impaired pulmonary diffusion capacities (diffusion capacity for carbon monoxide < 80% of
predicted)
● residual lung volume < 80% of predicted

– in analysis of 822 patients with nonacute kidney injury and normal estimated GFR during acute
phase and who had data during follow-up, 13% had estimated GFR < 90 mL/minute per 1.73 m2
– comparing acute phase of disease vs. follow-up in 94 patients with plasma samples
● seropositivity in 96.2% vs. 58.5% (p < 0.0001)

● median neutralizing antibody titer 19 vs. 10 (p < 0.0001)
– Reference - Lancet 2021 Jan 16;397(10270):220 , editorial can be found in Lancet 2021 Jan
16;397(10270):173
⚬ 1,276 patients (median age 59 years, 53% men) who completed both 6-month and 12-month follow-
up were included in follow-up analysis
– median follow-up 349 days for 12-month visit
– 88% of 479 patients who were employed prior to hospitalization had returned to work
– comparing outcomes at 12 months vs. 6 months
● any sequelae symptoms in 49% vs. 68% (p < 0.0001)

● fatigue or muscle weakness in 20% vs. 52% (p < 0.0001)
● sleep difficulties in 17% vs. 27% (p < 0.0001)
● less than lower limit of normal range on 6-minute walking distance test in 12% vs. 14% (p =
0.033)
● pain or discomfort in 29% vs. 27% (not significant)
● anxiety or depression in 26% vs. 23% (p = 0.015)
– consistent results for fatigue or muscle weakness and sleep difficulties in subgroups stratified by
severity scale
– other common symptoms at 12 months included joint pain in 12%, hair loss in 11%, palpitations
in 9%, chest pain in 7%, dizziness in 5%, headache in 5%, and smell disorder in 4%
– prevalence of > 1 symptom was significantly higher compared to matched cohort of adults who
did not have COVID-19 (+33%, p < 0.0001)
– Reference - Lancet 2021 Aug 28;398(10302):747 full-text
– consistent results for walking distance and pulmonary diffusion at 4 months after symptom onset
in cohort study comparing severe-to-critical disease to mild-to-moderate disease in 72 adults with
COVID-19 (Eur Respir J 2021 Jan 8 early online full text )
● radiologic and pulmonary function findings
STUDY
⚬ SUMMARY
56% of patients with COVID-19 reported to have residual chest computed tomography (CT)
abnormalities and 44% of patients reported to have residual pulmonary function test
abnormalities 3 months after symptom onset or hospital discharge
SYSTEMATIC REVIEW: BMC Pulm Med 2021 Mar 22;21(1):97 | Full Text
Details
– based on systematic review of cohort studies

– systematic review of 15 cohort studies reporting radiological and functional lung test findings in
3,066 patients (mean age 56 years, 54% male) with laboratory confirmed COVID-19 who had
follow-up chest CT or pulmonary function test after recovery and ≥ 1 month after discharge or
symptom onset
● 8 studies conducted in China, 7 studies conducted in Iran, Netherlands, Belgium, Canada,
Norway, Italy, and Switzerland
● mean follow-up 90 days from symptom onset or hospital discharge (range 1-6 months after
symptom onset)
– comorbidities included hypertension (29%), diabetes mellitus (12%), cardiovascular disease (6.2%),
chronic pulmonary disease (3.6%), malignancy (2.7%), chronic kidney disease (2.3%), and
cerebrovascular disease (1.6%)
– of 2,849 patients with available data, 22% had severe COVID-19 and 78% had mild-to-moderate
COVID-19
– residual symptoms at follow-up included fatigue (44.1%), sleep difficulty (16.9%), hair loss (13.9%),
anosmia (7.2%), arthralgia (6.9%), palpitation (6.4%), decreased appetite (5.3%), ageusia (5.1%),
and dyspnea (4.3%) in analysis of 9 studies with 2,580 patients
– residual CT abnormalities in 55.7% (95% CI 41%-70%) in analysis of 13 studies with 1,232 patients
● ground glass opacity in 44% (95% CI 30.5%-58%)

● parenchymal band or fibrous stripe in 34% (95% CI 18%-49%)
● thickening of adjacent pleura in 20% (95% CI 8.7%-31%)
● bronchovascular distortion or bronchiectasis in 24% (95% CI 6.4%-41%)
● interstitial thickening or interlobular septal thickening in 11% (95% CI 3.7%-18%)
● consolidation in 8.8% (95% CI 3.9%-14%)
● pleural effusion in 5% (95% CI -1.8% to 12%)
– residual pulmonary function test abnormalities in 44.3% (95% CI 32%-56%) in analysis of 10

studies with 1,359 patients
● impaired diffusion capacity in 35% (95% CI 26%-44%)
● restrictive pattern in 16% (95% CI 8.9%-24%)
● obstructive pattern in 7.7% (95% CI 4.2%-11%)
– Reference - BMC Pulm Med 2021 Mar 22;21(1):97 full-text
STUDY
⚬ SUMMARY
81% of patients with COVID-19 with hypoxemia reported to have ≥ 1 pulmonary lobe with
abnormalities by CT at 90 days after symptom onset
COHORT STUDY: Int J Tuberc Lung Dis 2022 Jul 1;26(7):629

Details

– 91 patients (mean age 55 years, 56% male) hospitalized with COVID-19 with hypoxemia (oxygen
saturation < 93% on room air at time of admission) had chest high-resolution CT at 90 days after
symptom onset
– chest CT findings at 90 days after symptom onset based on visual analysis
● ≥ 1 pulmonary lobe with abnormalities in 81%

● ground-glass opacities in 76%
● parenchymal bands in 65%
– consistent CT findings for pulmonary lobes with abnormalities at 90 days after symptom onset
based on automated algorithm
– Reference - Int J Tuberc Lung Dis 2022 Jul 1;26(7):629
STUDY
⚬ SUMMARY
radiological and pulmonary function test findings consistent with parenchymal lung disease
reported in 14%-33% of adults at > 6 months following hospitalization for COVID-19
SYSTEMATIC REVIEW: Thorax 2022 Mar 25 early online

Details
– based on noncomparative data in systematic review of observational studies

– systematic review of 94 observational studies and 1 randomized trial evaluating prevalence of
lung sequelae in adults hospitalized with COVID-19 or other viral pneumonitis
– 60 observational studies with 7,217 patients hospitalized with COVID-19 were included in analysis
– radiological findings consistent with parenchymal lung disease
● inflammatory findings (ground glass opacification or consolidation)
⚬ in 58% (95% CI 39%-77%) at < 3 months in analysis of 9 studies with 815 patients
⚬ in 49% (95% CI 39%-59%) at 3-6 months in analysis of 19 studies with 1,691 patients
⚬ in 28% (95% CI 10%-50%) at > 6 months in analysis of 3 studies with 164 patients
● fibrotic findings (reticulation, lung architectural distortion, interlobular septal thickening,

traction bronchiectasis, or honeycombing)
– pulmonary function test findings consistent with parenchymal lung disease
● impaired gas transfer (predicted diffusing capacity for carbon monoxide < 80%)
● restrictive lung impairment (total lung capacity < 80% predicted value or forced vital capacity <
80% predicted value, with normal-to-high ratio of forced expiratory volume in 1 second to
forced vital capacity)
– Reference - Thorax 2022 Mar 25 early online
STUDY
⚬ SUMMARY
in patients hospitalized with COVID-19 pneumonia, diffusion capacity for carbon monoxide
impairment (< 80% predicted) at 6 months reported in 54% who had invasive mechanical
ventilation (IMV), 36% who had continuous positive airway pressure (CPAP), and 58% who had
oxygen alone
COHORT STUDY: Respiration 2021;100(11):1078 | Full Text

Details

– 312 adults ≤ 80 years old (median age 61 years, 73% men) hospitalized with COVID-19 and without
prior diagnosis of structural lung disease were assessed for 6 months after hospital discharge
● all patients had polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection, signs of
interstitial pneumonia, and partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2)
< 300 on room air at admission
● maximum respiratory support was IMV in 31%, CPAP in 46%, and oxygen alone in 23%
– COVID-19 treatments included hydroxychloroquine (64%), lopinavir/ritonavir (42%), systemic

steroids (40%), prophylactic heparin (38%), mucolytics (25%), tocilizumab (13%), and remdesivir
(4.8%)
– rates of impairment (< 80% of predicted) of diffusion capacity for carbon monoxide (p = 0.002
across groups)
● 54% with IMV
● 36% with CPAP
● 58% with oxygen only
– rates of abnormal (including reticulations, ground-glass opacities, or consolidations) chest x-ray (p

= 0.008 across groups)
● 25% with oxygen only
● 44% with IMV
● 24% with CPAP
– factors associated with impairment of diffusion capacity for carbon monoxide
● asthma associated with increased risk (adjusted odds ratio [OR] 4.86, 95% CI 1.09-21.68)
● prophylactic heparin associated with decreased risk (OR 0.45, 95% CI 0.25-0.83)
– factors associated with increased risk of abnormal chest x-ray included
● IMV compared to oxygen alone (adjusted OR 3.9, 95% CI 1.38-11.01)

● increasing age (adjusted OR 1.05 per year increase, 95% CI 1.01-1.09)
– Reference - Respiration 2021;100(11):1078 full-text
Prevention and Management of Long COVID
STUDY
● SUMMARY
adenovirus vector (AstraZeneca) or messenger RNA (mRNA) (Pfizer-BioNTech or Moderna) COVID-
19 vaccination after testing positive for SARS-CoV-2 may be associated with reduced long COVID
with continued reduction after second vaccine dose at median of 67-day follow-up
INTERRUPTED TIME SERIES: BMJ 2022 May 18;377:e069676 | Full Text

Details
⚬ based on individual level interrupted time series analysis

⚬ 28,356 adults < 70 years old (mean age 46 years, 56% female, 89% White) testing positive for SARS-
CoV-2 and then receiving ≥ 1 dose of AstraZeneca, Pfizer-BioNTech, or Moderna COVID-19 vaccine
from Office for National Statistics COVID-19 Infection Survey in the United Kingdom from February
2021 to September 2021 were assessed
⚬ in addition to other factors, analysis was adjusted for temporal trends by including calendar time of
infection to control for predominant viral variant and changes in healthcare practice overtime
⚬ median follow-up of 141 days in 28,356 adults who had first vaccination and 67 days in 23,753 adults
who had second vaccination
⚬ 23.7% had long COVID defined as symptoms of any severity ≥ 12 weeks after infection and 16.7% had
activity-limiting long COVID
⚬ before vaccination, no significant difference in long COVID over time (adjusted odds ratio [OR] 0.997
per week, 95% CI 0.99-1.002)
⚬ first COVID-19 vaccine dose associated with
– initial reduction in long COVID of any severity (adjusted OR 0.87, 95% CI 0.81-0.93)
– initial reduction in activity-limiting long COVID (adjusted OR 0.88, 95% CI 0.8-0.96)
⚬ after initial reduction with first COVID-19 vaccine dose, no significant differences in long COVID or
activity-limiting long COVID over time up to second dose
⚬ second COVID-19 vaccine dose associated with
– initial reduction in long COVID (adjusted OR 0.91, 95% CI 0.86-0.97)

– initial reduction in activity-limiting long COVID (adjusted OR 0.91, 95% CI 0.84-0.98)
– continued reduction in long COVID over time (adjusted OR 0.989 per week, 95% CI 0.979-0.999)
– continued reduction in activity-limiting long COVID (adjusted OR 0.987 per week, 95% CI 0.976-
0.998)
⚬ Reference - BMJ 2022 May 18;377:e069676 full-text
STUDY
● SUMMARY
El programa en línea de respiración y bienestar (English National Opera [ENO] Breathe) puede
mejorar el componente mental de la calidad de vida relacionada con la salud en comparación con la
atención habitual en adultos que se recuperan de COVID-19 con disnea continua con o sin ansiedad ≥
4 semanas después del síntoma comienzo Nivel DynaMed 2
ENSAYO ALEATORIZADO : Lancet Respir Med 2022 27 de abril temprano en línea

Detalles
⚬ based on randomized trial with differential loss to follow-up

⚬ 158 adults in the United Kingdom recovering from COVID-19 with ongoing breathlessness with or
without anxiety ≥ 4 weeks after symptom onset were randomized to online breathing and well-being
program (ENO Breathe) vs. usual care and followed for 6 weeks
– ENO Breathe program:
● delivered via video conferencing application and focused on breathing retraining through
singing techniques and utilizing lullabies
● consisted of initial 20-minute discussion with program team member to establish rapport,
assess symptoms and expectations, confirm suitability, and answer questions, followed by 6
once-weekly 1-hour group sessions led by vocal specialist
● patients received welcome pack with welcome note and items including ENO mug, tea, biscuits,
and reusable straw for phonation exercises
● patients had access to audio-visual resources to support learning, and received emails with
new music and content to encourage them to practice techniques
● components were tailored to individual capabilities and needs through continuous feedback,
including exercises and tools selected, and intensity, rests, and suggested homework
– usual care was based on guidelines and included holistic, individualized, multidisciplinary
approaches responsive to varied symptoms
⚬ patients too unwell, having excessive fatigue or concerning upper airway symptoms, or unable to
participate due to comorbidities were excluded
⚬ primary outcome was health-related quality of life at 6 weeks, assessed using mental health
composite and physical health composite subscales of RAND 36-item short form survey instrument
(SF-36)
– range 0-100 points, with higher scores indicating better outcomes
– difference of 3-5 points considered clinically important
⚬ breathlessness was assessed using visual analog scale (VAS, range 0-100 points, with higher scores
indicating more severe symptoms)
⚬ 150 patients (95%) (mean age 49 years, 81% female; 82% White, 5% Black, 5% Asian) were allocated
to treatment groups
– mean time from onset of first COVID-19 symptoms to randomization was 320 days
– at baseline, comparing ENO Breathe program vs. usual care
● mean SF-36 mental health composite score 30.89 points vs. 33.21 points
● mean SF-36 physical health composite score 31.77 points vs. 32.18 points
– 22% in ENO Breathe program group and 7% in usual care group were lost to follow-up; 86% were
included in primary outcome analysis
⚬ comparing ENO Breathe program vs. usual care at 6 weeks
– ≥ 5-point improvement in SF-36 mental health composite score in 40% vs. 17% (p = 0.0038, NNT 5)
– ≥ 5-point improvement in SF-36 physical health composite score in 22% vs. 17% (not significant)
– mean increase in SF-36 mental health composite score 3.56 points vs. 0.78 points (p = 0.047)
– mean increase in SF-36 physical health composite score 1.73 points vs. 1.14 points (not significant)
– mean change in VAS score for breathlessness while running -10.03 points vs. +0.7 points (p =
0.0026)
⚬ no significant differences in chronic obstructive pulmonary disease assessment test scores, dyspnea-
12 scores, generalized anxiety disorder 7-item (GAD-7) scores, SF-36 subscale scores for physical
function, general health, energy, emotional well-being, or social functioning, or VAS scores for
breathlessness assessed at rest, while waking, or while climbing stairs
⚬ 1 adverse event (dizziness due to looking at computer screen) leading to study withdrawal reported
in ENO Breathe program group
⚬ no serious adverse events reported
⚬ Reference - ENO Breathe trial (Lancet Respir Med 2022 Apr 27 early online ), editorial can be found
in Lancet Respir Med 2022 Apr 27 early online
Síndrome inflamatorio multisistémico
● El síndrome inflamatorio multisistémico es una complicación rara pero grave de la COVID-19 que puede
afectar a niños (MIS-C) y adultos (MIS-A)
⚬ varios órganos pueden verse afectados, incluidos el corazón, los pulmones, los riñones, el cerebro, la
piel, los ojos o el tracto gastrointestinal
⚬ MIS-C y MIS-A pueden desarrollarse días o semanas después de COVID-19 o después de la
exposición a COVID-19
⚬ aconseje a los pacientes y a los padres que busquen atención médica si ellos o sus hijos tienen
fiebre continua después de COVID-19 y desarrollan síntomas que incluyen
– dolor de estómago
– ojos inyectados en sangre
– Diarrea
– mareos o aturdimiento
– sarpullido
– vómitos
⚬ Referencia: Síndrome inflamatorio multisistémico de los Centros para el Control y la Prevención de

Enfermedades ( CDC 25 de junio de 2021 )
● para obtener información adicional sobre MIS-C, consulte COVID-19 y pacientes pediátricos
● MIS-A
⚬ el síndrome inflamatorio multisistémico parece menos común en adultos que en niños

⚬ definición de caso para MIS-A incluye todos
– edad ≥ 21 años
– hospitalizado por ≥ 24 horas o con enfermedad que resultó en la muerte
– fiebre subjetiva o documentada MÁS ≥ 3 criterios clínicos dentro de las 24 horas previas a la
hospitalización o 3 días de hospitalización (1 debe ser un criterio clínico primario)
● criterios clínicos primarios
⚬ enfermedad cardíaca grave definida como miocarditis, pericarditis, dilatación/aneurisma

de la arteria coronaria o disfunción ventricular de nueva aparición, bloqueo AV de segundo
o tercer grado o taquicardia ventricular
⚬ sarpullido MÁS conjuntivitis no purulenta
● criterios clínicos secundarios
⚬ manifestaciones neurológicas de nueva aparición definidas como encefalopatía en

pacientes sin deterioro cognitivo previo, convulsiones, signos meníngeos o neuropatía
periférica (incluido el síndrome de Guillain-Barré)
⚬ shock o hipotensión no atribuible al tratamiento médico
⚬ dolor abdominal, vómitos o diarrea
⚬ trombocitopenia (recuento de plaquetas < 150 000/mcL)
– Infección por SARS-CoV-2 actual o reciente documentada mediante pruebas de amplificación de

ácidos nucleicos, serología o detección de antígenos.
– evidencia de laboratorio de ≥ 2 marcadores inflamatorios elevados (de la lista siguiente)
● Proteína C-reactiva
● ferritina
● interleucina 6 (IL-6)
● velocidad de sedimentación globular
● procalcitonina
⚬ Referencia: Síndrome inflamatorio multisistémico de los Centros para el Control y la Prevención de

Enfermedades ( CDC 25 de junio de 2021 )
RESUMEN
● DEL ESTUDIO
los adultos con síndrome inflamatorio multisistémico tenían una mediana de 5 sistemas de órganos
involucrados con una amplia variedad de manifestaciones y múltiples marcadores inflamatorios
elevados
REVISIÓN SISTEMÁTICA : JAMA Netw Open 2021 Sep 1;4(9):e2126456 | Texto completo
Detalles
⚬ based on systematic review

⚬ systematic review of case reports, voluntary CDC surveillance reports, and CDC MIS-C surveillance
system describing 221 adults aged ≥ 18 years (median age 21 years, 70% men) with multisystem
inflammatory syndrome
⚬ 58% had no underlying comorbidity
⚬ median time from onset of COVID-19 to MIS-A 28 days (longest reported time 68 days in 67-year-old
with cirrhosis and hypertension)
⚬ 96% presented with fever
⚬ organ system involvement
– median 5 organ systems involved

– hematologic manifestations in 92%
– cardiovascular manifestations in 87%, including
● hypotension in 60%
● cardiac dysfunction in 54%
● shock in 52%
● myocarditis in 30%
● chest pain, pressure, and/or tightness in 29%
● pericardial effusion in 25%
– gastrointestinal manifestations in 83%, including
● diarrhea in 52%
● abdominal pain in 48%
● vomiting in 44%
– respiratory manifestations in 74%, including
● shortness of breath in 52%

● cough in 37%
● pneumonia in 37%
● pleural effusion in 23%
● acute respiratory distress syndrome in 20%
– neurologic manifestations in 47%, including headache in 42%

– cutaneous manifestations in 46%, including
● rash in 38%
● conjunctival injection in 26%
● mucocutaneous lesions in 16%
– renal manifestations in 43%, including acute kidney injury in 39%
⚬ laboratory findings included
– elevated interleukin 6 (IL-6) in 98%

– elevated fibrinogen in 91%
– elevated D-dimer in 91%
– elevated ferritin in 91%
– elevated N-terminal proBNP (NT-proBNP) in 90%
– elevated C-reactive protein in 90%
– lymphopenia in 86%
– elevated troponin in 78%
– elevated B-type natriuretic peptide (BNP) in 74%
– thrombocytopenia in 49%
⚬ treatment included
– corticosteroids in 74%
– anticoagulation in 57%
– IV immunoglobulin in 55%
– vasoactive medications in 51%
– respiratory support in 47%
⚬ patient outcomes
– median hospital stay 8 days

– intensive care unit (ICU) admission in 57%
– mortality 7%
⚬ Reference - JAMA Netw Open 2021 Sep 1;4(9):e2126456 full-text

Otras complicaciones
● los pacientes que requieren cuidados intensivos pueden experimentar el síndrome posterior a
cuidados intensivos que incluye
⚬ disfunción física que incluye polineuropatía, miopatía, debilidad muscular o atrofia muscular
⚬ Disfunción cognitiva que incluye deterioro de la memoria, la función ejecutiva o la comunicación.
⚬ deterioro psicológico que incluye trastorno de estrés postraumático, depresión y ansiedad
RESUMEN
● DEL ESTUDIO
COVID-19 asociado con un mayor riesgo de primer infarto agudo de miocardio y accidente
cerebrovascular isquémico durante 2 semanas después de la infección en adultos en Suecia
ESTUDIO DE COHORTE : Lancet 2021 Jul 29 temprano en línea

Detalles

⚬ 86,742 adults (median age 48 years, 57% women ) with COVID-19 from Swedish Public Health Agency
database were matched with 348,481 adults without SARS-CoV-2 infection from Statistics Sweden
database between February 1 and September 14, 2020
⚬ adults with previous myocardial infarction or ischemic stroke were excluded
⚬ 83,937 adults with COVID-19 and 340,432 adults without SARS-CoV-2 infection were included in
analysis
⚬ clinical outcomes were assessed during weeks following COVID-19
⚬ COVID-19 associated with increased risk of
– acute myocardial infarction (odds ratio 6.61, 95% CI 3.56-12.2)

– ischemic stroke (odds ratio 6.74, 95% CI 3.71-12.2)
⚬ consistent results in self-controlled case-series using within-patient analysis to compare incidence

rates of acute myocardial infarction or ischemic stroke relative to duration of COVID-19 disease
⚬ Reference - Lancet 2021 Jul 29 early online full text
RESUMEN
● DEL ESTUDIO
en adultos ≤ 65 años, infección por SARS-CoV-2 confirmada por reacción en cadena de la polimerasa
(PCR) o diagnóstico de COVID-19 asociado con un mayor riesgo de secuelas clínicas que requieren
atención médica en la fase aguda de la infección en comparación con el diagnóstico de otras
infecciones virales de las vías respiratorias inferiores enfermedad del tracto
ESTUDIO DE COHORTE : BMJ 2021 19 de mayo; 373: n1098 | Texto completo

Detalles

⚬ 9,247,505 adults ≤ 65 years old enrolled in 1 commercial health insurance provider in United States
were assessed
– 266,586 (mean age 41 years, 52% women, 21% Hispanic patients, 17% Black patients) had PCR-
confirmed SARS-CoV-2 infection or diagnosis of COVID-19
– 8,980,919 were not diagnosed with COVID-19 or tested for SARS-CoV-2 in claims
⚬ propensity score was calculated for each adult based on 108 demographic, clinical, and healthcare
use factors to create 3 comparator groups with similar characteristics but which included adults
without positive PCR test for SARS-CoV-2 infection or diagnosis of COVID-19
– 2020 group: 193,113 adults who did not have PCR-confirmed SARS-CoV-2 infection or diagnosis of
COVID-19 during 2020
– 2019 group: 193,264 adults who did not have PCR-confirmed SARS-CoV-2 infection or diagnosis of
COVID-19 during 2019
– viral lower respiratory tract illness group: 181,613 adults who developed influenza, nonbacterial
pneumonia, acute bronchitis, acute lower respiratory infection, or chronic obstructive pulmonary
disease with acute lower respiratory infection in 2017, 2018, or 2019
⚬ acute phase of SARS-CoV-2 infection defined as date of first SARS-CoV-2 positive test or COVID-19
diagnosis (index date) plus 21 days
⚬ median follow-up 87 days
⚬ rates of adults with ≥ 1 new clinical sequela needing medical care
– 14% for patients after acute phase of SARS-CoV-2 infection (p < 0.01 vs. each group)
– 9% for 2020 group
– 9% for 2019 group
– 13% for viral lower respiratory tract illness group
⚬ estimated rates of new clinical sequelae per 100 persons after acute phase of infection comparing
patients with PCR-confirmed SARS-CoV-2 infection or diagnosis of COVID-19 vs. patients with other
viral lower respiratory tract illness (p < 0.001 for each)
– fatigue 4.84 vs. 3.63
– mental health diagnosis 3.7 vs. 3.12
– arrhythmia 1.52 vs. 1.09
– liver test abnormality 1.22 vs. 1.02
– type 2 diabetes 1.05 vs. 0.77
– memory difficulty 0.72 vs. 0.48
– deep vein thrombosis/pulmonary embolism 0.64 vs. 0.43
– peripheral neuropathy 0.32 vs. 0.2
– encephalopathy 0.23 vs. 0.14
– anosmia 0.22 vs. 0.04
– chronic respiratory failure 0.18 vs. 0.11
– myocarditis 0.04 vs. 0.01
⚬ Reference - BMJ 2021 May 19;373:n1098 full-text , editorial can be found in BMJ 2021 May
19;373:n1173
RESUMEN
● DEL ESTUDIO
en adultos ≥ 65 años, diagnóstico de infección por SARS-CoV-2 o COVID-19 confirmado por PCR
asociado con un mayor riesgo de insuficiencia respiratoria nueva o persistente y demencia que
requiera atención médica en la fase posaguda de la infección en comparación con el diagnóstico de
otro virus del tracto respiratorio inferior enfermedad
ESTUDIO DE COHORTE : BMJ 2022 9 de febrero; 376: e068414

Detalles

⚬ 6,481,232 adults ≥ 65 years old enrolled in Medicare Advantage plan in the United States were
assessed
⚬ 133,366 persons (mean age 77 years, 56% female, 11% Black, 3.4% Hispanic) had PCR-confirmed
SARS-CoV-2 infection or COVID-19 diagnosis before April 2020
⚬ propensity score was calculated for each person based on 120 demographic, clinical, and healthcare-
use factors to create 3 comparator groups with similar characteristics but which included persons
without positive PCR test for SARS-CoV-2 infection or COVID-19 diagnosis
– 2020 group: 132,847 persons who did not have PCR-confirmed SARS-CoV-2 infection or COVID-19
diagnosis during 2020
– 2019 group: 133,266 persons who did not have PCR-confirmed SARS-CoV-2 infection or COVID-19
diagnosis during 2019
– viral lower respiratory tract illness group: 113,190 persons who developed influenza, nonbacterial
pneumonia, acute bronchitis, acute lower respiratory infection, or chronic obstructive pulmonary
disease with acute lower respiratory infection in 2017, 2018, or 2019
⚬ postacute phase of SARS-CoV-2 infection defined as ≥ 21 days after index date (date of first PCR-
confirmed SARS-CoV-2 infection or COVID-19 diagnosis)
⚬ after excluding persons with < 21 days of observation from index date, propensity-score matched
analyses included
– 87,337 persons who had SARS-CoV-2 infection and 87,337 controls in 2020 group
– 88,070 persons who had SARS-CoV-2 infection and 88,070 controls in 2019 group
– 73,490 persons who had SARS-CoV-2 infection and 73,490 controls in viral lower respiratory tract
illness group
⚬ median follow-up was 64 days in SARS-CoV-2 infection and 2020 control groups, 62 days in SARS-
CoV-2 infection and 2019 control groups, and 68 days in SARS-CoV-2 infection and viral lower
respiratory tract illness groups
⚬ rates of new or persistent clinical sequelae needing medical attention
– 32%-33% during postacute phase in SARS-CoV-2 infection group (p < 0.01 vs. each group)
– 21% in 2020 control group
– 24% in 2019 control group
– 34% in viral lower respiratory tract illness group
⚬ cumulative incidence of new or persistent clinical sequelae comparing patients in postacute phase of
SARS-CoV-2 infection vs. patients with viral lower respiratory tract illness
– 9.03 vs. 6.64 (p < 0.001) for respiratory failure
– 8.04 vs. 4.77 (p < 0.001) for acute respiratory failure
– 2.97 vs. 2.26 (p < 0.001) for dementia
– 0.23 vs. 0.04 (p < 0.001) for postviral fatigue
– 3.05 vs. 2.51 (p = 0.05) for type 2 diabetes
⚬ Reference - BMJ 2022 Feb 9;376:e068414
RESUMEN
● DEL ESTUDIO
hospitalización por COVID-19 asociada con mayores riesgos de muerte, enfermedad respiratoria de
nueva aparición, diabetes, evento cardiovascular adverso mayor, enfermedad renal crónica y
enfermedad hepática crónica hasta 140 días después del alta en comparación con la población
general en Inglaterra sin COVID-19
ESTUDIO DE COHORTE : BMJ 2021 31 de marzo; 372: n693 | Texto completo

Detalles

⚬ 47,780 patients (mean age 64 years, 55% men, 72% White) in England hospitalized for laboratory
confirmed (80%) or clinically diagnosed COVID-19 and who were discharged by August 31, 2020 were
matched to 47,780 persons from general population with active records with the National Health
Service and who were not hospitalized for COVID-19
– 9.9% of patients hospitalized for COVID-19 were admitted to intensive care unit (ICU)
– patients were matched for age, sex, race/ethnicity, poverty level, geographic location, smoking
status, body mass index, and comorbidities
⚬ mean follow-up of 140 days for patients with COVID-19 and 153 days for general population in
England without COVID-19
⚬ index date defined as date of discharge from hospital for patients with COVID-19 and start of follow-
up for persons from general population (each match from general population had follow-up begin
on same day of hospital discharge of patient with COVID-19)
⚬ outcomes after discharge in patients hospitalized for COVID-19
– death in 12.3%
– readmission in 29.4%
– respiratory disease in 29.6%
– diabetes in 4.9%
– major adverse cardiovascular event (heart failure, myocardial infarction, stroke, or arrhythmia) in
4.8%
– chronic kidney disease in 1.5%
– chronic liver disease in 0.3%
⚬ comparing rates of outcomes per 1,000 person-years after index date in patients hospitalized for
COVID-19 vs. general population in England without COVID-19 (p < 0.05 for each)
– death 320 vs. 41.3
– readmission/admission to hospital 766 vs. 218.9
– new-onset respiratory disease 538.9 vs. 19.7
– new-onset diabetes 28.7 vs. 8.2
– new-onset major adverse cardiovascular event (heart failure, myocardial infarction, stroke, or
arrhythmia) 65.9 vs. 12.3
– new-onset chronic kidney disease 14.6 vs. 7.2
– new-onset chronic liver disease 4 vs. 0.9
⚬ Reference - BMJ 2021 Mar 31;372:n693 full-text
RESUMEN
● DEL ESTUDIO
cardiac injury and acute respiratory distress syndrome (ARDS) may be among most common acute
complications of COVID-19
SYSTEMATIC REVIEW: Crit Care 2020 Jul 2;24(1):389 | Full Text

Details

⚬ systematic review of 1 randomized trial and 43 observational studies reporting mortality and acute
complications in 14,866 patients with laboratory-confirmed COVID-19
– 41 studies were conducted in China (13,038 patients)
– mean patient age ranged from 38 to 69 years; 56.4% were men
– 43 studies enrolled only hospitalized patients (median hospital stay 15 days)
– 13 studies had follow-up of ≥ 2 weeks
⚬ acute complications
– cardiac injury in 15% (95% CI 11%-20%) in analysis of 10 studies with 2,389 patients
– ARDS in 14% (95% CI 10%-21%) in analysis of 23 studies with 6,322 patients
– venous thromboembolism in 15% (95% CI 8%-27%) in analysis of 3 studies with 318 patients
– kidney injury in 6% (95% CI 3%-10%) in analysis of 15 studies with 4,682 patients
– coagulopathy in 6% (95% CI 3%-11%) in analysis of 9 studies with 3,370 patients
– shock in 3% (95% CI 1%-8%) in analysis of 13 studies with 4,309 patients
● ARDS
STUDY
⚬ SUMMARY
ARDS may be most common complication of COVID-19
COHORT STUDY: JAMA 2020 Feb 7 early online

COHORT STUDY: Lancet 2020 Feb 15;395(10223):497
COHORT STUDY: Lancet 2020 Feb 15;395(10223):507
Details
– based on 3 cohort studies

– cohort admitted to Zhongnan Hospital in Wuhan, China January 1-28, 2020
● 138 adults aged 22-92 years (median age 56 years, 54% men) with confirmed COVID-19
pneumonia consecutively admitted to Zhongnan Hospital in Wuhan, China, from January 1-28,
2020, were evaluated through February 3, 2020
⚬ ARDS in 19.6%
⚬ arrhythmia in 16.7%
⚬ shock in 8.7%
⚬ acute cardiac injury in 7.2%
⚬ acute kidney injury in 3.6%
● Reference - JAMA 2020 Feb 7 early online , commentary can be found in JAMA 2020 Feb 5
early online
– cohort admitted to Jinyintan Hospital in Wuhan, China by January 2, 2020
● 41 patients (mean age 49 years, 73% male) with confirmed COVID-19 pneumonia admitted to
⚬ ARDS in 29%
⚬ acute cardiac injury in 12%
⚬ secondary infection in 10%
● Reference - Lancet 2020 Feb 15;395(10223):497 , correction can be found in Lancet 2020 Feb
15;395(10223):496
– cohort admitted to Jinyintan Hospital in Wuhan, China from January 1-20, 2020
● 99 adults aged 21-82 years (mean age 55 years, 68% men) with confirmed COVID-19
pneumonia admitted to Jinyintan Hospital in Wuhan, China, from January 1-20, 2020, were
evaluated up to January 25, 2020
⚬ ARDS in 17%
⚬ ventilator-associated pneumonia in 11%
⚬ acute respiratory injury in 8%
⚬ septic shock in 4%
⚬ acute kidney injury in 3%
● Reference - Lancet 2020 Feb 15;395(10223):507
STUDY
⚬ SUMMARY
lung histopathology findings reported to include diffuse alveolar damage in 88% and pulmonary
microthrombi in 57% of patients with COVID-19-related death
SYSTEMATIC REVIEW: Chest 2020 Oct 7 early online | Full Text

Details

– systematic review of 54 observational studies (42 case series and 12 case reports) reporting on
lung histopathology findings from pre- or postmortem samples from 522 patients who died and
had infection with SARS-CoV-2, SARS-CoV associated with 2003 outbreak, or 2009 A influenza
(H1N1) virus
– 32.7% had SARS-CoV-2 infection, 12.3% had SARS-CoV infection, and 55% had H1N1 infection
– lung histopathology findings associated with SARS-CoV-2 vs. SARS-CoV vs. H1N1 infection
● diffuse alveolar damage in 88% vs. 98% vs. 90%

● pulmonary microthrombi in 57% vs. vs. 58% vs. 24%
● organizing fibrosis in 52% vs. 47% vs. 40%
● superimposed pneumonia in 32% vs. 31% vs. 30%
● pulmonary thrombosis in 15% vs. 28% vs. 6%
● acute fibrinous and organizing pneumonia in 4% vs. 9% vs. 0.3%
● end-stage fibrosis in 1% vs. 6% vs. 3%
– Reference - Chest 2020 Oct 7 early online full-text
STUDY
⚬ SUMMARY
incidence of ventilator-associated events may be higher in patients with COVID-19 than in other
patients on mechanical ventilation, with higher rate of events due to progressive ARDS
COHORT STUDY: Ann Am Thorac Soc 2021 Jun 25 early online

Details

– 13,270 episodes of mechanical ventilation in 11,502 adults from 2017 to 2020 in the United States
were assessed
● 661 episodes during pandemic in 628 patients with COVID-19
● 2,898 episodes during pandemic in 2,477 patients without COVID-19
● 9,711 episodes in 11,178 patients in prepandemic period
– ventilator-associated event defined as ≥ 2 days of sustained increases in ventilator settings (≥ 3-

cm H2O increase in positive end-expiratory pressure [PEEP] or ≥ 20% increase in absolute fraction
of inspired oxygen [FiO2]) after ≥ 2 days of stable or decreasing ventilator settings
– comparing patients with COVID-19 vs. without COVID-19 during pandemic
● incidence of ventilator-associated events
⚬ 29 vs. 7.1 per 100 ventilation episodes (p < 0.01)

⚬ 17.2 vs. 12.2 per 1,000 ventilator-days (p < 0.01)
● proportion of events triggered by progressive ARDS 53% vs. 14% (no p value reported)
● median ventilation duration 22 days vs. 14 days (p < 0.01)
● in-hospital mortality 30% vs. 38% (not significant)
– consistent result for increased incidence of ventilator-associated events comparing pandemic

period vs. prepandemic period
– Reference - Ann Am Thorac Soc 2021 Jun 25 early online
● renal complications
⚬ reported renal complications include 2
⚬ – acute kidney injury

– electrolyte abnormalities, including hyperkalemia, hyponatremia, and hypernatremia
– proteinuria
– hematuria
– metabolic acidosis
– clotting of extracorporeal circuits used for renal replacement therapy
⚬ review of kidney injury in patients with SARS-CoV-2 infection can be found in J Urol 2020 Jul 17 early
online
⚬ hypokalemia detected in 41% of 290 non-ICU hospitalized patients with COVID-19 in cohort study,
91% of whom had mild potassium decrease (serum potassium 3-3.4 mEq/L) (Clin Exp Nephrol 2021
Apr;25(4):401 full-text )
⚬ systematic review of cohort studies evaluating dysnatremia and risk of adverse outcomes in patients
with COVID-19 can be found in Eur J Endocrinol 2021 Sep 6;185(4):R103
STUDY
⚬ SUMMARY
acute kidney injury reported in 4.5% of adults with COVID-19
SYSTEMATIC REVIEW: Crit Care 2020 Jun 18;24(1):356

Details

– systematic review of 24 observational studies evaluating renal impairment in 4,963 adults with
COVID-19
● age ranged from 41 to 67 years
● 21 studies were from China and 3 studies from United States
– prevalence of acute kidney injury
● 4.5% (95% CI 3%-6%) in adults with COVID-19 in analysis of 17 studies

● 1.3% (95% CI 0.2%-2.4%) in adults with mild or moderate disease in analysis of 7 studies
● 2.8% (95% CI 1.4%-4.2%) in adults with severe disease in analysis of 5 studies
● 36.4% (95% CI 14.6%-58.3%) in adults with critical disease in analysis of 7 studies
● 52.9% (95% CI 34.5%-71.4%) in patients who died in analysis of 3 studies
● 0.7% (95% CI 0.3%-1.8%) in patients who survived in analysis of 3 studies
– kidney abnormalities included
● elevated serum creatinine in 9.6% (95% CI, 5.7%–13.5%) in analysis of 13 studies

● elevated blood urea nitrogen in 13.7% (95% CI, 5.5%–21.9%) in analysis of 6 studies
● proteinuria in 57.2% (95% CI, 40.6%–73.8%) in analysis of 3 studies
– continuous renal replacement therapy in
● 5.6% (95% CI 2.6%–8.6%) severe patients

● 0.1% (95% CI -0.1% to +0.2%) nonsevere patients
● 15.6% (95% CI 10.8%–20.5%) in patients who died in analysis of 3 studies
● 0.4% (95% CI -0.2% to +1%) inpatients who survived in analysis of 3 studies
– Reference - Crit Care 2020 Jun 18;24(1):356 full text
STUDY
⚬ SUMMARY
acute kidney injury reported in 17% of adults hospitalized with COVID-19
SYSTEMATIC REVIEW: Kidney Int Rep 2020 Aug;5(8):1149 | Full Text

Details

– systematic review of 20 cohort studies with data to assess risk of acute kidney injury in 13,137
hospitalized adults with COVID-19 in China, Korea, United States, or Europe
● mean age ranged from 43 to 72 years
● 43% had severe disease
● comorbidities included hypertension (33%) and diabetes (17%)
– acute kidney injury in 17% (range 0.5%-80.3%)

– clinical heterogeneity affecting prevalence of acute kidney injury included definition of disease
severity and clinical monitoring practices for renal dysfunction
– 11% died, including 52% of patients with acute kidney injury
– Reference - Kidney Int Rep 2020 Aug;5(8):1149 full-text
STUDY
⚬ SUMMARY
en adultos con COVID-19 ingresados en UCI en Nueva York, Nueva York, lesión renal aguda en
78% y necesidad de diálisis en 35%
ESTUDIO DE COHORTE : BMJ 2020 29 de mayo; 369: m1996 | Texto completo

Detalles

– 1,000 consecutive adults (mean age 63 years, 60% men) with laboratory-confirmed COVID-19
presenting to hospital in New York, New York, between March 1 and April 5, 2020, had medical
records evaluated
– analysis of 236 patients admitted to ICU
● in-hospital mortality 43.6%

● ARDS in 89.8%
● acute kidney injury in 78%
● inpatient dialysis in 35.2%
● new-onset arrhythmia in 26.3%
● ventilator-associated pneumonia in 24.6%
– analysis of 614 patients admitted to nonintensive hospital care
● in-hospital mortality 14%

● acute kidney injury in 16.9%
● ARDS in 14.2%
● inpatient dialysis in 5.5%
● new onset arrhythmia in 2.8%
– Reference - BMJ 2020 May 29;369:m1996 full-text

● complicaciones cardiovasculares
⚬ Las complicaciones cardiovasculares notificadas incluyen 2
– isquemia miocárdica e infarto de miocardio

– miocarditis
– arritmias incluyendo
● fibrilación y aleteo auricular de nueva aparición

● taquicardia sinusal
● bradicardia sinusal
● Prolongación del intervalo QT (a menudo inducida por fármacos)
● torsades de pointes
● muerte cardíaca súbita
● actividad eléctrica sin pulso
– miocardiopatía, que puede ser biventricular o disfunción ventricular derecha o izquierda aislada
– shock cardiogénico
RESUMEN
⚬ DEL ESTUDIO
anomalías cardíacas posteriores al alta (incluidas enfermedades cardíacas no isquémicas e
isquémicas) notificadas en el 54 % de los adultos que tenían niveles anormales de troponina de
alta sensibilidad en el momento del ingreso hospitalario por COVID-19 grave
ESTUDIO DE COHORTE : Eur Heart J 2021 14 de mayo;42(19):1866 | Texto completo

Detalles

– 148 adults (mean age 64 years, 70% men) discharged following hospitalization for severe COVID-
19 (with abnormal high-sensitivity troponin at time of hospital admission) in the United Kingdom
had cardiovascular magnetic resonance imaging and were assessed
● patients with severe renal impairment and severe comorbid disease and/or frailty and patients
admitted to hospital for acute coronary syndrome were excluded
● mean high-sensitivity troponin level at time of hospital admission 39 ng/L
– 128 patients had laboratory-confirmed COVID-19, and 20 patients had COVID-19 diagnosis based
on clinical symptoms, blood biomarkers, and radiologic features
– medical history included hypertension (57%), hypercholesterolemia (46%), diabetes mellitus (34%),
history of smoking (24%), previous percutaneous coronary intervention or coronary artery bypass
graft (12%), and previous myocardial infarction (7%)
– 48 patients admitted to ICU for ventilatory support
– median duration of hospital stay 9 days
– median time to cardiovascular magnetic resonance imaging posthospital discharge 56 days
– imaging outcomes
● cardiac abnormalities in 54%
⚬ nonischemic heart disease (myocarditis-like scar) in 26%

⚬ ischemic heart disease (infarction and/or inducible ischemia) in 22%
⚬ dual pathology in 6%
● normal left ventricular function in 89%

● among persons with no associated left ventricular dysfunction, myocarditis-like injury limited
to ≤ 3 myocardial segments in 88%
● myocardial infarction in 19%
● pleural effusions in 9%
● pericardial effusion in 5%
– no evidence of diffuse fibrosis or edema in remote myocardium in patients who had COVID-19
compared to historical controls
– Reference - Eur Heart J 2021 May 14;42(19):1866 full-text
RESUMEN
⚬ DEL ESTUDIO
paro cardíaco intrahospitalario informado en el 14% de los adultos ingresados en la UCI con
COVID-19
ESTUDIO DE COHORTE : BMJ 2020 30 de septiembre; 371: m3513 | Texto completo

Detalles

– 5,019 adults (mean age 63 years, 65% men) with laboratory-confirmed COVID-19 consecutively
admitted to ICU in the United States during March to June 2020 from STOP-COVID study were
assessed
– 701 (14%) had in-hospital cardiac arrest defined as unexpected hemodynamic instability with
absence of palpable pulse for which cardiopulmonary resuscitation would normally be
administered (excluding patients whose death was expected due to progressive clinical
deterioration)
● 57.1% received cardiopulmonary resuscitation
● in-hospital mortality 93.2% (6.8% survived and discharged from hospital)
– in 400 patients who had cardiopulmonary resuscitation, 12% survived to discharge

– in 48 patients who survived to discharge
● 58.3% had normal or mild neurologic impairment (cerebral performance category score 1-2)
● 41.7% had moderate or severe neurologic impairment (cerebral performance category score 3-
4)
– factors associated with in-hospital cardiac arrest
● age 65-79 years compared to < 45 years old (adjusted odds ratio [OR] 1.58, 95% CI 1.12-2.23)
● age ≥ 80 years old compared to < 45 years old (adjusted OR 1.75, 95% CI 1.15-2.67)
● Black ethnicity/race compared to non-Hispanic White ethnicity/race (adjusted OR 1.58, 95% CI
1.23-2.02)
● increasing modified sequential organ failure assessment (mSOFA) score on admission to ICU
(adjusted OR 1.31 per 2-unit increase, 95% CI (1.24-1.38)
– in adjusted analysis of patients who received cardiopulmonary resuscitation, age ≥ 80 years and
male sex each associated with significantly increased risk of death
– Reference - BMJ 2020 Sep 30;371:m3513 full-text
● complicaciones endocrinas incluyendo 2
⚬ hiperglucemia
⚬ cetoacidosis
⚬ cetosis euglucémica
⚬ enfermedad grave en pacientes con diabetes u obesidad preexistentes
● complicaciones gastrointestinales y hepatobiliares incluyendo 2
⚬ transaminasas hepáticas moderadamente elevadas (típicamente dentro de 5 veces el límite superior

de lo normal)
⚬ bilirrubina elevada
⚬ albúmina sérica baja
⚬ hepatitis aguda grave (raro)
⚬ isquemia mesentérica (raro)
⚬ sangrado gastrointestinal (raro)
● Se han informado complicaciones oftalmológicas que incluyen congestión conjuntival, conjuntivitis y
cambios en la retina 2
● complicaciones psiquiátricas
RESUMEN
⚬ DEL ESTUDIO
agitación y confusión reportadas en aproximadamente el 65% de los pacientes con COVID-19 en
la UCI
REVISIÓN SISTEMÁTICA : Lancet Psychiatry 2020 18 de mayo temprano en línea | Texto completo
Detalles

– systematic review of 72 observational studies reporting psychiatric outcomes in 3,559 patients
with suspected or laboratory-confirmed COVID-19, SARS, or Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
● 976 patients had COVID-19, 2,068 patients had SARS, and 515 patients had MERS-CoV
(estimated unique cases across studies)
● mean age across studies ranged from 12 to 68 years
– 7 studies included in meta-analysis

– acute psychiatric outcomes in patients hospitalized with COVID-19
● agitation in 69% of 58 patients in ICU in 1 study

● confusion in 65% of 40 patients in ICU in 1 study
● altered consciousness in 21% of patients who subsequently died in 1 study
● dysexecutive syndrome at discharge in 33% in 1 study with 45 patients
– meningitis-encephalitis reported in 1 patient, and hypoxic encephalopathy reported in 2 patients

– Reference - Lancet Psychiatry 2020 May 18 early online full-text
RESUMEN
⚬ DEL ESTUDIO
COVID-19 asociado con un mayor riesgo de enfermedad psiquiátrica dentro de los 90 días en los
Estados Unidos
ESTUDIO DE COHORTE : Lancet Psychiatry 2020 9 de noviembre temprano en línea

Detalles
– based on population-based retrospective cohort study

– 62,345 patients aged ≥ 10 years (mean age 49 years, 55% women, 51% White) with COVID-19 in
United States were compared to propensity score-matched patients with other health events for
incident psychiatric diagnosis 14-90 days after health event
● other health events included influenza (26,497 patients), other respiratory tract infection
(44,775), skin infection (38,977), cholelithiasis (19,733), urolithiasis (28,827), and large bone
fracture (37,841)
● patients excluded if health event before January 20, 2020 or if they died or had health event
after August 1, 2020
● propensity scores based on baseline characteristics including risk factors for COVID-19 and
severe COVID-19
– COVID-19 associated with increased risks of
● first psychiatric illness
⚬ 5.8% with COVID-19 (p < 0.0001 vs. each of the other health events)
⚬ 2.5%-3.4% with other health events
⚬ consistent results in most sensitivity analyses such as those based on race, housing and
economic factors, and laboratory confirmed COVID-19
⚬ increased risk compared to most other health events also for anxiety disorders, mood
disorders, insomnia, and dementia (in patients aged ≥ 65 years)
● any incident psychiatric illness (including first diagnosis and relapse)
⚬ 18.1% with COVID-19 (p < 0.0001 vs. each of the other health events)
⚬ 12.7%-15.1% with other health events
⚬ increased risk compared to most other health events also for anxiety disorders, mood
disorders, and psychotic disorders
– Reference - Lancet Psychiatry 2020 Nov 9 early online , correction can be found in Lancet
Psychiatry 2020 Nov 12 early online
● coinfección
RESUMEN
⚬ DEL ESTUDIO
coinfección bacteriana reportada en 7% y coinfección viral en 3% de pacientes hospitalizados con
COVID-19
REVISIÓN SISTEMÁTICA : J Infect 2020 27 de mayo temprano en línea | Texto completo

Detalles
– based on systematic review of mostly observational studies

– systematic review of 30 studies (1 randomized trial and 29 observational studies) evaluating
coinfections in 3,834 hospitalized patients with COVID-19
● 23 studies were from China, 3 from United States, 2 from Spain, and 1 each from Thailand and
Singapore
● 3 studies included 86 children
● data on time from admission to detection of infection not reported for 29 studies
– pooled rates of bacterial or viral coinfections in patients hospitalized with COVID-19
● bacterial coinfection 7% (95% CI 3%-12%) overall in analysis of 19 studies with 2,183 patients
⚬ 4% (95% CI 1%-9%) in analysis of 13 studies with 1,979 mixed hospital or ICU patients
⚬ 14% (95% CI 5%-26%) in analysis of 6 studies with 204 ICU patients
● viral coinfection 3% (95% CI 1%-6%) overall in analysis of 16 studies with 1,014 patients
⚬ 3% (95% CI 1%-5%) in analysis of 14 studies with 972 mixed hospital or ICU patients
⚬ 5% (95% CI 1%-14%) in analysis of 2 studies with 42 ICU patients
– 6 patients with Candida albicans, 2 patients with Aspergillus flavus, 1 patient with Aspergillus
fumigatus, and 1 patient with Candida glabrata reported in 3 studies
– most commonly detected bacterial or viral pathogens included
● Mycoplasma pneumoniae (42%),Pseudomonas aeruginosa (12%), and Haemophilus influenzae
(12%)
● respiratory syncytial virus (17%) and influenza A (16%)
– coinfection associated with increased risk of death (pooled odds ratio 5.82, 95% CI 3.4-9.9) in
analysis of 4 studies with 733 patients, results limited by significant heterogeneity
– Reference - J Infect 2020 May 27 early online full-text
– consistent results in systematic review of 24 studies evaluating coinfections in 3,506 patients with
confirmed COVID-19 (Clin Microbiol Infect 2020 Jul 22 early online )
⚬ Las Consideraciones de la Organización Mundial de la Salud (OMS) para la atención de la

tuberculosis se pueden encontrar en OMS 2021 May 5
● La revisión sistemática de 27 informes de casos, series de casos, informes de literatura gris o

comentarios sobre trasplante de pulmón bilateral en 21 pacientes con insuficiencia pulmonar en etapa
terminal secundaria a COVID-19 se puede encontrar en Transplantation 2021 16 de febrero temprano
en línea
● estudio de cohorte prospectivo que evalúa las complicaciones hospitalarias en 80 388 adultos con
COVID-19 en el Reino Unido entre el 17 de enero y el 4 de agosto de 2020 se puede encontrar en Lancet
2021 Jul 17;398(10296):223 texto completo
Pronóstico
Mortalidad
● las tasas de mortalidad debido a COVID-19 varían ampliamente con factores importantes que incluyen
la gravedad de la enfermedad y la edad 1
● tasas de mortalidad por nivel de atención requerida según estudios publicados
⚬ todos los pacientes 0,3%-2,3%

⚬ pacientes ingresados en el hospital 10%-23%
⚬ pacientes ingresados en unidad de cuidados intensivos 26%-50%
⚬ pacientes que requieren ventilación mecánica u oxigenación por membrana extracorpórea (ECMO)
37%-88%
● las tasas de mortalidad notificadas aumentan con la edad, desde < 5 % en pacientes menores de 40
años hasta > 60 % en pacientes de 80 a 89 años en los Estados Unidos 1
RESUMEN
● DEL ESTUDIO
mortalidad hospitalaria 28% en adultos ingresados en unidad de cuidados intensivos (UCI) con
COVID-19 grave hasta agosto de 2020
REVISIÓN SISTEMÁTICA : Cofre 2021 Feb;159(2):524 | Texto completo

Detalles

⚬ systematic review of 45 observational studies evaluating in-hospital mortality in 16,561 adults (mean
age 62 years, 66% men) with confirmed COVID-19 admitted to ICU in 17 countries
– 16 studies were conducted in Europe (13,485 patients), 15 studies in China (1,385 patients), 11
studies in North America (1,469 patients), and 3 studies in Middle East (222 patients)
– common comorbidities included hypertension (49.5%), diabetes (26.6%), cardiovascular disease
(22.2%), obstructive sleep apnea (20%), and chronic kidney disease (10%)
– median time from onset of symptoms to ICU admission 9 days
⚬ all results limited by significant heterogeneity

⚬ pooled rates of outcomes
– in-hospital mortality 28.1% (95% CI 23.4%-33%) in analysis of all studies

– discharge from hospital 43.9% (95% CI 38.9%-48.9%) in analysis of 33 studies with 15,896 patients
– acute respiratory distress syndrome 76.1% (95% CI 65.7%-85.2%) in analysis of 13 studies with
1,260 patients
– invasive mechanical ventilation 67.7% (95% CI 59.1%-75.7%) in analysis of 28 studies with 13,543
patients
– extracorporeal membrane oxygenation 6.4% (95% CI 4.1%-9.1%) in analysis of 18 studies with
1,828 patients
– shock 25.3% (95% CI 16.7%-35%) in analysis of 7 studies with 895 patients
– vasopressor support 65.9% (95% CI 52.4%-78.4%) in analysis of 12 studies with 1,052 patients
– acute kidney injury 27.1% (95% CI 20.6%-34.2%) in analysis of 13 studies with 1,287 patients
– renal replacement therapy 16.9% (95% CI 12.1%-22.2%) in analysis of 18 studies with 12,276
patients
⚬ pooled mean ICU length of stay 10.8 days (95% CI 9.3-18.4 days) in analysis of 11 studies with 2,484
patients
⚬ pooled mean hospital length of stay 19.1 days (95% CI 16.3-21.9 days) in analysis of 10 studies with
2,518 patients
⚬ Reference - Chest 2021 Feb;159(2):524 full-text
RESUMEN
● DEL ESTUDIO
mortalidad general 10% en pacientes hospitalizados con COVID-19 confirmado por laboratorio y
34% en pacientes ingresados en la unidad de cuidados intensivos
REVISIÓN SISTEMÁTICA : Crit Care 2020 Jul 2;24(1):389 | Texto completo

Detalles

⚬ systematic review of 1 randomized trial and 43 observational studies reporting mortality and acute
complications in 14,866 patients with laboratory-confirmed COVID-19
⚬ 41 studies were conducted in China (13,038 patients)
⚬ mean patient age ranged from 38 to 69 years; 56.4% were men
⚬ 43 studies enrolled only hospitalized patients (median hospital stay 15 days)
⚬ 13 studies had follow-up of ≥ 2 weeks
⚬ all results limited by significant heterogeneity
⚬ all-cause mortality 10% (95% CI 8%-13%) in analysis of 43 studies with 14,203 patients
– 34% (95% CI 23%-47%) in patients admitted to intensive care unit in analysis of 10 studies with
2,368 patients
– 83% (95% CI 42%-97%) in patients requiring invasive ventilation in analysis of 6 studies with 220
patients
– 75% (95% CI 63%-84%) in patients who developed acute respiratory distress syndrome (ARDS) in
RESUMEN
● DEL ESTUDIO
45%-56% de mortalidad informada en adultos con COVID-19 que recibieron ventilación mecánica
invasiva
REVISIÓN SISTEMÁTICA : Am J Respir Crit Care Med 2020 Oct 29 temprano en línea
Detalles
⚬ based on systematic review

⚬ systematic review of 69 observational studies and national registries reporting mortality in 57,420
adults in 23 countries with laboratory-confirmed COVID-19 and who had invasive mechanical
ventilation
⚬ mean age 59 years, 55% men
⚬ most results limited by significant heterogeneity
⚬ pooled overall mortality
– 56% (95% CI 47%-65%) in analysis of 54 studies limited to 13,120 patients with known outcome
(total population included patients who died or were discharged from hospital)
– 45% (95% CI 39%-52%) in analysis of 69 studies with 57,420 patients (total population included
patients who died, were discharged, or remained in hospital)
⚬ pooled mortality by age in analysis of 6 studies
– 47.9% (95% CI 46.4%-49.4%) in 4,145 adults ≤ 40 years old

– 54.3% (95% CI 53%-55.7%) in 5,284 adults aged 41-50 years
– 59.3% (95% CI 58.3%-60.3%) in 5,373 adults aged 51-60 years
– 71.3% (95% CI 70.5%-72.2%) in 7,676 adults aged 61-70 years
– 77.1% (95% CI 76.2%-78%) in 8,743 adults aged 71-80 years
– 84.4% (95% CI 83.3%-85.4%) in 4,627 adults > 80 years old
⚬ Reference - Am J Respir Crit Care Med 2020 Oct 29 early online
RESUMEN
● DEL ESTUDIO
Mortalidad a 90 días 37,4% en pacientes ≥ 16 años con COVID-19 que recibieron ECMO
ESTUDIO DE COHORTE : Lancet, 10 de octubre de 2020; 396 (10257): 1071

Detalles

⚬ 1,035 patients ≥ 16 years old (median age 49 years, 74% men) with laboratory-confirmed COVID-19
and who had ECMO between mid-January 2020 and May 2020 recorded in Extracorporeal Life
Support Organization registry were assessed
– median duration from endotracheal intubation to ECMO was 4 days
– ECMO was venovenous in 94%, venoarterial in 4.3%, and other in 1.7% for median duration of
13.9 days
⚬ 70% had ≥ 1 comorbidity including obesity (body mass index > 30 kg/m2) in 47%, diabetes in 24%,
and asthma in 11%
⚬ 79% had ARDS, 29% had acute kidney injury, 5% had acute heart failure, and 2% had myocarditis
⚬ estimated 90-day mortality
– 37.4% overall
– 38% in 819 patients with ARDS
⚬ factors significantly associated with increased mortality included age ≥ 50 years compared to age 16-
39 years, immunocompromised state, chronic respiratory disease, cardiac arrest before ECMO, acute
kidney injury, and having venoarterial or venovenoarterial initial mode of ECMO compared to
venovenous ECMO
⚬ in analysis of 983 patients, complications included circuit change (15%), membrane lung failure (8%),
central nervous system hemorrhage (6%), and hemolysis (5%)
⚬ Reference - Lancet 2020 Oct 10;396(10257):1071 full text
RESUMEN
● DEL ESTUDIO
en pacientes con COVID-19 perioperatorio sometidos a cirugía, se informó mortalidad a los 30 días
en el 24 % y complicación pulmonar en el 51 % de los pacientes
ESTUDIO DE COHORTE : Lancet 2020 Jul 4;396(10243):27 | Texto completo

Detalles

⚬ 1,128 patients with laboratory (in 86%) or clinically confirmed COVID-19 within 7 days before or 30
days after surgery for any indication performed between January 1 and March 31, 2020, were
assessed
– 19% were < 50 years old, 31.3% were aged 50-69 years, and 49.5% were ≥ 70 years old
– 71% had postoperative diagnosis of SARS-CoV-2 infection
– 74% had emergency surgery, and 75% had major surgery
– indications for surgery were benign in 54.5%, cancer in 24.6%, and trauma in 20.1%
⚬ 30-day mortality
– 23.8% overall
– 38% in 577 patients with pulmonary complications
⚬ 51.2% had ≥ 1 pulmonary complication
– pneumonia in 40.4%
– unexpected postoperative ventilation in 21.3%
– ARDS in 14.4%
⚬ factors associated with increased 30-day mortality included
– American Society of Anesthesiologists grades 3-5 compared to grades 1-2 (adjusted odds ratio
[OR] 2.35, 95% CI 1.57-3.53)
– age ≥ 70 years compared to < 70 years (adjusted OR 2.3, 95% CI 1.65-3.22)
– male sex (adjusted OR 1.75, 95% CI 1.28-2.4)
– emergency surgery compared to elective surgery (adjusted OR 1.67, 95% CI 1.06-2.63)
– malignant diagnosis compared to benign or obstetric diagnosis (adjusted OR 1.55, 95% CI 1.01-
2.39)
– major surgery compared to minor surgery (adjusted OR 1.52, 95% CI 1.01-2.31)
⚬ Reference - Lancet 2020 Jul 4;396(10243):27 full-text
RESUMEN
● DEL ESTUDIO
life expectancy appears to have fallen in 2020 in most upper-middle- and high-income countries
due to COVID-19 pandemic
COHORT STUDY: BMJ 2021 Nov 3;375:e066768

Details

⚬ 37 upper-middle- and high-income countries were assessed in time series analysis using all-cause
mortality data from Human Mortality database between 2005 and 2020 to evaluate changes in life
expectancy and years of life lost associated with COVID-19 pandemic
– countries included Austria, Belgium, Bulgaria, Canada, Chile, Croatia, Czech Republic, Denmark,
England and Wales, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Israel, Italy,
Latvia, Lithuania, Luxembourg, the Netherlands, New Zealand, Northern Ireland, Norway, Poland,
Portugal, Russia, Scotland, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, Taiwan,
and the United States
– reduction in life expectancy defined as difference between observed life expectancy from birth in
2020 and predicted life expectancy based on historical data from 2005 to 2019
– excess years of life lost defined as difference between observed years of life lost in 2020 and
expected years of life lost within sex and age groups based on historical data from 2005 to 2019
⚬ countries with highest reductions in life expectancy in 2020
– Russia (2.33 years for male persons, 2.14 years for female persons)
– United States (2.27 years for male persons, 1.61 years for female persons)
– Bulgaria (1.96 years for male persons, 1.37 years for female persons)
– Lithuania (1.83 years for male persons, 1.21 years for female persons)
– Chile (1.64 years for male persons, 0.88 years for female persons)
– Spain (1.35 years for male persons, 1.13 years for female persons)
⚬ estimated life expectancy slightly increased in New Zealand and Taiwan; no change in life expectancy
in Denmark, South Korea, and Norway
⚬ countries with highest excess years of life lost (per 100,000 population) in 2020
– Bulgaria (7,260 for male persons, 3,730 for female persons)

– Russia (7,020 for male persons, 4,760 for female persons)
– Lithuania (5,430 for male persons, 2,640 for female persons)
– United States (4,350 for male persons, 2,430 for female persons)
– Poland (3,830 for male persons, 2,040 for female persons)
– Hungary (2,770 for male persons, 1,920 for female persons)
⚬ estimated years of life lost across all countries in 2020 > 5 times higher than during 2015 seasonal
influenza epidemic
⚬ Reference - BMJ 2021 Nov 3;375:e066768 full text
STUDY
● SUMMARY
estimated 18.2 million excess deaths worldwide associated with COVID-19 pandemic in 2020-2021,
with highest number of excess deaths in India, the United States, Russia, Mexico, Brazil, Indonesia,
and Pakistan
COHORT STUDY: Lancet 2022 Mar 10 early online | Full Text

Details

⚬ 74 countries and territories and 266 subnational locations including 31 locations in low- and middle-
income countries with weekly or monthly all-cause mortality data in 2020-2021 and for up to 11
years previously were assessed
⚬ excess mortality due to COVID-19 pandemic was defined as difference between number of deaths
during pandemic (measured by observed or estimated all-cause mortality) and number of expected
deaths based on past trends in all-cause mortality
⚬ estimated excess deaths worldwide was 18.2 million (95% uncertainty interval [UI] 17.1-19.6) in 2020-
2021
⚬ countries with highest number of excess deaths
– India, with 4.07 million (95% UI 3.71-4.36 million) excess deaths

– the United States, with 1.13 million (95% UI 1.08-1.18 million) excess deaths
– Russia, with 1.07 million (95% UI 1.06-1.08 million) excess deaths
– Mexico, with 798,000 (95% UI 741,000-867,000) excess deaths
– Brazil, with 792,000 (95% UI 730,000-847,000) excess deaths
– Indonesia, with 736,000 (95% UI 594,000-955,000) excess deaths
– Pakistan, with 664,000 (95% UI 498,000-847,000) excess deaths
⚬ excess mortality per 100,000 of population
– 120.3 globally
– > 300 in 21 countries, including Albania, Armenia, Belarus, Bolivia, Bosnia and Herzegovina,
Botswana, Bulgaria, Ecuador, Eswatini, Latvia, Lebanon, Lesotho, Lithuania, Mexico, Montenegro,
Namibia, North Macedonia, Peru, Romania, Russia, and Tunisia
⚬ countries with highest ratio of excess deaths to reported COVID-19 deaths included Tanzania (179),
Nicaragua (150), Central African Republic (139), Burundi (127), Tajikistan (116), and South Sudan (109)
⚬ negative values for excess mortality were estimated in Iceland, Australia, Singapore, New Zealand,
and Taiwan
⚬ Reference - Lancet 2022 Mar 10 early online full-text
STUDY
● SUMMARY
estimated excess death associated with COVID-19 pandemic in 2020 was 8.5% in Sweden, 12.5% in
Switzerland, and 17.3% in Spain
COHORT STUDY: Ann Intern Med 2022 Feb 1 early online | Full Text
Details

⚬ 3 countries (Sweden, Switzerland, and Spain) with monthly mortality data from each country's official
national statistical office from earliest available year (1877 for Switzerland, 1851 for Sweden, and
1908 for Spain) to 2021 were assessed
⚬ countries included were chosen due to militarily neutral status during World War I and II and
availability of monthly mortality data spanning ≥ 100 years
⚬ excess deaths defined as difference between observed all-cause deaths during COVID-19 pandemic
and expected deaths estimated based on historical data
⚬ absolute excess deaths per 100,000 persons in 2020
– 75 (95% credible interval [CrI] 40-105) in Sweden

– 100 (95% CrI 60-135) in Switzerland
– 155 (95% CrI 110-195) in Spain
⚬ relative excess deaths in 2020
– 8.5% (95% CrI 4.5%-12.6%) in Sweden

– 12.5% (95% CrI 7.4%-17.7%) in Switzerland
– 17.3% (95% CrI 11.8-23.1%) in Spain
⚬ Reference - Ann Intern Med 2022 Feb 1 early online full-text
STUDY
● SUMMARY
estimó un exceso de muertes de 979 000 asociado con la pandemia de SARS-CoV-2 en 29 países de
ingresos altos en 2020, con el mayor número de muertes en exceso en los Estados Unidos, Italia,
Inglaterra y Gales, España y Polonia
ESTUDIO DE COHORTE : BMJ 2021 19 de mayo; 373: n1137 | Texto completo

Detalles

⚬ 29 high-income countries (Austria, Belgium, the Czech Republic, Denmark, England and Wales,
Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Lithuania, the Netherlands,
New Zealand, Northern Ireland, Norway, Poland, Portugal, Scotland, Slovakia, Slovenia, South Korea,
Spain, Sweden, Switzerland, and the United States) of Organization for Economic Cooperation and
Development with complete 2020 weekly mortality data in Human Mortality Database were assessed
⚬ excess deaths defined as difference between all-cause deaths during COVID-19 pandemic and
expected deaths estimated based on historical data from 2016 to 2019
⚬ estimated 979,000 excess deaths occurred in 2020
⚬ all countries had excess deaths in 2020 except New Zealand, Norway, and Denmark
⚬ countries with highest number of excess deaths
– United States, with 458,000 (95% CI 454,000-461,000) excess deaths

– Italy, with 89,100 (95% CI 87,500-90,700) excess deaths
– England and Wales, with 85,400 (95% CI 83,900-86,800) excess deaths
– Spain, with 84,100 (95% CI 82,800-85,300) excess deaths
– Poland, with 60,100 (95% CI 58,800-61,300) excess deaths
⚬ countries with highest age-standardized excess death rates
– in men
● Lithuania, with 360 (95% CI 324-396) excess deaths per 100,000 men
● Poland, with 298 (95% CI 289-307) excess deaths per 100,000 men
● Hungary, with 235 (95% CI 217-254) excess deaths per 100,000 men
● Slovenia, with 222 (95% CI 189-256) excess deaths per 100,000 men
● Czech Republic, with 211 (95% CI 194-228) excess deaths per 100,000 men
– in women
● Lithuania, with 152 (95% CI 134-171) excess deaths per 100,000 women
● Hungary, with 144 (95% CI 133-156) excess deaths per 100,000 women
● United States, with 131 (95% CI 129-133) excess deaths per 100,000 women
● Spain, with 125 (95% CI 121-129) excess deaths per 100,000 women
● Northern Ireland, with 121 (95% CI 97-146) excess deaths per 100,000 women
⚬ countries with highest ratio of excess deaths to COVID deaths (excess deaths divided by COVID
deaths × 100) included South Korea (488), Lithuania (422), Estonia (328), Slovakia (248), and Poland
(222)
⚬ age-standardized excess death rates were higher in men than in women in all countries except
Northern Ireland, Portugal, Greece, Estonia, Latvia, Finland, South Korea, Norway, Denmark, and New
Zealand
⚬ lowest age-standardized excess mortality rates for both men and women were in New Zealand,
Denmark, Norway, South Korea, and Finland
⚬ Reference - BMJ 2021 May 19;373:n1137 full-text , editorial can be found in BMJ 2021 May
19;373:n1239
● Porcelana
RESUMEN
⚬ DEL ESTUDIO
mortalidad general 2,3 % para los primeros pacientes con COVID-19 en China, con mayor
mortalidad en pacientes de edad avanzada
ESTUDIO DE COHORTE : Zhonghua Liu Xing Bing Xue Za Zhi 2020 17 de febrero; 41 (2): 145
Detalles

– 44,672 patients with confirmed COVID-19 with symptom onset between December 8, 2019 and
– 1,023 patients died (overall mortality 2.3%)
– mortality by age
● 14.8% in patients ≥ 80 years old

● 8% in patients aged 70-79 years
● 3.6% in patients aged 60-69 years
● 0% in patients aged 0-9 years
– mortality by comorbid conditions
● 10.5% in patients with cardiovascular disease

● 7.3% in patients with diabetes
● 6.3% in patients with chronic respiratory disease
● 6% in patients with hypertension
● 5.6% in patients with cancer
● 0.9% in patients without comorbid condition
– Reference - Zhonghua Liu Xing Bing Xue Za Zhi 2020 Feb 17;41(2):145 [Chinese], also published
in China CDC Weekly 2020;2(8):113 [English]
RESUMEN
⚬ DEL ESTUDIO
SDRA y sepsis informados en el 100 % de los pacientes con COVID-19 confirmado que fallecieron
ESTUDIO DE COHORTE : BMJ 2020 26 de marzo; 368: m1091 | Texto completo

Detalles

– 799 patients admitted to hospital designated for severely or critically ill patients with COVID-19 in
China from January 13 to February 12, 2020, were followed until February 28, 2020
● 14.1% died
● 20.2% recovered and were discharged
● 65.7% remained in hospital
– median time from onset of symptoms to death was 16 days, and median time from onset of
symptoms to discharge was 26 days
– comparing patients who died vs. patients who recovered (no p values reported)
● characteristics at baseline
⚬ median age 68 years vs. 51 years

⚬ ≥ 60 years old in 83% vs. 37%
⚬ male gender in 73% vs. 55%
⚬ ≥ 1 chronic medical condition in 63% vs. 39%
– hypertension in 48% vs. 24%

– diabetes in 21% vs. 14%
– cardiovascular disease in 14% vs. 4%
– chronic lung disease in 10% vs. 4%
– cerebrovascular disease in 4% vs. 0%
– chronic kidney disease in 4% vs. 1%
● symptoms
⚬ dyspnea in 62% vs. 31%

⚬ chest tightness in 49% vs. 30%
⚬ disorder of consciousness in 22% vs. 1%
● vital signs on admission
⚬ arterial pressure ≥ 140 mm Hg in 44% vs. 20%

⚬ heart rate > 100 beats per minute in 50% vs. 30%
⚬ respiratory rate ≥ 24 breaths per minute in 58% vs. 13.8%
⚬ percutaneous oxygen saturation ≤ 93% in 64% vs. 12%
⚬ leukocytosis (≥ 10 × 109 cells/L) in 50% vs. 4%

⚬ lymphopenia (< 1 × 109 cells/L) in 91% vs. 47%
⚬ severe lymphopenia (< 0.5 × 109 cells/L) in 39% vs. 5%
⚬ hypoalbuminemia (albumin < 32 g/L) in 65% vs. 14%
⚬ elevated aspartate aminotransferase (> 40 units/L) in 52% vs. 16%
⚬ elevated cardiac troponin I (> 15.6 pg/mL) in 72% vs. 14%
⚬ elevated N-terminal pro-brain natriuretic peptide (> 285 pg/mL) in 85% vs. 18%
⚬ elevated D-dimer (> 21 mcg/mL) in 35% vs. 2%
● complications
⚬ ARDS in 100% vs. 52%

⚬ sepsis in 100% vs. 41%
⚬ acute cardiac injury in 77% vs. 17%
⚬ type I respiratory failure in 51% vs. 0%
⚬ heart failure in 49% vs. 3%
⚬ alkalosis in 40% vs. 16%
⚬ hyperkalemia in 37% vs. 14%
⚬ acute kidney injury in 25% vs. 1%
⚬ hypoxic encephalopathy in 20% vs. 1%
– Reference - BMJ 2020 Mar 26;368:m1091 full-text
● Estados Unidos
⚬ las tasas de mortalidad varían según la edad 1
Table 5. Mortality Rates in the United States

Age Deaths per 1,000 COVID-19 Cases
< 18 years 0.4
18-29 years 1.1
30-39 years 3.5
40-49 years 8.6
50-64 years 29.7
65-74 years 105
75-84 years 210.5
≥ 85 years 304.9
⚬ Evidencia • Actualizado 18 Oct 2022
RESUMEN DEL ESTUDIO

La infección por SARS-CoV-2 con la variante Omicron se asoció con un menor riesgo de
reinfección y hospitalización y muerte relacionadas con la reinfección después de 4 meses en
comparación con personas sin infección previa en Carolina del Norte, Estados Unidos
ESTUDIO DE COHORTE : JAMA 2022 11 de octubre; 328 (14): 1415 | Texto completo
Detalles

– 10,600,823 persons (mean age 39 years, 51% female, 72% White, 23% Black, and 10% Hispanic) in
North Carolina COVID-19 Surveillance System and COVID-19 Vaccine Management System were
assessed between December 11, 2020 and June 3, 2022
– overall, 2,771,364 SARS-CoV-2 infections occurred, with hospitalization rate 6.3% and mortality
1.4%
– compared to no prior SARS-CoV-2 infection
● infection with Omicron variant associated with
⚬ decreased reinfection after 4 months (adjusted rate ratio 0.23, 95% CI 0.22-0.24)
⚬ decreased hospitalization caused by reinfection after 4 months (adjusted hazard ratio [HR]
0.1, 95% CI 0.07-0.14)
⚬ decreased mortality caused by reinfection after 4 months (adjusted HR 0.11, 95% CI 0.08-
0.15)
● infection with Delta or Omicron variant associated with
⚬ decreased hospitalization caused by reinfection after 5 months (adjusted HR 0.12, 95% CI

0.08-0.17)
⚬ decreased mortality caused by reinfection after 5 months (adjusted HR 0.13, 95% CI 0.09-
0.18)
– Reference - JAMA 2022 Oct 11;328(14):1415 full-text , editorial can be found in JAMA 2022 Oct
11;328(14):1402
RESUMEN
⚬ DEL ESTUDIO
23% de mortalidad para hombres y 15% para mujeres entre asegurados hospitalizados con
COVID-19 antes del 10 de abril de 2020 en Washington y California, Estados Unidos

Detalles

– 9,596,321 persons from health insurance database enrolling residents of Washington and
California were assessed through April 22, 2020
– most members received employer-sponsored health insurance and population assessed may
include higher proportion of persons with higher incomes than national average
– 1,328 patients (median age 61 years) were admitted to hospital with laboratory (96%) or clinically
confirmed COVID-19 infection by April 9, 2020 and assessed for ≥ 2 weeks
● adjusted overall mortality 18.9%
⚬ 23.5% for men

⚬ 14.9% for women
● adjusted overall probability of intensive care unit (ICU) admission 40.7%
⚬ 48.5% for men

⚬ 32% for women
● adjusted median length of stay in hospital was 10.1 days (9.3 days among survivors and 12.7
days among patients who died)
● adjusted median duration of ICU stay was 10.6 days
RESUMEN
⚬ DEL ESTUDIO
mortalidad 33,7 % entre los residentes de centros de enfermería en el condado de King,
Washington
ESTUDIO DE COHORTE : N Engl J Med 2020 21 de mayo; 382 (21): 2005 | Texto completo
Detalles

– 167 patients (median age 83 years) with confirmed COVID-19 associated with skilled nursing
facility in Washington state, United States, from February 28 to March 18, 2020, were assessed
● 101 residents of facility
● 50 healthcare personnel
● 16 visitors
– most cases had respiratory illness, and 7 cases had no symptoms

– mortality 33.7% for nursing facility residents (34 of 101 residents)
– hospitalization rates
● 54.5% for facility residents

● 6% for staff
● 50% for visitors
– Reference - N Engl J Med 2020 May 21;382(21):2005 full-text
RESUMEN
⚬ DEL ESTUDIO
Mortalidad hospitalaria a 28 días 29,9% en adultos críticos con COVID-19 ingresados en UCI con
insuficiencia respiratoria aguda o shock entre marzo y mayo de 2020 en Pensilvania, Estados
Unidos
ESTUDIO DE COHORTE : Ann Intern Med 2021 19 de enero temprano en línea

Detalles

– 468 critically ill adults (median age 65 years, 58% men) with COVID-19 admitted to ICU with acute
respiratory failure or shock between March 1 and May 11, 2020 in Pennsylvania, United States,
were assessed
– 52% identified as Black, 24.6% as White, 22.6% as other race, and 9.2% as Hispanic
– 72% had high comorbidity burden, defined as Charlson Comorbidity Index ≥ 2 points
– therapies included
● mechanical ventilation in 68.2%

● high-flow nasal cannula in 51.5%
● noninvasive ventilation in 22.9%
● vasopressors in 25.9%
● acute renal replacement therapy in 9.8%
● extracorporeal life support in 3.2%
– 28-day in-hospital mortality
● 29.9% overall
● 37% in adults who had mechanical ventilation
● 14.8% in adults without mechanical ventilation
– 28-day in-hospital mortality 43.5% during first 15-day period compared to 19.2% during last 15-
day period of ICU admission dates
– Reference - Ann Intern Med 2021 Jan 19 early online
RESUMEN
⚬ DEL ESTUDIO
50 % de mortalidad notificada en adultos con COVID-19 confirmado admitidos en unidades de
cuidados intensivos en el área de Seattle, Washington
ESTUDIO DE COHORTE : N Engl J Med 2020 21 de mayo; 382 (21): 2012 | Texto completo
Detalles

– 24 adults aged 23-97 years (mean age 64 years, 63% male) with confirmed COVID-19 admitted to
intensive care units in Seattle, Washington, area between February 24 and March 9, 2020, were
assessed for ≥ 14 days
● mean duration of symptoms before hospital admission was 7 days
● 22% were current or former tobacco smoker
– coexisting medical conditions included
● diabetes mellitus in 58%

● chronic kidney disease in 21%
● obstructive sleep apnea in 21%
● asthma in 14%
● chronic obstructive pulmonary disease (COPD) in 4%
– symptoms on admission included
● cough in 88%
● shortness of breath in 88%
● sputum production in 42%
● fever in 50%
● rhinorrhea in 17%
● sore throat in 8%
– therapies included
● invasive mechanical ventilation in 75%

● vasopressors in 71%
● high-flow nasal cannula in 42%
● inhaled pulmonary vasodilators in 28%
– outcomes at ≥ 14 days
● overall in-hospital mortality 50%

● in-hospital mortality in patients ≤ 65 years old 37%
● hospital discharge in 21%
● extubation in 33%
● median length of hospital stay in survivors 17 days
● median length of intensive care unit stay in survivors 14 days
● median duration of mechanical ventilation in patients who were extubated 11 days
– Reference - N Engl J Med 2020 May 21;382(21):2012 full-text
RESUMEN
⚬ DEL ESTUDIO
88,1% de mortalidad notificada en pacientes hospitalizados en Nueva York que reciben
ventilación mecánica
SERIE DE CASOS : JAMA 2020 22 de abril temprano en línea

Detalles

– 5,700 patients (median age 63 years) with COVID-19 admitted to hospitals in New York, United
States, between March 1 and April 4, 2020, were evaluated
– 46% were discharged from hospital or died (definite outcomes), and 54% remained hospitalized at
end of study
– among patients with definite outcomes
● median length of stay 4.1 days

● 14.2% were treated in intensive care unit (ICU)
● 12.2% received mechanical ventilation
● 3.2% had renal replacement therapy
● 2.2% were readmitted
● 21% died
– mortality 88.1% among patients requiring mechanical ventilation

● 97.2% in patients > 65 years old
– mortality 11.7% among patients not requiring mechanical ventilation

● 26.6% in patients > 65 years old
– Reference - JAMA 2020 Apr 22 early online
RESUMEN
⚬ DEL ESTUDIO
aumento en el número de casos de COVID-19 en los hospitales asociado con una mayor
mortalidad en los hospitales de los Estados Unidos
ESTUDIO DE COHORTE : Ann Intern Med 2021 Jul 6 temprano en línea

Detalles
– based on retrospective population-based cohort study

– 144,116 adults with COVID-19 admitted to 558 hospitals in United States from March to August
2020 in Premier Healthcare Database were assessed
– 24.9% were admitted to ICU and 13.6% received mechanical ventilation
– overall in-hospital mortality 17.6% (25,344 deaths)
– each hospital-month was stratified by percentile rank on surge index representing burden due to
surging COVID-19 caseload (patients admitted to ICU or needing invasive or noninvasive
ventilation) relative to baseline bed capacity
– 78,144 patients (54.2%) were admitted to hospitals in top surge index decile (90th-100th)
– compared to hospitals not having surges (in < 50th percentile of surge index), increased in-
hospital mortality associated with hospitals in
● 50th-75th percentile of surge index (adjusted odds ratio [OR] 1.11, 95% CI 1.01-1.23)
● 75th-90th percentile of surge index (adjusted OR 1.24, 95% CI 1.12-1.38)
● > 99th percentile of surge index (adjusted OR 2, 95% CI 1.69-2.38)
– overall, higher surge index associated with increased in-hospital mortality (adjusted OR 1.22 per
unit increase in log-transformed surge index, 95% CI 1.18-1.27)
– 23.2% (5,868 deaths, 95% CI 3,584-8,171 deaths) of COVID-related deaths were potentially
attributable to hospital caseload surge
– Reference - Ann Intern Med 2021 Jul 6 early online , editorial can be found in Ann Intern Med
2021 Jul 6 early online
● África
RESUMEN
⚬ DEL ESTUDIO
Mortalidad hospitalaria a los 30 días 48 % en adultos con COVID-19 admitidos en unidades de
cuidados intensivos en África, equivalente a 11-23 muertes en exceso por cuidados intensivos por
COVID-19 por cada 100 admisiones en comparación con las muertes por cuidados intensivos por
COVID-19 en todo el mundo
ESTUDIO DE COHORTE : Lancet 2021 22 de mayo; 397 (10288): 1885

Detalles

– 6,779 adults in Africa referred to high-care units or ICUs with suspected or confirmed COVID-19
between May 7, 2020 and December 18, 2020 were assessed
● participating countries included Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique,
Niger, Nigeria, and South Africa
● 77% of hospitals were university affiliated, 88% had government funding, and 70% were
tertiary care
● resources included median of 12 critical care beds providing invasive ventilation, 4 specialist
doctors, 2 intensivists, median nurse-to-patient ratio of 1:2, and median surge ventilator
capacity of 5 ICU ventilators and 4 anesthesia ventilators
● 86% of sites could provide pulse oximetry to all patients in critical care and 68% could provide
renal replacement therapy
– 3,752 adults were admitted to critical care units

– 3,140 adults (mean age 56 years, 61% men) were included in analysis
– 95.4% had laboratory-confirmed SARS-CoV-2 infection
– 30-day in-hospital mortality was 48.2% overall
● 43.5% for patients from emergency departments

● 48.5% for in-hospital referrals
● 51.2% for patients from other hospitals
– impact of ICU resources on in-hospital mortality
● admission delay because of shortage of resources associated with significant increase in in-
hospital mortality (odds ratio 2.14, 97.5% CI 1.42-3.22)
● higher nurse-to-patient ratio associated with nonsignificant increase in in-hospital mortality
(odds ratio 1.31, 97.5% CI 0.98-1.74 per unit increase)
– overall global COVID-19 critical care mortality was 31.5% in updated meta-analysis
– excess COVID-19 critical care mortality in Africa was calculated as 11-23 excess deaths per 100
admissions compared to global rate
– Reference - ACCCOS trial (Lancet 2021 May 22;397(10288):1885 full text )
● Europa
RESUMEN
⚬ DEL ESTUDIO
Mortalidad a los 28 días 0,4 % en adultos > 30 años infectados con la variante preocupante (VOC)
202012/1 (Alpha) del SARS-CoV-2 frente al 0,3 % con variantes anteriores

Detalles

– 941,518 adults > 30 years old with single positive TaqPath test for SARS-CoV-2 identified at United
Kingdom community test centers between October 1, 2020 and January 28, 2021 were assessed
● 394,943 patients were S gene negative (infection with VOC-202012/1 [Alpha])
● 469,714 patients were S gene positive (infection with previous variants)
– 54,906 patients (mean age 46 years) infected with variant VOC-202012/1 were matched to 54,906
patients (mean age 46 years) infected with previously circulating variants based on age, sex,
ethnicity, location, index of multiple deprivation, and date of specimen collection
– all patients were followed for ≥ 14 days, 85% were followed for ≥ 28 days
– 367 patients (0.3%, mean age 66 years) died within 28 days
– 28-day mortality
● 0.4% with variant VOC-202012/1

● 0.3% with previously circulating variants
– Reference - BMJ 2021 Mar 9;372:n579 full-text
RESUMEN
⚬ DEL ESTUDIO
26 % de mortalidad notificada en adultos ≥ 21 años con COVID-19 confirmado admitidos en UCI
exclusivas para COVID en Lombardía, Italia
ESTUDIO DE COHORTE : JAMA 2020 6 de abril temprano en línea

Detalles

– 1,591 children and adults aged 14-91 years (median age 63 years, 82% male) with laboratory-
confirmed COVID-19 consecutively admitted to 72 COVID-only ICUs in Lombardy, Italy, between
February 20 and March 18, 2020, were assessed until March 25, 2020
● 1,043 had data on comorbidities
● 1,300 had data on respiratory support
● 1,581 had data on ICU outcome
– 0.2% were ≤ 20 years old, 13% were aged 21-50 years, 64% were aged 51-70 years, and 22.8%
were ≥ 71 years old
– 68% had ≥ 1 comorbidity, including
● hypertension in 49%
● cardiovascular disease in 21%
● hypercholesterolemia in 18%
● type 2 diabetes in 17%
● malignancy in 8%
● COPD in 4%
● chronic kidney disease in 3%
● chronic liver disease in 3%
– 32% had no comorbidities

– 100% needed respiratory support
● invasive mechanical ventilation in 88%

● noninvasive ventilation in 11%
● oxygen mask in 1%
● median positive end-expiratory pressure (PEEP) was 14 cm H2O
● median fraction of inspired oxygen (FiO2) needed was 70%
⚬ FiO2 ≥ 50% needed in 89%

⚬ FiO2 100% needed in 12%
● median arterial partial pressure of oxygen (PaO2)/FiO2 ratio was 160
– ICU outcomes
● overall mortality 26%
⚬ mortality for ages 21-40 years 7%

⚬ mortality for ages ≥ 81 years 55%
● 58% remained in ICU

● 16% were discharged
● median length of stay in patients discharged from ICU 8 days
– comparing patients ≤ 63 years old vs. ≥ 64 years old
● ICU mortality 15% vs. 36% (p < 0.001)

● median PEEP 14 cm H2O vs. 14 cm H2O (not significant)
● median FiO2 60% vs. 70% (p = 0.006)
● median PaO2/FiO2 163.5 vs. 156 (p = 0.02)
– comparing patients with history of hypertension vs. no hypertension
● median age 66 years vs. 62 years (p < 0.001)

● ICU mortality 38% vs. 22% (no p value reported)
● median PaO2/FiO2 146 vs. 173 (p = 0.005)
● median FiO2 70% vs. 60% (p = 0.05)
– Reference - JAMA 2020 Apr 6 early online , editorial can be found in JAMA 2020 Apr 6 early
online
RESUMEN
⚬ DEL ESTUDIO
Tasa estimada de letalidad por infección asociada al SARS-CoV-2 del 0,8% en España entre el 27
de abril y el 22 de junio de 2020
ESTUDIO DE COHORTE : BMJ 2020 27 de noviembre; 371: m4509 | Texto completo

Detalles

– 61,098 community-dwelling persons in Spain were evaluated in ENE-COVID survey for
immunoglobulin G (IgG) antibodies against SARS-CoV-2 between April 27 and June 22, 2020
– deaths due to laboratory-confirmed SARS-CoV-2 infection were estimated using National
Epidemiological Surveillance Network (RENAVE) database
– overall estimated SARS-CoV-2 seroprevalence 4.9% (2.3 million persons)
– overall estimated SARS-CoV-2 infection fatality rate 0.83% (19,228 patients died)
● in females (0.58% across age groups)
⚬ 0% (95% CI 0%-0.01%) for ages 0-9 years

⚬ 0% (95% CI 0%-0.01%) for ages 10-19 years
⚬ 0.01% (95% CI 0.01%-0.02%) for ages 20-29 years
⚬ 0.02% (95% CI 0.01%-0.03%) for ages 30-39 years
⚬ 0.05% (95% CI 0.04%-0.06%) for ages 40-49 years
⚬ 0.17% (95% CI 0.14%-0.21%) for ages 50-59 years
⚬ 0.53% (95% CI 0.44%-0.65%) for ages 60-69 years
⚬ 2.01% (95% CI 1.6%-2.52%) for ages 70-79 years
⚬ 4.62% (95% CI 3.38%-6.29%) for age ≥ 80 years
● in males (1.11% across age groups)
⚬ 0% (95% CI 0%-0.01%) for ages 0-9 years

⚬ 0% (95% CI 0%-0.01%) for ages 10-19 years
⚬ 0.01% (95% CI 0.01%-0.02%) for ages 20-29 years
⚬ 0.03% (95% CI 0.02%-0.05%) for ages 30-39 years
⚬ 0.09% (95% CI 0.07%-0.11%) for ages 40-49 years
⚬ 0.38% (95% CI 0.32%-0.45%) for ages 50-59 years
⚬ 1.5% (95% CI 1.24%-1.82%) for ages 60-69 years
⚬ 4.96% (95% CI 3.87%-6.33%) for ages 70-79 years
⚬ 11.6% (95% CI 8.06%-16.5%) for age ≥ 80 years
– overall infection fatality rate based on excess all-cause mortality estimated using Monitoring
Mortality System (MoMo) database 1.1% (24,778 excess deaths)
– Reference - BMJ 2020 Nov 27;371:m4509 full-text
● Corea
RESUMEN
⚬ DEL ESTUDIO
Proporción de letalidad del 0,9% notificada en pacientes con COVID-19 confirmado en la
República de Corea
ESTUDIO DE COHORTE : Osong Public Health Res Perspect 2020 Apr;11(2):85 | Texto completo
Detalles

– 7,755 patients with confirmed COVID-19 in the Republic of Korea's National Notifiable Disease
Surveillance System as of March 12, 2020, were evaluated
– 66 patients died (case fatality proportion 0.9%)
● case fatality proportion by age
⚬ 0% for ages 0-29 years

⚬ 0.1% for ages 30-49 years
⚬ 5% for ages 70-79 years
⚬ 8.5% for ages ≥ 80 years
● case fatality proportion by sex
⚬ 0.5% for females

⚬ 1.2% for males
– coexisting medical conditions among patients who died included
● hypertension in 47.6%
● diabetes mellitus in 36.5%
● neurodegenerative disorder in 25.4%
● pulmonary disease in 17.5%
● heart disease in 15.9%
● cancer in 11.1%
● cerebrovascular disease in 7.9%
● kidney disease in 7.9%
– Reference - Osong Public Health Res Perspect 2020 Apr;11(2):85 full-text
Factores médicos y condiciones comórbidas asociadas con los resultados de COVID-19
● factores asociados con un mayor riesgo de enfermedad grave y complicaciones
⚬ mayor edad
⚬ historia de fumar
⚬ trastorno por consumo de sustancias
⚬ la inactividad física
⚬ Las condiciones subyacentes asociadas con un mayor riesgo de enfermedad grave incluyen (en
orden alfabético)
– cáncer
– enfermedad renal cronica
– enfermedad cronica del higado
– enfermedades pulmonares crónicas, incluyendo
● asma (moderada a grave)

● bronquiectasias
● displasia broncopulmonar
● Enfermedad Pulmonar Obstructiva Crónica (EPOC)
● fibrosis quística
● enfermedad pulmonar intersticial
● embolia pulmonar
● hipertensión pulmonar
– demencia u otras condiciones neurológicas

– diabetes (tipo 1 o tipo 2)
– afecciones cardíacas, como insuficiencia cardíaca, enfermedad de las arterias coronarias,
cardiomiopatías o hipertensión
– infección por VIH
– condiciones de salud mental
– 2
sobrepeso y obesidad (índice de masa corporal ≥ 25 kg/m )
– el embarazo
– enfermedad de células falciformes o talasemia
– trasplante de órganos sólidos o células madre sanguíneas
– accidente cerebrovascular o enfermedad cerebrovascular
– trastorno por consumo de sustancias
– tuberculosis
⚬ las personas con algunos tipos de discapacidades pueden tener más probabilidades de desarrollar
COVID-19 grave debido a la comorbilidad, las desigualdades sociales o de salud, o vivir en entornos
congregados, incluidos
– cualquier tipo de discapacidad que dificulte realizar ciertas actividades, incluidas aquellas que
necesitan ayuda con el cuidado personal o las actividades diarias
– trastorno por déficit de atención/hiperactividad (TDAH)
– defecto de nacimiento
– parálisis cerebral
– Síndrome de Down
– discapacidad intelectual y del desarrollo
– discapacidad de aprendizaje
– lesión de la médula espinal
⚬ Las condiciones subyacentes que podrían estar asociadas con un mayor riesgo de enfermedad grave
en los niños incluyen
– asma y otras enfermedades pulmonares crónicas
– diabetes
– cardiopatía congénita
– desordenes genéticos
– complejidad medica
– desordenes metabólicos
– trastornos neurológicos
– obesidad
– anemia drepanocítica
⚬ Referencia: información de los Centros para el Control y la Prevención de Enfermedades sobre la

COVID-19 para grupos específicos de personas ( CDC 25 de marzo de 2022 )
RESUMEN
● DEL ESTUDIO
sexo masculino, edad > 65 años, tabaquismo actual y comorbilidades que incluyen diabetes,
enfermedad cardiovascular, enfermedad respiratoria e hipertensión, cada una asociada con un
mayor riesgo de enfermedad crítica o muerte en pacientes con COVID-19
REVISIÓN SISTEMÁTICA : J Infect 2020 ago;81(2):e16 | Texto completo

Detalles

⚬ systematic review of 13 retrospective observational studies evaluating risk factors associated with
critical disease or death in 3,027 patients with COVID-19
– sample size ranged from 27 to 1,099 patients
– definitions of critical disease varied across studies
⚬ factors associated with increased rates of critical disease or death
– demographic factors
● age > 65 years (odds ratio [OR] 6, 95% CI 3.9-9.2) in analysis of 2 studies
● current smoking status (OR 2, 95% CI 1.3-3.2) in analysis of 5 studies
● male sex (OR 1.8, 95% CI 1.4-2.2) in analysis of all studies
– comorbidities
● cardiovascular disease (OR 5.2, 95% CI 3.3-8.3) in analysis of 10 studies

● respiratory disease (OR 5.2, 95% CI 2.5-10.6) in analysis of 7 studies
● diabetes (OR 3.7, 95% CI 2.7-5) in analysis of 11 studies
● hypertension (OR 2.7, 95% CI 1.6-4.6) in analysis of 10 studies
– biomarkers
● high-sensitivity cardiac troponin-I > 28 pg/mL (OR 43, 95% CI 9.9-188) in analysis of 2 studies
● lactate dehydrogenase > 245 units/L (OR 8.9, 95% CI 2.7-28.9) in analysis of 4 studies
● procalcitonin > 0.5 ng/mL (OR 8.2, 95% CI 1.9-35) in analysis of 4 studies
● D-dimer > 0.5 mg/L (OR 4.8, 95% CI 1.5-15.7) in analysis of 2 studies
⚬ Reference - J Infect 2020 Aug;81(2):e16 full-text
RESUMEN
● DEL ESTUDIO
el sexo masculino y las comorbilidades, incluida la enfermedad pulmonar crónica, la hipertensión y
la diabetes, cada una de ellas asociada con una mayor mortalidad en pacientes con COVID-19
REVISIÓN SISTEMÁTICA : J Infect 2020 Oct;81(4):e18

Detalles

⚬ systematic review of 28 observational studies evaluating risk factors for mortality in 16,095 patients
with COVID-19, Severe Acute Respiratory Syndrome (SARS), or Middle East respiratory syndrome
coronavirus (MERS)
⚬ 10 studies evaluated 16,095 patients with COVID-19
⚬ in patients with COVID-19, factors associated with increased mortality
– chronic lung disease (odds ratio [OR] 4.75, 95% CI 2.37-9.52) in analysis of 5 studies with 2,307
patients
– any comorbidity (OR 3.5, 95% CI 2.35-5.2) in analysis of 7 studies with 2,517 patients
– hypertension (OR 3.25, 95% CI 2.15-4.91) in analysis of 6 studies with 3,342 patients
– diabetes (OR 2.63, 95% CI 1.45-4.76) in analysis of 5 studies with 2,307 patients
– male sex (OR 1.96, 95% CI 1.43-2.69) in analysis of 6 studies with 927 patients
⚬ Reference - J Infect 2020 Oct;81(4):e18
RESUMEN
● DEL ESTUDIO
mayor gravedad de la disfunción orgánica, la enfermedad hepática crónica, el VIH/SIDA, la
enfermedad renal crónica y la diabetes, cada uno asociado con una mayor mortalidad hospitalaria en
adultos con COVID-19 en África
ESTUDIO DE COHORTE : Lancet 2021 22 de mayo; 397 (10288): 1885

Detalles

⚬ 6,779 adults in Africa referred to high-care units or intensive care units (ICUs) with suspected or
confirmed COVID-19 between May 7, 2020 and December 18, 2020 were assessed
– participating countries included Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger,
Nigeria, and South Africa
– 77% of hospitals were university affiliated, 88% had government funding, and 70% were tertiary
care
– resources included median of 12 critical care beds providing invasive ventilation, 4 specialist
doctors, 2 intensivists, median nurse-to-patient ratio of 1:2, and median surge ventilator capacity
of 5 ICU ventilators and 4 anesthesia ventilators
– 86% of sites could provide pulse oximetry to all patients in critical care and 68% could provide
renal replacement therapy
⚬ 3,752 adults were admitted to high-care unit or ICU

⚬ 3,140 adults (mean age 56 years, 61% men) were included in analysis
⚬ 95.4% had laboratory-confirmed SARS-CoV-2 infection
⚬ 30-day in-hospital mortality was 48.2% overall
– 43.5% for patients from emergency departments (EDs)

– 48.5% for in-hospital referrals
– 51.2% for patients from other hospitals
⚬ 97.7% had quick sequential organ failure assessment (qSOFA) score at hospital admission
⚬ factors associated with increased in-hospital mortality
– increasing qSOFA score (compared to no risk factors)
● 1 risk factor (odds ratio [OR] 1.44, 97.5% CI 1.01-2.04)

● 2 risk factors (OR 2, 97.5% CI 1.33-2.99)
● 3 risk factors (OR 3.66, 97.5% CI 2.12-6.33)
– chronic liver disease (OR 3.48, 97.5% CI 1.48-8.18)

– HIV/AIDS (OR 1.91, 97.5% CI 1.31-2.79)
– chronic kidney disease (OR 1.89, 97.5% CI 1.28-2.78)
– diabetes (OR 1.25, 97.5% CI 1.01-1.56)
– respiratory support
● invasive mechanical ventilation (OR 15.27, 97.5% CI 8.51-27.37)

● continuous positive airway pressure (OR 3.93, 97.5% CI 2.13-7.26)
● high-flow nasal oxygenation (OR 2.72, 97.5% CI 1.46-5.08)
– vasopressor support (inotropes or vasoconstrictors) (OR 3.67, 97.5% CI 2.77-4.86)

– cardiorespiratory arrest within 24 hours of critical care referral (OR 4.43, 97.5% CI 2.25-8.73)
– delayed admission to critical care (OR 2.14, 97.5% CI 1.42-3.22)
⚬ Reference - ACCCOS trial (Lancet 2021 May 22;397(10288):1885 full text )
RESUMEN
● DEL ESTUDIO
delirio asociado con aumento de la mortalidad en adultos hospitalizados por COVID-19
REVISIÓN SISTEMÁTICA : Edad Envejecimiento 2021 12 de mayo temprano en línea

Detalles

⚬ systematic review of 48 observational studies (37 retrospective and 11 prospective studies)
evaluating prevalence or incidence of delirium or delirium-related mortality in 11,553 adults with
COVID-19
– most studies conducted in hospitalized patients (setting was nursing home [3 studies] and unclear
[2 studies], and mixed hospital ward and outpatient, geriatric institute, and outpatient in 1 study
each)
– studies conducted in 13 countries (Spain, France, United Kingdom, Italy, Scotland, Switzerland,
Belgium, Norway, Sweden, Tunisia, Brazil, China, and the United States)
⚬ 17 studies evaluated mortality in 6,457 adults with and without delirium
– 2,394 had delirium and 4,063 adults did not have delirium
– pooled mortality in patients with delirium 47.3% vs. 22.4% in patients without delirium (adjusted
odds ratio 3.2, 95% CI 2.1-4.8)
⚬ Reference - Age Ageing 2021 May 12 early online
RESUMEN
● DEL ESTUDIO
edad avanzada y comorbilidades que incluyen obesidad, enfermedad renal crónica y enfermedad
hepática asociadas con un mayor riesgo de muerte hospitalaria en pacientes con COVID-19
ESTUDIO DE COHORTE : BMJ 2020 22 de mayo; 369: m1985 | Texto completo

Detalles

⚬ 20,133 children and adults (median age 72 years) hospitalized with COVID-19 in United Kingdom
from April 19 to May 3, 2020, were assessed
⚬ compared to age < 50 years, increasing age associated with increased risk of in-hospital death with
adjusted hazard ratio ranging from 2.63 (95% CI 2.06-3.35) for ages 50-59 years to 11.09 (95% CI 8.93-
13.77) for age ≥ 80 years
⚬ comorbidities associated with increased in-hospital mortality included
– moderate to severe liver disease (adjusted hazard ratio [HR] 1.51, 95% CI 1.21-1.88)
– dementia (adjusted HR 1.4, 95% CI 1.28-1.52)
– obesity (adjusted HR 1.33, 95% CI 1.19-1.49)
– chronic kidney disease (adjusted HR 1.28, 95% CI 1.18-1.39)
– chronic nonasthmatic pulmonary disease (adjusted HR 1.17, 95% CI 1.09-1.27)
– chronic neurological disorder (such as stroke) (adjusted HR 1.17, 95% CI 1.06-1.29)
– chronic cardiac disease (adjusted HR 1.16, 95% CI 1.08-1.24)
– malignancy (adjusted HR 1.13, 95% CI 1.02-1.24)
⚬ Reference - ISARIC WHO CCP-UK trial (BMJ 2020 May 22;369:m1985 full-text )
⚬ consistent findings for association between in-hospital mortality and age and cardiac and pulmonary
comorbidities in cohort of 1,150 adults with COVID-19 in New York, New York (Lancet 2020 Jun
6;395(10239):1763 full-text )
RESUMEN
● DEL ESTUDIO
fibrilación auricular asociada con mayor mortalidad hospitalaria en pacientes con COVID-19
ESTUDIO DE COHORTE : Ritmo cardíaco 2021 22 de enero temprano en línea | Texto completo
Detalles

⚬ 9,564 patients (mean age 64 years, 59% men) hospitalized with polymerase chain reaction (PCR)-
confirmed COVID-19 between March 1 and April 27, 2020 and who died or were discharged by May
31, 2020 from medical records of 13 hospitals were assessed
– 1,687 patients (17.6%) had atrial fibrillation during hospitalization (including 1,109 patients with
new-onset atrial fibrillation)
– 109 (1.4%) with history of atrial fibrillation did not have atrial fibrillation during hospitalization
⚬ mechanical ventilation in 37.5% with atrial fibrillation vs. 15.9% with no atrial fibrillation (p < 0.0001)
⚬ propensity scores for likelihood of atrial fibrillation were calculated based on multiple demographic
and clinical variables
⚬ in-hospital mortality in propensity-matched pairs of patients
– 54.3% for patients with atrial fibrillation during hospitalization vs. 37.2% for patients with no atrial
fibrillation during hospitalization (risk ratio [RR] 1.46, 95% CI 1.34-1.59) in analysis of 2,476
patients
– 56.1% for patients with new-onset atrial fibrillation vs. 36% for patients with no atrial fibrillation
during hospitalization (RR 1.56, 95% CI 1.42-1.71) in analysis of 2,214 patients
– 55.2% for patients with new-onset atrial fibrillation vs. 46.8% for patients with history of atrial
fibrillation (RR 1.18, 95% CI 1.04-1.33) in analysis of 1,000 patients
– 48.1% for patients with atrial fibrillation and cardiac disease vs. 52.6% for patients with atrial
fibrillation and without cardiac disease (not significant) in analysis of 1,136 patients
⚬ Reference - Heart Rhythm 2021 Jan 22 early online full-text
RESUMEN
● DEL ESTUDIO
mortalidad hospitalaria notificada en el 51 % de los pacientes con lesión renal aguda tardía (IRA) y en
el 14,3 % de los pacientes con LRA temprana en pacientes con COVID-19 en China a principios de
2020
ESTUDIO DE COHORTE : Nephrol Dial Transplant 2020 4 de diciembre; 35 (12): 2095

Detalles

⚬ 4,020 adults (median age 61 years, 52% women) hospitalized with laboratory-confirmed COVID-19
from January 1 to March 23, 2020 were assessed using medical health records from National Health
Commission of China
⚬ 7% developed AKI defined as increase in serum creatinine 0.3 mg/dL (26.5 mcmol/L) within 48 hours,
or 50% increase in serum creatinine from baseline within 7 days or within hospital stay for patients
who did not have repeat creatinine within 7 days
– 194 adults (mean age 70 years) had late AKI (development of AKI after other organ dysfunction)
– 91 adults (mean age 71 years) had early AKI (development of AKI prior to other organ dysfunction)
⚬ therapies comparing late AKI group vs. early AKI group vs. no AKI group
– antiviral therapy in 68.6% vs. 82.4% vs. 66.3%

– glucocorticoid in 63.9% vs. 41.8% vs. 19.1%
– chloroquine/hydroxychloroquine in 8.8% vs. 13.2% vs. 11.4%
– tocilizumab in 8.2% vs. 6.6% vs. 2%
⚬ therapies were not adjusted for analysis

⚬ in-hospital mortality in patients
– with late AKI 51% (adjusted hazard ratio 3.09, 95% CI 2.17-4.4 vs. without AKI)
– with early AKI 14.3% (adjusted hazard ratio 2.46, 95% CI 1.35-4.49 vs. without AKI)
– without AKI 2.2%
⚬ factors associated with increased risk of late AKI
– age (adjusted risk ratio [RR] 1.05 per year increase, 95% CI 1.04-1.07)
– chronic kidney disease (adjusted RR 4.21, 95% CI 1.67-10.64)
– high sensitivity C-reactive protein ≥ 10 mg/L (adjusted RR 7.81, 95% CI 2.72-22.44)
– ferritin ≥ 300 mg/mL (adjusted RR 4.59, 1.97-10.68)
⚬ hypertension associated with increased risk of early AKI (adjusted RR 2.29, 95% CI 1.12-4.67)
⚬ Reference - Nephrol Dial Transplant 2020 Dec 4;35(12):2095
RESUMEN
● DEL ESTUDIO
grasa visceral más alta asociada con un mayor riesgo de ingreso en la UCI y necesidad de ventilación
mecánica invasiva en pacientes con COVID-19
REVISIÓN SISTEMÁTICA : Obesidad (Silver Spring) 2021 Mar;29(3):521

Detalles

⚬ systematic review of 6 observational studies evaluating associations between CT-quantified fat mass
distribution and critical disease in 560 patients hospitalized with confirmed COVID-19
⚬ visceral fat area (VFA) ranged from 70.9 cm2 to 240 cm2
⚬ admission to ICU ranged from 18.5% to 43.3%
⚬ 4 studies included in meta-analysis
⚬ comparing to patients on general ward, patients admitted to ICU had higher VFA (standardized mean
difference 0.46 cm2, 95% CI 0.2-0.71 cm2) in analysis of 3 studies with 300 patients
⚬ comparing to patients without invasive mechanical ventilation, patients requiring invasive
mechanical ventilation had higher VFA (standardized mean difference 0.38 cm2, 95% CI 0.05-0.71
cm2) in analysis of 3 studies with 208 patients
⚬ Reference - Obesity (Silver Spring) 2021 Mar;29(3):521
RESUMEN
● DEL ESTUDIO
los antecedentes de cirugía bariátrica podrían estar asociados con una reducción de la mortalidad y el
riesgo de ventilación mecánica invasiva en adolescentes y adultos con obesidad ingresados en el
hospital con COVID-19
ESTUDIO DE COHORTE : Obes Surg 2020 18 de noviembre temprano en línea | Texto completo
Detalles
⚬ based on retrospective population-based cohort study

⚬ 4,248,253 adolescents and adults aged 15-75 years hospitalized for obesity and discharged during
2010-2019 were followed for mean 5.4 years
⚬ 8,226 adolescents and adults hospitalized for COVID-19 who met criteria for enrollment and who
were discharged between January 1, 2020 and May 15, 2020 were assessed
– 6.6% (mean age 49 years, 76% female, body mass index [BMI] 30-39.9 in 41.8%) had history of
bariatric surgery
– 93.4% (mean age 59 years, 46% female, BMI 30-39.9 in 81.6%) did not have bariatric surgery
⚬ comparing patients who had bariatric surgery vs. no bariatric surgery in 486 patients matched by
sex, age (15-30 years, 31-45 years, 46-60 years, 61-75 years), BMI ≥ 40 or not, and Charlson
Comorbidity Index ≤ 3 or not
– mortality 2.5% vs. 7.4% (p < 0.05)
– need for invasive mechanical ventilation in 6.6% vs. 14.8% (p < 0.05)
⚬ Reference - Obes Surg 2020 Nov 18 early online full-text
RESUMEN
● DEL ESTUDIO
> 50 % de compromiso pulmonar en la tomografía computarizada (TC) de tórax al ingreso
hospitalario asociado con un mayor riesgo de combinación de muerte o ingreso a la UCI dentro de los
7 días posteriores al ingreso hospitalario en adultos con COVID-19 confirmado
ESTUDIO DE COHORTE : Clin Microbiol Infect 2020 Oct;26(10):1417 | Texto completo

Detalles

⚬ 572 adults (mean age 66 years, 60% men) with confirmed COVID-19 who had chest CT at time of
hospital admission were assessed
⚬ median time between onset of symptoms and CT 7 days
⚬ percentage of lung parenchyma affected by COVID-19 lesions was assessed visually
– 16.6% had > 50% lung involvement

– 29.9% had 26%-50% lung involvement
– 53.5% had ≤ 25% lung involvement
– 2.4% had normal CT (lung involvement 0%-10%)
⚬ rates of death or admission to ICU within 7 days of hospital admission by extent of lung involvement
– 69.5% with > 50% involvement (adjusted odds ratio 2.35, 95% CI 1.24-4.46 vs. ≤ 25% involvement)
– 40.9% with 26%-50% involvement (not significant vs. ≤ 25% involvement)
– 22.9% with ≤ 25% involvement
– 0% with 0%-10% involvement
⚬ 30-day mortality by extent of lung involvement
– 28.4% with > 50% involvement (p < 0.001 vs. ≤ 25% involvement)
– 17% with 26%-50% involvement (p < 0.001 vs. ≤ 25% involvement)
– 10.8% with ≤ 25% involvement
⚬ 16.8% with lung involvement > 50% were diagnosed with pulmonary embolism
⚬ Reference - Clin Microbiol Infect 2020 Oct;26(10):1417 full-text
RESUMEN
● DEL ESTUDIO
en adultos que reciben atención médica en el hogar después de la hospitalización por COVID-19, sexo
masculino, raza blanca, insuficiencia cardíaca, diabetes con complicaciones, dolor diario y deterioro
cognitivo, cada uno asociado con un mayor riesgo de combinación de rehospitalización y muerte
ESTUDIO DE COHORTE : Ann Intern Med 2020 Nov 24 temprano en línea

Detalles

⚬ 1,409 patients (mean age 67 years, 51% men) admitted to home healthcare after hospitalization for
laboratory-confirmed COVID-19 in New York City between April 1 and June 15, 2020 were assessed
for mean 32 days during home healthcare
– ethnicity/race was Hispanic (35%), non-Hispanic Black (28%), and non-Hispanic White (27%)
– comorbidities included hypertension (69%), diabetes (41%), and chronic pulmonary disease (16%)
⚬ outcomes at end of home healthcare
– 94% were discharged from home healthcare

– 87% discharged without rehospitalization or death
– 9.7% were rehospitalized
– 0.78% died
⚬ 7.6% died, were still receiving home healthcare, or were hospitalized at end of follow-up and did not
contribute data for outcomes at end of home healthcare
⚬ comparing status at admission to home healthcare vs. status at discharge in 1,302 patients
discharged from home healthcare
– pain present daily or always in 41% vs. 6%
– dyspnea in 84% vs. 27%
– cognitive alertness in 71% vs. 87%
– anxiety in 50% vs. 18%
– confusion in 47% vs. 22%
– functional dependency for ≥ 4 activities of daily living in 84% vs. 12.4%
– mean number of dependencies for activities of daily living 6 vs. 1.2
– no dependency in activities of daily living in 1.8% vs. 60%
⚬ factors associated with increased risk of rehospitalization or death included
– heart failure (adjusted hazard ratio [HR] 2.12, CI 1.41-3.19)

– ≥ 2 emergency department visits in past 6 months (HR 1.78 CI, 1.21-2.62)
– non-Hispanic White race (adjusted HR 1.74, CI 1.22-2.47)
– diabetes with complications (adjusted HR 1.71, CI 1.17-2.52)
– cognitive impairment (adjusted HR 1.49, CI 1.04-2.13)
– pain present daily or always (adjusted HR 1.46, CI 1.05-2.05)
– male sex (HR 1.45, CI 1.04-2.03)
⚬ Reference - Ann Intern Med 2020 Nov 24 early online full text
RESUMEN
● DEL ESTUDIO
La edad avanzada y la enfermedad cardiovascular preexistente se asocian con una mayor mortalidad
en pacientes hospitalizados con COVID-19
ESTUDIO DE COHORTE : Cuidados intensivos Med 2020 May;46(5):846 | Texto completo

Detalles
⚬ 150 patients with COVID-19 at 2 hospitals in Wuhan, China, were evaluated
⚬ 68 patients died, with cause of death
– respiratory failure in 53%

– respiratory failure plus circulatory failure in 33%
– circulatory failure in 7%
– unknown cause in 7%
⚬ comparing patients who died vs. patients discharged
– median age 67 years vs. 50 years (p < 0.001)

– preexisting cardiovascular disease in 19% vs. 0% (p < 0.001)
– clinical factors
● dyspnea in 87% vs. 62% (p = 0.001)

● respiratory failure in 85% vs. 16% (p < 0.001)
● acute respiratory distress syndrome (ARDS) in 81% vs. 9% (p < 0.001)
● acute kidney injury in 31% vs. 2% (p < 0.001)
● secondary infection in 16% vs. 1% (p = 0.002)
– laboratory findings
● mean white blood cell count 10.6 × 109 cells/L vs. 6.8 × 109 cells/L (p < 0.001)
● mean lymphocyte count 0.6 × 109 cells/L vs. 1.4 × 109 cells/L (p < 0.001)
● mean platelet count 174 × 109 cells/L vs. 222 × 109 cells/L (p < 0.001)
● mean albumin 28.8 g/L vs. 32.7 g/L (p < 0.001)
● mean blood urea nitrogen 8.7 mmol/L vs. 5.1 mmol/L (p < 0.001)
● mean cardiac troponin 30.3 pg/mL vs. 3.5 pg/mL (p < 0.001)
● mean C-reactive protein 126.6 mg/L vs. 34.1 mg/L (p < 0.001)
● mean interleukin-6 11.4 ng/mL vs. 6.8 ng/mL (p < 0.001)
● mean total bilirubin 18.1 mcmol/L vs. 12.8 mcmol/L (p = 0.001)
● mean creatinine 91.2 mmol/L vs. 72.1 mmol/L (p = 0.02)
⚬ Reference - Intensive Care Med 2020 May;46(5):846 full-text
RESUMEN
● DEL ESTUDIO
antecedentes de tabaquismo y edad avanzada asociados con el deterioro en pacientes hospitalizados
con neumonía por COVID-19 en China
ESTUDIO DE COHORTE : Chin Med J (inglés) 5 de mayo de 2020; 133 (9): 1032 | Texto completo
Detalles

⚬ 78 patients (median age 38 years) with COVID-19 pneumonia hospitalized for > 2 weeks in 3 hospitals
in Wuhan, China, between December 30, 2019 and January 15, 2020, were evaluated
⚬ deterioration in 11 patients (14.1%) after 2 weeks of hospitalization
⚬ factors associated with deterioration in multivariate analysis
– history of smoking (odds ratio [OR] 14.3, 95% CI 1.6-25)

– C-reactive protein > 8.2 mg/L (OR 10.5, 95% CI 1.2-34.7)
– maximum body temperature at admission ≥ 37.3 degrees C (99.14 degrees F) (OR 9, 95% CI 1.04-
78.1)
– respiratory failure (OR 8.8, 95% CI 1.9-40)
– age ≥ 60 years (OR 8.5, 95% CI 1.6-44.9)
– albumin < 40 g/L (OR 7.4, 95% CI 1.1-50)
⚬ Reference - Chin Med J (Engl) 2020 May 5;133(9):1032 full-text
RESUMEN
● DEL ESTUDIO
monoterapia con tiopurina, combinación de antagonista del factor de necrosis tumoral (TNF) más
tratamiento con tiopurina y tratamiento con mesalamina/sulfasalazina, cada uno asociado con un
mayor riesgo de COVID-19 grave en comparación con la monoterapia con antagonista del TNF en
pacientes con enfermedad inflamatoria intestinal y COVID-19 confirmado
ESTUDIO DE COHORTE : Gut 2020 Oct 20 temprano en línea

Detalles

⚬ 1,439 patients (mean age 44 years, 51% men) from Surveillance Epidemiology of Coronavirus Under
Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry with inflammatory bowel
disease and confirmed COVID-19 were evaluated
– 55.2% had Crohn disease
– most common medications were TNF antagonists (38.5%) and mesalamine/sulfasalazine (30.6%)
⚬ 7.8% had severe COVID-19, defined as composite of ICU admission, mechanical ventilation, or death
⚬ COVID-19-specific mortality 3.4%
⚬ compared to TNF antagonist monotherapy
– increased risk of severe COVID-19 associated with
● thiopurine monotherapy (adjusted odds ratio [OR] 4.08, 95% CI 1.73-9.61)

● combination therapy with TNF antagonist plus thiopurine (adjusted OR 4.01, 95% CI 1.65-9.78)
● mesalamine/sulfasalazine therapy (adjusted OR 3.52, 95% CI 1.93-6.45)
– no significant difference in risk of severe COVID-19 associated with
● mesalamine/sulfasalazine plus TNF antagonist

● interleukin-12/23 antagonist monotherapy
● integrin antagonist monotherapy
⚬ compared to no mesalamine/sulfasalazine use, mesalamine/sulfasalazine associated with increased

risk of severe COVID-19 (adjusted OR 1.7, 95% CI 1.26-2.29)
⚬ Reference - Gut 2020 Oct 20 early online
RESUMEN
● DEL ESTUDIO
en adultos con COVID-19 que reciben tratamiento para la enfermedad inflamatoria mediada por el
sistema inmunitario, la monoterapia con un inhibidor de TNF se asoció con una menor probabilidad
de hospitalización o muerte específica de COVID-19 que la mayoría de las otras monoterapias o
tratamientos inmunomoduladores combinados
ESTUDIO DE COHORTE : JAMA Netw Open 2021 Oct 1;4(10):e2129639 | Texto completo
Detalles

⚬ 8,268 adults receiving immunomodulatory treatment for immune-mediated inflammatory disease
who were diagnosed with COVID-19 were evaluated
⚬ 6,077 patients (mean age 48 years) from 74 countries (52.9% in Europe, 33.2% in North America)
were included in analyses
– 35.3% had rheumatoid arthritis, 25.3% had Crohn disease, 12.5% had ulcerative colitis, 10.3% had
spondyloarthritis, and 4.9% had psoriasis
– most common comorbidities were hypertension (22.4%), diabetes (8.9%), COPD (7.1%), and
cardiovascular disease (6.4%)
– immunomodulatory treatments included
● TNF inhibitor monotherapy in 46.8%

● methotrexate monotherapy in 25.4%
● TNF inhibitor plus methotrexate in 11%
● TNF inhibitor plus azathioprine/6-mercaptopurine in 5.5%
● azathioprine/6-mercaptopurine monotherapy in 6.5%
● Janus kinase (JAK) inhibitor monotherapy in 4.7%
– 84.9% were taking daily glucocorticoid
⚬ TNF inhibitors included adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab
⚬ JAK inhibitors included tofacitinib, baricitinib, and upadacitinib
⚬ COVID-19-specific outcomes
– mortality 3.1%
– hospitalization in 21.3%
⚬ compared to TNF inhibitor monotherapy, increased likelihood of COVID-19-specific hospitalization or

death associated with
– methotrexate monotherapy (adjusted odds ratio [OR] 2, 95% CI 1.57-2.56)
– TNF inhibitor plus azathioprine/6-mercaptopurine therapy (adjusted OR 1.74, 95% CI 1.17-2.58)
– azathioprine/6-mercaptopurine monotherapy (adjusted OR 1.84, 95% CI 1.3-2.61)
– JAK inhibitor monotherapy (adjusted OR 1.82, 95% CI 1.21-2.73)
⚬ no significant difference in COVID-19-specific hospitalization or death comparing TNF inhibitor plus

methotrexate vs. TNF inhibitor monotherapy (adjusted OR 1.18, 95% CI 0.85-1.63)
⚬ Reference - JAMA Netw Open 2021 Oct 1;4(10):e2129639 full-text , editorial can be found in
JAMA Netw Open 2021 Oct 1;4(10):e2129707
● Evidencia • Actualizado 14 Sep 2022
RESUMEN DEL ESTUDIO

niveles elevados de antígeno plasmático asociados con un empeoramiento del estado pulmonar y un
mayor tiempo hasta el alta en adultos hospitalizados con COVID-19
ESTUDIO DE COHORTE : Ann Intern Med 2022 30 de agosto temprano en línea | Texto completo
Detalles

⚬ 2,540 adults (median age 57 years, 58% male) from Therapeutics for Inpatients With COVID-19
platform trial hospitalized for acute SARS-CoV-2 infection and who had symptom onset within 12
days between August 2020 and November 2021 were assessed
– participating regions included Africa, Asia, Europe, and the United States
– Delta variant became dominant strain in circulation beginning in late June 2021
⚬ median baseline plasma viral N antigen level 1,422 ng/L
– 57% had level ≥ 1,000 ng/L

– 5% below level of quantification
⚬ median time from symptom onset 8 days

⚬ plasma antigen level ≥ 1,000 ng/L associated with increased
– risk of worsened pulmonary status at day 5 (odds ratio [OR] 5.06, 95% CI 3.41-7.5)
– time to hospital discharge (7 days with higher antigen level vs. 4 days with lower level; subhazard
ratio 0.51, 95% CI 0.45-0.57)
⚬ factors associated with increased plasma antigen level
– pulmonary status (compared to room air)
● noninvasive ventilation or high-flow nasal cannula (OR 3.1, 95% CI 2.22-4.34)

● supplemental oxygen ≥ 4 L/minute (OR 2.88, 95% CI 2.23-3.71)
● supplemental oxygen < 4 L/minute (OR 1.77, 95% CI 1.39-2.26)
– renal impairment (OR 2.63, 95% CI 1.88-3.68)

– unvaccinated or unknown vaccination status (OR 1.51, 95% CI 1.11-2.05)
– negative antispike antibody (OR 6.42, 95% CI 5.37-7.66)
– Delta variant (OR 1.73, 95% CI 1.41-2.13)
⚬ no significant association between plasma antigen level and race, ethnicity, body mass index, or
immunocompromising conditions
⚬ Reference - Ann Intern Med 2022 Aug 30 early online full-text
● fragilidad
RESUMEN
⚬ DEL ESTUDIO
fragilidad asociada con mayor mortalidad en adultos con COVID-19
REVISIÓN SISTEMÁTICA : J Am Geriatr Soc 2021 28 de mayo temprano en línea

Detalles

– systematic review of 52 observational studies evaluating frailty in 118,373 adults with suspected
or confirmed COVID-19
– mean age range 56-87 years
– prevalence of frailty ranged from 8.3% to 87.2%
– 42 studies used Clinical Frailty Scale (CFS) to assess frailty
– CFS-assessed frailty associated with
● increased mortality (adjusted odds ratio [OR] 1.79, 95% CI 1.49-2.14) in analysis of 14 studies
● increased risk of prolonged hospital stay (> 10 days) (adjusted OR 1.15, 95% CI 1.07-1.24) in
● increased risk of delirium (OR 2.91, 95% CI 2-4.25) in analysis of 7 studies
● reduced risk of ICU admission (OR 0.24, 95% CI 0.08-0.71) in analysis of 8 studies (no significant
association in adjusted analysis of 3 studies)
– no significant association between CFS-assessed frailty and need for mechanical ventilation in
– Reference - J Am Geriatr Soc 2021 May 28 early online
⚬ una revisión sistemática de estudios de cohortes que evalúan la asociación entre fragilidad y
mortalidad en adultos hospitalizados con COVID-19 se puede encontrar en Age Aging 2021 May
5;50(3):608
● trastornos intelectuales o del desarrollo
RESUMEN
⚬ DEL ESTUDIO
entre las personas con discapacidad intelectual o del desarrollo que reciben servicios
residenciales, enfermedad cardíaca asociada con un mayor riesgo de mortalidad relacionada con
COVID-19
ESTUDIO DE COHORTE : JAMA Netw Open 2021 Jun 1;4(6):e2112862 | Texto completo
Detalles

– 543 persons (median age 57 years, 60% men, 49.5% White) with intellectual or developmental
disability receiving residential services in New York, New York, from March 1 to October 1, 2020,
were assessed
– types of residential services
● 19.7% had supportive residence defined as up to 23 hours/week of assistance with activities of

independent daily living
● 69.2% had supervised living defined as 24/7 on-site staff support for assistance with activities
of daily living, with or without intermittent nursing care
● 11.1% had intermediate care facilities residence defined as 24/7 on-site staff support for
complex medical needs with 24-hour nursing coverage
– case rates of persons with intellectual or developmental disability vs. overall population in New
York, New York (no p values reported)
● COVID-19 positive case rate per 100,000 persons 16,759 vs. 2,978
● mortality rate per 100,000 persons 6,446 vs. 286
● case-fatality rate 38.5% vs. 9.6%
– increased risk of COVID-19 mortality associated with heart disease (odds ratio [OR] 10.6, 95% CI
2.68-41.9)
– increased risk of COVID-19 positivity associated with
● increased age (OR 1.04, 95% CI 1.02-1.06)

● Down syndrome (OR 2.91, 95% CI 1.49-5.69)
● increased number of residents (OR 1.07, 95% CI 1-1.14)
● chronic kidney disease (OR 4.17, 95% CI 1.9-9.15)
– Reference - JAMA Netw Open 2021 Jun 1;4(6):e2112862 full-text
RESUMEN
⚬ DEL ESTUDIO
problemas de aprendizaje, síndrome de Down y parálisis cerebral, cada uno asociado con un
mayor riesgo de hospitalización y muerte relacionadas con COVID-19 en personas ≥ 16 años en
Inglaterra
ESTUDIO DE COHORTE : BMJ 2021 14 de julio; 374: n1592

Detalles

– 2 cohorts of children and adults ≤ 105 years old living in England during first 2 waves of COVID-19
infections from OpenSAFELY platform (contains records of about 40% of population) were
assessed
● cohort 1 assessed during first wave between March 1, 2020 and August 31, 2020
● cohort 2 assessed during second wave between September 1, 2020 and February 8, 2021
– cohort 1 included 14,312,023 adolescents and adults ≥ 16 years old

● 90,307 persons (58% aged 16-44 years, 59% men, 90% White, 6% South Asian) had learning
disability
⚬ mild-to-moderate learning disability in 82%
⚬ Down syndrome in 8% and cerebral palsy in 8%
⚬ living in residential care (defined as living in household with ≥ 5 people designated as
having learning disability) in 9%
● 14,221,716 persons (45% aged 16-44 years, 48% men, 85% White, 8% South Asian) did not have
learning disability
⚬ Down syndrome or cerebral palsy in 0.08%
⚬ living in residential care in 0.01%
● analyses adjusted for several factors including residential care status as defined
● rates of COVID-19-related hospitalization per 1,000 person-years
⚬ 11.9 with learning disability (adjusted hazard ratio [HR] 5.3, 95% CI 4.85-5.8 vs. no learning
disability)
– 10.5 with mild learning disability (adjusted HR 4.74, 95% CI 4.3-5.23 vs. no learning
disability)
– 18.2 with profound learning disability (adjusted HR 7.75, 95% CI 6.43-9.33 vs. no learning
disability)
⚬ 18.9 with Down syndrome (adjusted HR 10.59, 95% CI 8.47-13.23 vs. no Down syndrome)
⚬ 10.7 with cerebral palsy (adjusted HR 4.95, 95% CI 3.86-6.36 vs. no cerebral palsy)
⚬ 4.2 for each: no learning disability, no Down syndrome, and no cerebral palsy
● rates of COVID-19-related death per 1,000 person-years
⚬ 4.9 with learning disability (adjusted HR 8.21, 95% CI 7.15-9.42 vs. no learning disability)
– 4.3 with mild learning disability (adjusted HR 7.15, 95% CI 6.12-8.34 vs. no learning
disability)
– 7.8 with profound learning disability (adjusted HR 13.14, 95% CI 9.94-17.39 vs. no
learning disability)
⚬ 10.3 with Down syndrome (adjusted HR 36.34, 95% CI 26.67-49.51 vs. no Down syndrome)
⚬ 3.3 with cerebral palsy (adjusted HR 5.83, 95% CI 4.12-8.26 vs. no cerebral palsy)
⚬ 1.9 for each: no learning disability, no Down syndrome, and no cerebral palsy
– consistent results in 14,351,944 adolescents and adults ≥ 16 years old in cohort 2

– Reference - BMJ 2021 Jul 14;374:n1592
● trastornos de salud mental
RESUMEN
⚬ DEL ESTUDIO
trastornos de salud mental preexistentes asociados con una mayor mortalidad por COVID-19 y
hospitalización por COVID-19
REVISIÓN SISTEMÁTICA : Lancet Psychiatry 2021 15 de julio temprano en línea | Texto completo
Detalles

– systematic review of 33 observational studies evaluating preexisting mental health disorders and
COVID-19-related outcomes in patients with COVID-19
– 23 studies with 1,469,731 patients included in meta-analysis
– 43,938 patients (3%) had mental health disorders
– any preexisting mental health disorder associated with
● increased COVID-19 mortality (adjusted odds ratio [OR] 1.31, 95% CI 1.12-1.52) in analysis of 11
studies with 204,151 patients
● increased COVID-19 hospitalization (adjusted OR 1.77, 95% CI 1.29-2.42) in analysis of 6 studies
with 134,863 patients
– in analysis by diagnosis and drug exposure
● increased COVID-19 mortality associated with
⚬ psychotic disorders (adjusted OR 1.68, 95% CI 1.29-2.18) in analysis of 5 studies with

110,203 patients
⚬ mood disorders (adjusted OR 1.43, 95% CI 1.15-1.79) in analysis of 5 studies with 17,629
patients
⚬ antipsychotic exposure (adjusted OR 2.43, 95% CI 1.81-3.25) in analysis of 3 studies
⚬ anxiolytic exposure (adjusted OR 1.47, 95% CI 1.15-1.88) in analysis of 2 studies
● no significant association between COVID-19 mortality and
⚬ anxiety disorders in analysis of 3 studies with 13,072 patients

⚬ substance use disorders in analysis of 4 studies with 79,432 patients
⚬ antidepressant exposure in analysis of 2 studies
– Reference - Lancet Psychiatry 2021 Jul 15 early online full-text
RESUMEN
⚬ DEL ESTUDIO
trastornos del estado de ánimo preexistentes asociados con un mayor riesgo de hospitalización y
mortalidad por COVID-19
REVISIÓN SISTEMÁTICA : JAMA Psychiatry 2021 Jul 28 temprano en línea

Detalles

– systematic review of 21 observational studies evaluating preexisting mood disorders and COVID-
19 outcomes in > 91,000,000 patients
– mood disorders defined as depression or bipolar disorder using standardized diagnostic criteria
– COVID-19 severe events included ICU admission, mechanical ventilatory support, oxygen therapy,
extracorporeal membrane oxygenation, acute respiratory distress syndrome, or cardiopulmonary
resuscitation
– comparing preexisting mood disorders to no preexisting mood disorders
● preexisting mood disorders associated with
⚬ increased risk of COVID-19 hospitalization (odds ratio [OR] 1.31, 95% CI 1.12-1.53) in
analysis of 7 studies with 26,554,397 patients
⚬ increased COVID-19 mortality (OR 1.51, 95% CI 1.34-1.69) in analysis of 12 studies with
25,808,660 patients
● no significant differences in
⚬ COVID-19 test positivity (OR 1.27, 95% CI 0.73-2.19) in analysis of 15 studies with 65,514,469
patients
⚬ COVID-19 severe events (OR 0.94, 95% CI 0.87-1.03) in analysis of 7 studies with 83,240
patients
– Reference - JAMA Psychiatry 2021 Jul 28 early online

⚬
RESUMEN DEL ESTUDIO
trastornos de salud mental asociados con una mayor mortalidad por COVID-19
REVISIÓN SISTEMÁTICA : JAMA Psychiatry 2021 Jul 27 temprano en línea

Detalles

– systematic review of 16 population-based cohort studies evaluating mental health disorders and
COVID-19 mortality
– 19,086 patients had mental health disorders
– compared to no mental health disorders, mental health disorders associated with increased
COVID-19 mortality
● adjusted odds ratio 1.38 (95% CI 1.15-1.65) in overall analysis of all studies
● adjusted odds ratio 1.67 (95% CI 1.02-2.73) in analysis of 5 studies including only patients with
severe mental health disorders (schizophrenia spectrum disorder or bipolar disorders)
– Reference - JAMA Psychiatry 2021 Jul 27 early online
● biomarcadores
⚬ Evidencia • Actualizado El 2 De Noviembre De 2022
RESUMEN DEL ESTUDIO

La proteína plasmática de la nucleocápsida viral del SARS-CoV-2 (antígeno N) con un punto de
corte ≥ 1000 pg/mL puede tener una sensibilidad moderada para predecir el empeoramiento del
estado de salud en 1 semana, pero una sensibilidad baja para predecir la ventilación mecánica a los
28 días o la muerte en adultos hospitalizados dentro de los 72 horas con COVID-19 confirmado
Nivel DynaMed 2
ESTUDIO DE COHORTE : Crit Care 2022 14 de septiembre; 26 (1): 278 | Texto completo
Detalles
– based on prognostic cohort study without independent validation

– 445 adults hospitalized within 72 hours with confirmed or suspected COVID-19 between March
2020 and August 2021 were followed for 28 days
– 256 patients (mean age 57 years, 67% male, 54% Hispanic or Latino, 18% Asian, 17% White, 9%
Black or African American) with confirmed COVID-19 and sufficient plasma volume for biomarker
measurements were included in analysis
– median plasma SARS-CoV-2 N-antigen concentration 735 pg/mL
– outcomes overall
● worsened health status on World Health Organization scale at 1 week in 13.8%

● ICU admission in 23.8% among 168 patients not in ICU at baseline
● 28-day mechanical ventilation in 20.5% among 220 patients
● 28-day mortality 16.4% among 244 patients
– prognostic performance of plasma SARS-CoV-2 N-antigen with cutoff ≥ 1,000 pg/mL
● for predicting worsening health status at 1 week
⚬ sensitivity 77%
⚬ specificity 59%
● for predicting ICU admission
⚬ sensitivity 70%
⚬ specificity 62%
● for predicting 28-day mechanical ventilation
⚬ sensitivity 59%
⚬ specificity 58%
● for predicting 28-day mortality
⚬ sensitivity 52%
⚬ specificity 56%
– Reference - COMET study (Crit Care 2022 Sep 14;26(1):278 full-text )
RESUMEN
⚬ DEL ESTUDIO
Niveles de péptido natriurético tipo N-terminal pro-B, troponina I cardíaca de alta sensibilidad,
mioglobina, creatina fosfoquinasa-MB y creatina fosfoquinasa en puntos de corte inferiores al
límite superior de lo normal (LSN), cada uno asociado con una mayor mortalidad a los 28 días en
adultos hospitalizados con COVID-19
ESTUDIO DE COHORTE : Hipertensión 2020 Oct;76(4):1104 | Texto completo

Detalles

– 6,033 adults ≤ 75 years old with clinical or laboratory-confirmed COVID-19 admitted to hospitals in
Hubei Province, China from December 31, 2019 to March 4, 2020 were assessed
– 3,219 adults with available cardiac injury biomarker measurements were included in analysis
– 28-day mortality 6%
– serum cardiac biomarkers at levels lower than ULN associated with increased 28-day mortality
included
● N-terminal pro-B type natriuretic peptide ≥ 0.189 × ULN and ≤ ULN (adjusted hazard ratio [HR]
8.7, 95% CI 4.5-16.82)
● high-sensitivity cardiac troponin I ≥ 0.49 × ULN and ≤ ULN (HR 8.54, 95% CI 4.99-14.63)
● myoglobin ≥ 0.498 × ULN and ≤ ULN (adjusted HR 3.55, 95% CI 2.2-5.73)
● creatine phosphokinase-MB ≥ 0.491 × ULN and ≤ ULN (adjusted HR 2.87, 95% CI 1.99-4.14)
● creatine phosphokinase 0.448 × ULN and ≤ ULN (adjusted HR 1.71, 95% CI 1.14-2.58)
– D-dimer ≥ 1.126 × ULN associated with increased 28-day mortality (adjusted HR 5.55, 95% CI 3.32-
9.3)
– Reference - Hypertension 2020 Oct;76(4):1104 full-text
RESUMEN
⚬ DEL ESTUDIO
en pacientes con COVID-19 grave, enfermedad coronaria asociada con un mayor riesgo de lesión
miocárdica y lesión miocárdica al ingreso asociada con una mayor mortalidad
ESTUDIO DE COHORTE : Eur Heart J 2020 Jun 7;41(22):2070 | Texto completo

Detalles

– 671 adults (median age 63 years, 52% female) with severe laboratory-confirmed COVID-19
consecutively admitted to hospital in Wuhan, China, from January 1 to February 23, 2020, and who
had data for cardiac troponin I (cTnI) were assessed for median 17 days
● severe disease defined as any of following: respiratory rate > 30/minute, oxygen saturation ≤
93%, ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ≤ 300
mm Hg, needing mechanical ventilation, shock, or respiratory failure plus other organ failure
needing care in ICU
● comorbidities included hypertension (29.7%), diabetes (14.5%), coronary heart disease (8.9%),
chronic renal disease (4.2%), COPD (3.4%), cancer (3.4%), chronic heart failure (3.3%),
cerebrovascular disease (3.3%), and atrial fibrillation (1%)
– myocardial injury defined as cTnI increased above 99th percentile upper reference limit
– oxygen therapy included
● oxygen inhalation in 78.5%

● noninvasive ventilation in 11.3%
● invasive mechanical ventilation in 5.4%
● extracorporeal membrane oxygenation in 0.3%
– mortality 9.2%
– incidence of myocardial injury on admission in
● 15.8% overall
● 75.8% of adults who died vs. 9.7% of adults who survived (p < 0.001)
– increased mortality associated with
● cTnI > 0.026 ng/mL (adjusted hazard ratio [HR] 4.56, 95% CI 1.28-16.28)
● creatinine kinase-myocardial band > 2.2 ng/mL (adjusted HR 6.62, 95% CI 2.49-17.59)
● N-terminal pro-B-type natriuretic peptide > 900 pg/mL (adjusted HR 3.12, 95% CI 1.25-7.8)
– increased prevalence of coronary heart disease, chronic heart failure, and cerebrovascular
disease comparing patients who died and patients who survived in unadjusted analysis (p < 0.001
for each)
– no significant differences in mortality for patients who had coronary heart disease, chronic heart
failure, or cerebrovascular disease compared to patients without condition in adjusted analysis
– increased risk of myocardial injury associated with
● chronic renal disease (adjusted odds ratio [OR] 9.03, 95% CI 2.43-33.59)
● COPD (adjusted OR 4.01, 95% CI 1.28-12.61)
● hypertension (adjusted OR 3.3, 95% CI 1.77-6.14)
● coronary heart disease (adjusted OR 2.92, 95% CI 1.32-6.48)
● age (adjusted OR 1.64 per 10-year increase, 95% CI 1.28-2.1)
● elevated C-reactive protein (adjusted OR 1.01, 95% CI 1.01-1.02)
– Reference - Eur Heart J 2020 Jun 7;41(22):2070 full-text
RESUMEN
⚬ DEL ESTUDIO
niveles más altos de biomarcadores de inflamación y trombosis asociados con una mayor
mortalidad hospitalaria en pacientes críticos con COVID-19
ESTUDIO DE COHORTE : Lancet 2020 Jun 6;395(10239):1763 | Texto completo

Detalles
– 257 adults (median age 62 years, 67% men, 82% with ≥ 1 chronic illness) with COVID-19 were
followed through April 28, 2020
– all patients were critically ill defined as receiving mechanical ventilation or supplemental oxygen
at flow rate ≥ 15 L/minute (acute hypoxemic respiratory failure)
– in-hospital mortality 39%
– increased risk of in-hospital death associated with
● increased interleukin-6 concentration (adjusted hazard ratio 1.11 per decile increase, 95% CI
1.02-1.2)
● increased D-dimer concentration (adjusted hazard ratio 1.1 per decile increase, 95% CI 1.01-
1.19)
– Reference - Lancet 2020 Jun 6;395(10239):1763 full-text
RESUMEN
⚬ DEL ESTUDIO
niveles elevados de proteína C reactiva, troponina o dímero D al ingreso asociados con un mayor
riesgo de COVID-19 grave

Detalles

– 2,725 patients admitted to hospital with COVID-19 in New York, New York, were assessed
– biomarkers associated with severe COVID-19 disease included
● first C reactive protein > 200 mg/L (adjusted odds ratio [OR] 5.09, 95% CI 2.82-9.2)
● first C reactive protein 100-200 mg/L (adjusted OR 3.86, 95% CI 2.23-6.7)
● first troponin > 1 ng/mL (adjusted OR 4.78, 95% CI 2.1-10.9)
● first D-dimer > 2,500 ng/mL (adjusted OR 3.93, 95% CI 2.6-6)
● oxygen saturation < 88% on admission (adjusted OR 3.67, 95% CI 2.78-4.8)
RESUMEN
⚬ DEL ESTUDIO
mayor edad, puntuación más alta en la Evaluación Secuencial de Fallos Orgánicos (SOFA) y
dímero D > 1 mcg/mL asociados con una mayor mortalidad hospitalaria en adultos con COVID-19
ESTUDIO DE COHORTE : Lancet 2020 28 de marzo; 395 (10229): 1054 | Texto completo
Detalles

– 191 adults aged 18-87 years (median age 56 years, 62% men) with laboratory-confirmed COVID-19
admitted to 2 hospitals in Wuhan, China, and who died (28%) or were discharged by January 31,
2020, were assessed
● most common symptoms on admission included fever (94%), cough (79%), sputum (23%),
fatigue (23%), and myalgia (15%)
● 48% had comorbidity
– 95% received antibiotics, and 21% received antivirals (lopinavir/ritonavir)

– increased in-hospital mortality associated with
● older age (adjusted odds ratio [OR] 1.1 per year increase, 95% CI 1.03-1.17)
● higher SOFA score (adjusted OR 5.65, 95% CI 2.61-12.23)
● d-dimer > 1 mcg/mL on admission (adjusted OR 18.42, 95% CI 2.64-128.55) compared to ≤ 0.5
mcg/mL
– comparing nonsurvivors vs. survivors (p < 0.0001 for each unless otherwise indicated)
● median age 69 years vs. 52 years

● SOFA score 4.5 points vs. 1 point
● comorbidities
⚬ hypertension in 48% vs. 23% (p = 0.0008)

⚬ diabetes in 31% vs. 14% (p = 0.0051)
⚬ coronary heart disease in 24% vs. 1%
⚬ chronic obstructive lung disease in 7% vs. 1% (p = 0.047)
⚬ chronic kidney disease in 4% vs. 0% (p = 0.024)
⚬ d-dimer ≥ 1 mcg/mL in 81% vs. 24%

⚬ median white blood cell count 9.8 × 109/L vs. 5.2 × 109/L
⚬ lymphocyte < 0.8 × 109/L in 76% vs. 26%
⚬ anemia in 26% vs. 11% (p = 0.0094)
⚬ platelet count < 100 × 109/L in 20% vs. 1%
⚬ high-sensitivity cardiac troponin I ≥ 28 pg/mL in 46% vs. 1%
● thoracic imaging
⚬ consolidation in 74% vs. 53% (p = 0.0065)

⚬ ground glass opacity in 81% vs. 67% (p = 0.049)
⚬ bilateral pulmonary infiltration in 83% vs. 72% (p = 0.09)
● outcomes
⚬ sepsis in 100% vs. 42%

⚬ respiratory failure in 98% vs. 36%
⚬ ARDS in 93% vs. 7%
⚬ septic shock in 70% vs. 0%
⚬ acute cardiac injury in 59% vs. 1%
⚬ acute kidney injury in 50% vs. 1%
⚬ heart failure in 52% vs. 12%
⚬ secondary infection in 50% vs. 1%
⚬ coagulopathy in 50% vs. 7%
● treatments
⚬ invasive mechanical ventilation in 57% vs. 1%

⚬ noninvasive mechanical ventilation in 44% vs. 1%
⚬ extracorporeal membrane oxygenation in 6% vs. 0% (p = 0.0054)
⚬ renal replacement therapy in 19% vs. 0%
⚬ intravenous immunoglobulin in 67% vs. 7%
⚬ corticosteroid in 48% vs. 23% (p = 0.0005)
– median time from illness onset to
● discharge 22 days
● death 18.5 days
● invasive mechanical ventilation 14.5 days
● stop viral shedding in survivors 20 days (range 8-37 days)
– Reference - Lancet 2020 Mar 28;395(10229):1054 full-text

RESUMEN
⚬ DEL ESTUDIO
edad ≥ 65 años y lactato deshidrogenasa elevada asociada con enfermedad grave y mortalidad en
pacientes hospitalizados con COVID-19 en China
ESTUDIO DE COHORTE : J Allergy Clin Immunol 2020 Jul;146(1):110 | Texto completo

Detalles

– 548 adults (median age 60 years) with COVID-19 admitted to Tongji hospital in Wuhan, China,
between January 26 and February 5, 2020, had clinical and laboratory records evaluated and were
followed until March 3, 2020
– 269 patients (49.1%) classified as severe at admission based on American Thoracic
Society/Infectious Diseases Society of America definition for severe community-acquired
pneumonia
– factors associated with severe disease at admission in multivariable analysis
● lactate dehydrogenase > 445 units/L (odds ratio [OR] 4.4, 95% CI 2.6-7.6)
● age ≥ 65 years (OR 2.2, 95% CI 1.5-3.5)
● d-dimer > 1 mg/L (OR 2.2, 95% CI 1.4-3.3)
● hypertension (OR 2, 95% CI 1.3-3.2)
– during mean 32 days of follow-up
● 32.5% of patients with severe disease died, and 31.7% were discharged
● 1.1% of patients with nonsevere disease died, and 72.9% were discharged
– factors associated with mortality in patients with severe disease in multivariable analysis
● administration of high-dose corticosteroids (adjusted hazard ratio [HR] 3.5, 95% CI 1.79-6.86)
● cardiac injury during hospitalization (adjusted HR 2.92, 95% CI 1.8-4.76)
● blood leukocyte count > 10 cells/mm3 at admission (adjusted HR 2.04, 95% CI 1.26-3.31)
● lactate dehydrogenase > 445 units/L at admission (adjusted HR 2, 95% CI 1.21-3.3)
● hyperglycemia during hospitalization (adjusted HR 1.77, 95% CI 1.11-2.84)
● male sex (adjusted HR 1.72, 95% CI 1.05-2.82)
● age ≥ 65 years (adjusted HR 1.72, 95% CI 1.09-2.73)
– Reference - J Allergy Clin Immunol 2020 Jul;146(1):110 full-text
RESUMEN
⚬ DEL ESTUDIO
químicas hepáticas elevadas en la presentación asociadas con una mayor mortalidad y riesgo de
enfermedad grave en pacientes con COVID-19
REVISIÓN SISTEMÁTICA : Aliment Pharmacol Ther 2020 Aug;52(4):584 | Texto completo

Detalles

– systematic review of 107 studies with data to assess association between liver chemistries and
incidence of severe disease or death in 20,874 patients with COVID-19
● markers evaluated included bilirubin, aspartate transaminase (AST), alanine transaminase
(ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), and albumin and
prothrombin time
● 92 studies in adults, 11 studies in children, and 4 studies in both adults and children (63% of
patients were from China)
– 23% had elevated liver chemistries (> laboratory upper limit of normal) at presentation in analysis
of 68 studies
– overall mortality 12.7% (95% CI 9.9%-16.2%) in analysis of 46 studies
– compared to no elevated liver chemistries at initial presentation, elevated liver chemistries
associated with
● increased mortality (odds ratio 3.46, 95% CI 2.42-4.95) in analysis of 4 studies with 1,321
patients
● increased rates of severe disease (odds ratio 2.87, 95% CI 2.29-3.6) in analysis of 9 studies with
1,980 patients
– Reference - Aliment Pharmacol Ther 2020 Aug;52(4):584 full-text

– consistent findings in cohort study evaluating factors associated with poor prognosis in 1,040
hospitalized adults with COVID-19 in Hong Kong (Gut 2021 Apr;70(4):733 full-text )
RESUMEN
⚬ DEL ESTUDIO
en adultos sin enfermedad hepática preexistente hospitalizados con infección por SARS-CoV-2,
hiperbilirrubinemia asociada con una mayor mortalidad específica de COVID-19 e
hipoalbuminemia, AST elevada y ALT elevada cada una asociada con un mayor riesgo de
combinación de mortalidad específica de COVID-19 y ingreso en la UCI
ESTUDIO DE COHORTE : Gut 2021 29 de enero temprano en línea

Detalles

– 217 adults (median age 63 years, 66% men) without preexisting liver disease who were
hospitalized with laboratory-confirmed COVID-19 between March and July 2020 were assessed
– severe COVID-19 defined as composite outcome of COVID-19-specific mortality and ICU admission
– 125 patients (57.6%) had abnormal liver biochemistry values at hospital admission including
● elevated total bilirubin in 4.6%

● hypoalbuminemia in 32.7%
● elevated AST in 41.9%
● elevated ALT in 27.2%
● elevated gamma-glutamyltransferase (GGT) in 36.9%
– comparing elevated vs. normal total bilirubin
● severe COVID-19 in 50% vs. 41.6% (not significant)

● COVID-19-specific mortality 40% vs. 12.7% (adjusted odds ratio [OR] 4.8, 95% CI 1.14-20.16)
● ICU admission in 30% vs. 37.1% (not significant)
– comparing hypoalbuminemia vs. normal albuminemia
● severe COVID-19 in 80.3% vs. 25.6% (adjusted OR 9.95, 95% CI 4.4-22.78)

● COVID-19-specific mortality 22.5% vs. 8.9% (not significant)
● ICU admission in 76.1% vs. 20% (adjusted OR 13.95, 95% CI 5.72-34.03)
– comparing elevated vs. normal AST

● ICU admission in 49.5% vs. 26.7% (adjusted OR 3.43, 95% CI 1.75-6.72)
– comparing elevated vs. normal ALT

● ICU admission in 50.8% vs. 30.6% (adjusted OR 3.01, 95% CI 1.51-5.99)
– comparing elevated vs. normal GGT
● severe COVID-19 in 46.3% vs. 37.2% (not significant)

● ICU admission in 45% vs. 29.5% (adjusted OR 2.06, 95% CI 1.08-3.92)
– hypoalbuminemia plus any elevated liver biochemistry abnormality associated with increased
severe COVID-19 (adjusted OR 17.84, 95% CI 6.57-48.41) and increased ICU admission (adjusted
OR 24.13, 95% CI 8.61-67.6)
– Reference - Gut 2021 Jan 29 early online
RESUMEN
⚬ DEL ESTUDIO
nivel más alto de dímero D, producto de degradación de fibrina y tiempo de protrombina (PT)
prolongado al ingreso asociado con una disminución de la supervivencia en pacientes
hospitalizados por neumonía por COVID-19
ESTUDIO DE COHORTE : J Thromb Haemost 2020 Apr;18(4):844 | Texto completo

Detalles

– 183 patients (mean age at disease onset 54 years) with confirmed COVID-19 pneumonia
presenting to Tongji hospital in Wuhan, China, between January 1, 2020 and February 3, 2020, had
their clinical and laboratory records evaluated
– 41% had chronic diseases such as cardiovascular and cerebrovascular disease, respiratory system
disease, malignancy, or chronic liver or kidney disease
– all patients received antiviral and supportive therapies
– by February 13, 2020, 11.5% had died, 42.6% were discharged, and 45.9% remained in hospital in
stable condition; patients who died were significantly older (mean age 64 years vs. 52 years
among survivors, p < 0.001)
– comparing nonsurvivors vs. survivors
● baseline patient characteristics
⚬ D-dimer level 2.12 mg/L vs. 0.61 mg/L (p < 0.001)

⚬ fibrin degradation product 7.6 mg/L vs. 4 mg/L (p < 0.001)
⚬ median PT 15.5 seconds vs. 13.6 seconds (p < 0.001)
⚬ median activated partial thromboplastin time 44.8 seconds vs. 41.2 seconds (p = 0.096)
⚬ fibrinogen 5.16 g/L vs. 4.51 g/L (not significant)
⚬ antithrombin activity 84% vs. 91% (p = 0.096)
● development of overt disseminated intravascular coagulation (DIC) as defined by International

Society on Thrombosis and Haemostasis diagnostic criteria (≥ 5 points) in 71.4% vs. 0.6%;
median time to DIC 4 days
– factors associated with death at 10 days and 14 days after hospitalization
● elevated D-dimer levels, prolonged PT, or elevated fibrinogen degradation products (p < 0.05)
● reduced fibrinogen levels and antithrombin activity (p < 0.05)
– Reference - J Thromb Haemost 2020 Apr;18(4):844 full-text , commentary can be found in J

Thromb Haemost 2020 Apr;18(4):786
RESUMEN
⚬ DEL ESTUDIO
sexo masculino, presencia de comorbilidades, disnea y creatinina > 105 mcmol/L (1,19 mg/dL)
asociado a mayor mortalidad en pacientes ≥ 65 años hospitalizados por COVID-19
ESTUDIO DE COHORTE : J Gerontol A Biol Sci Med Sci 2020 11 de abril temprano en línea
Detalles

– 203 adults (median age 54 years) with COVID-19 admitted to 1 hospital in Wuhan, China, from
January 1 to February 10, 2020, were evaluated
– 55 patients were ≥ 65 years old
– mortality 34.5% in patients ≥ 65 years old vs. 4.7% in patients < 65 years old (p < 0.001)
– factors associated with mortality in patients ≥ 65 years old in multivariate analysis
● presence of any comorbidities (odds ratio [OR] 16.1, 95% CI 1.9-133.8)

● male sex (OR 13.8, 95% CI 1.4-136.1)
● shortness of breath (OR 12.9, 95% CI 1.8-94.4)
● creatinine > 105 mcmol/L (1.19 mg/dL) (OR 4.8, 95% CI 1.2-17)
– Reference - J Gerontol A Biol Sci Med Sci 2020 Apr 11 early online
RESUMEN
⚬ DEL ESTUDIO
recuento de linfocitos más bajo y recuento de leucocitos más alto, cada uno asociado con
enfermedad grave en adultos con COVID-19
REVISIÓN SISTEMÁTICA : Emerg Infect Dis 2020 May 8;26(8):doi:10.3201/eid2608.201160 | Texto

completo
Detalles

– systematic review of 8 observational studies evaluating lymphocyte and leukocyte counts in 1,289
adults with COVID-19
– 45.9% had severe COVID-19, defined as significant respiratory distress including acute hypoxic
respiratory failure, ARDS, need for mechanical ventilation, or ICU admission
– comparing severe disease to mild disease in analysis of all studies, severe disease associated with
● lower lymphocyte count (mean difference -0.36 × 109 cells/L, 95% CI -0.5 to -0.22 × 109 cells/L),
● higher leukocyte count (mean difference 1.32 × 109 cells/L, 95% CI 0.62-2.02 × 109 cells/L),
– Reference - Emerg Infect Dis 2020 May 8;26(8):doi:10.3201/eid2608.201160 full-text
RESUMEN
⚬ DEL ESTUDIO
niveles elevados de procalcitonina y proteína C reactiva y recuentos de neutrófilos y recuentos
bajos de linfocitos asociados con una supervivencia reducida en pacientes con COVID-19
COHORT STUDY: Clin Infect Dis 2020 Jun 18 early online

Details

– 210 patients with confirmed COVID-19 in Wuhan, China, were assessed
– reduced survival associated with
● neutrophil count ≥ 6.3 × 109 cells/L (p = 0.016)

● procalcitonin ≥ 0.05 ng/mL (p = 0.025)
● lymphocyte counts < 0.8 × 109 cells/L (p = 0.002)
● C-reactive protein ≥ 10 mg/L (p = 0.11)
– nonsignificant increase in mortality associated with C-reactive protein ≥ 10 mg/L (hazard ratio
4.65, 95% CI 0.72-30.21)
– consistent results in additional cohort of 60 patients with COVID-19
– risk score developed based on biomarkers and age, but insufficient data provided to guide clinical
use
– Reference - Clin Infect Dis 2020 Jun 18 early online
⚬ cohort study evaluating association between presence of peripheral plasma cells and mortality in
adults hospitalized with severe COVID-19 can be found in Am J Med 2021 Mar 31 early online
● community interventions
STUDY
⚬ SUMMARY
COVID Watch automated text messaging service may reduce mortality compared to usual care in
community-dwelling adults with SARS-CoV-2 infection DynaMed Level 2
COHORT STUDY: Ann Intern Med 2021 Nov 16 early online | Full Text
Details

– 7,865 community-dwelling adults (mean age 43 years, 60% female) with positive test for SARS-
CoV-2 infection at Penn Medicine between March 23, 2020 and November 30, 2020 were enrolled
in COVID Watch 14-day automated text messaging service with 24-hour clinician monitoring (44%)
or had usual care (56%) and were assessed for 60 days
– COVID Watch consists of automated text message check-ins twice daily plus possibility to
communicate worsening symptoms
– propensity score for likelihood of enrollment in COVID Watch was calculated for each patient
based on demographic, clinical, healthcare use, and socioeconomic factors
– comparing COVID Watch vs. usual care in propensity-adjusted analysis
● 60-day mortality 0.14% vs. 0.37% (adjusted rate difference [RD] per 1,000 persons -2.5, 95% CI
-4 to -0.9)
⚬ 0.1% vs. 0.41% (adjusted RD per 1,000 persons -2.5, 95% CI -4.3 to -0.7) among 2,989 non-
Hispanic White patients
⚬ 0.18% vs. 0.21% (adjusted RD per 1,000 persons -2.5, 95% CI -4.2 to -0.5) among 3,076 non-
Hispanic Black patients
⚬ 0.34% vs. 0.75% (adjusted RD per 1,000 persons -4.1, 95% CI -0.8 to -0.1) among 697
Hispanic patients
● 30-day mortality 0.09% vs. 0.27% (adjusted RD per 1,000 persons -1.8, 95% CI -3.1 to -0.5)
– at 60 days, 0% of deaths in COVID Watch group and 37% of deaths in usual care group occurred
outside of hospital
– COVID Watch associated with
● increased telemedicine encounters, ED visits, and hospitalizations (each p < 0.001)

● earlier presentation to ED (mean of 1.9 days earlier, 95% CI 0.9-2.9 days)
– Reference - Ann Intern Med 2021 Nov 16 early online full-text , editorial can be found in Ann
Intern Med 2021 Nov 16 early online
STUDY
● SUMMARY
SARS-CoV-2 viral load on nasopharyngeal swabs not associated with in-hospital mortality or severe
COVID-19 in adults
COHORT STUDY: Acad Emerg Med 2021 Jan 22 early online

Details

⚬ 287 adults (median age 63 years, 66% men) hospitalized between March and April 2020 in France
who had ≥ 1 nasopharyngeal swab positive for SARS-CoV-2 by real-time polymerase chain reaction
(RT-PCR) were evaluated
– 145 patients (50.5%, median age 61 years, 59% men) had mild COVID-19
– 142 patients (49.5%, median age 65 years, 73% men) had severe COVID-19 and needed
mechanical ventilation
⚬ median SARS-CoV-2 viral load on initial upper respiratory swab 4.76 log10 copies per reaction
⚬ overall mortality 14.6%

⚬ no significant association of SARS-CoV-2 viral load on initial swab with
– in-hospital mortality (adjusted odds ratio [OR] 1.05, 95% CI 0.85-1.31)

– risk of severe COVID-19 (adjusted OR 0.88, 95% CI 0.73-1.06)
⚬ factors associated with significantly increased in-hospital mortality included
– age > 65 years (adjusted OR 4.7, 95% CI 1.29-17.07)

– history of dialysis (adjusted OR 14.43, 95% CI 1.38-151.14)
– anemia (adjusted OR 5.14, 95% CI 1.19-22.19)
⚬ factors associated with increased risk of severe COVID-19
– C-reactive protein > 100 mg/L (adjusted OR 8.82, 95% CI 3.36-19.96)

– creatinine > 90 mcmol/L (adjusted OR 13.51, 95% CI 2.97-61.54)
– platelet count > 400 × 109 cells/L (adjusted OR 12.11, 95% CI 1.26-116.29)
– lymphopenia (adjusted OR 16.59, 95% CI 4.11-66.95)
⚬ Reference - Acad Emerg Med 2021 Jan 22 early online
Comparing Variants
● Evidence • Updated 31 Oct 2022
STUDY SUMMARY
entre los trabajadores esenciales y de primera línea no vacunados con infección confirmada por
SARS-CoV-2, infección causada por la variante Omicron asociada con un aumento de la infección
asintomática por SARS-CoV-2 y reducción de la duración de la enfermedad en comparación con la
infección causada por la variante Delta

Detalles

⚬ 5,219 essential and frontline workers in the United States between December 2020 and April 2022
who completed weekly polymerase chain reaction (PCR) testing for SARS-CoV-2 were assessed
⚬ 1,199 essential and frontline workers (median age 41 years, 59.5% female, 72.6% non-Hispanic
White, 19.3% Hispanic) who had PCR-confirmed SARS-CoV-2 infection were included in analysis
⚬ essential and frontline worker defined as anyone working ≥ 20 hours/week in an occupation
consisting of regular contact within 3 feet of others
⚬ occupations included primary healthcare personnel (18.1%), nurses and other allied health providers
(32.4%), first responders (22.1%), and other (27.4%)
⚬ SARA-CoV-2 infection caused by Alpha variant in 14%, Delta variant in 24%, and Omicron variant in
62%
⚬ 29.4% were unvaccinated
⚬ comparing Delta variant vs. Omicron variant among unvaccinated adults
– asymptomatic SAR-SoV-2 infection in 3.9% vs. 20.2% (p < 0.05)

– fever or chills in 84.9% vs. 79% (not significant)
– received medical care for COVID-19 in 47.3% vs. 24.7% (p < 0.05)
– mean duration of COVID-19 symptoms 16.4 days vs. 12.3 days (p < 0.05)
– mean time spent sick in bed for ≥ half of day 4.9 days vs. 2.6 days (p < 0.05)
– mean time missed work due to COVID-19 62.8 hours vs. 35.9 hours (p < 0.05)
RESUMEN
● DEL ESTUDIO
entre las personas embarazadas no vacunadas, la infección por SARS-CoV-2 durante el período de
predominio de la variante Delta, pero no el predominio de la variante Omicron, se asoció con un
mayor riesgo de muerte materna y parto prematuro con < 34 semanas de gestación en comparación
con el período anterior a la variante Delta
ESTUDIO DE COHORTE : Ultrasonido Obstet Gynecol 2022 20 de abril temprano en línea

Detalles

⚬ 1,285 unvaccinated persons with RT-PCR-proven SARS-CoV-2 infection during pregnancy between
April 1, 2020 and February 14, 2022 in Turkey and the United Kingdom were evaluated
– 870 persons were from pre-Delta variant period (April 1, 2020 to July 31, 2021)
– 339 persons were from period when Delta variant was predominant (June 9, 2021 to December
27, 2021)
– 77 persons were from period when Omicron variant was predominant (after December 27, 2021)
⚬ propensity score for likelihood of SARS-CoV-2 infection during pre-Delta variant period or period of
Delta/Omicron variant predominance was calculated for each patient based on demographic and
clinical factors
⚬ 339 persons from period of Delta variant predominance and 339 persons from pre-Delta variant
period were included in propensity score-matched analysis
– mean age was 30 years and mean BMI was 26.3 kg/m2
– mean gestational age at diagnosis was 29.5 weeks (7% were diagnosed during first trimester, 31%
during second trimester, and 62% during third trimester)
⚬ comparing period of Delta variant predominance vs. pre-Delta variant period in propensity score-
matched analysis
– maternal death in 5.3% vs. 1.5% (p = 0.01)
– preterm birth at < 34 weeks gestation in 15.4% vs. 4.9% (p < 0.001)
– preterm birth at < 37 weeks gestation in 25.2% vs. 17.8% (p = 0.081)
– stillbirth in 3.2% vs. 1% (not significant)
– mechanical ventilation in 6.2% vs. 1.5% (p = 0.003)
– need for extracorporeal membrane oxygenation in 3.5% vs. 0.3% (p = 0.021)
– need for nasal oxygen support in 25.4% vs. 10% (p < 0.001)
– need for continuous positive airway pressure or high-flow oxygen in 10.3% vs. 4.1% (p = 0.002)
– preeclampsia in 2.3% vs. 3.5% (not significant)
⚬ 77 persons from period of Omicron variant predominance and 308 persons from pre-Delta variant
period were included in propensity score-matched analysis
– mean age was 29 years and mean BMI was 27.1 kg/m2
– mean gestational age at diagnosis was 35.6 weeks (7.8% were diagnosed during first trimester,
16.9% during second trimester, and 75.3% during third trimester)
⚬ comparing period of Omicron variant predominance vs. pre-Delta variant period in propensity score-
matched analysis
– maternal death in 1.3% vs. 1.3% (not significant)
– preterm birth at < 34 weeks gestation in 2.8% vs. 4.9% (not significant)
– preterm birth at < 37 weeks gestation in 8.3% vs. 16% (not significant)
– stillbirth in 0% vs. 0.7% (not significant)
– mechanical ventilation in 1.3% vs. 2.9% (not significant)
– need for extracorporeal membrane oxygenation in 0% vs. 0.6% (no p value reported)
– need for nasal oxygen support in 6.5% vs. 10.4% (not significant)
– need for continuous positive airway pressure or high-flow oxygen in 5.2% vs. 4.9% (not significant)
– preeclampsia in 6.5% vs. 3.6% (not significant)
⚬ comparing 77 persons infected during period of Omicron variant predominance to 154 persons
infected during period of Delta variant predominance in propensity score-matched analysis
– SARS-CoV-2 infection during Omicron variant predominance associated with decreased need for
nasal oxygen support (risk ratio 0.26, 95% CI 0.11-0.64)
– no significant differences in maternal mortality, preterm birth, or stillbirth
⚬ Reference - Ultrasound Obstet Gynecol 2022 Apr 20 early online
RESUMEN
● DEL ESTUDIO
Infección por la variante Omicron del SARS-CoV-2 asociada con una disminución de la mortalidad a
los 28 días y de los riesgos de ingreso y presentación en el hospital en comparación con la variante
Delta en Inglaterra entre noviembre de 2021 y enero de 2022
ESTUDIO DE COHORTE : Lancet 2022 16 de marzo temprano en línea

Detalles
⚬ based on population-based retrospective cohort study

⚬ 4,135,347 patients with laboratory-confirmed SARS-CoV-2 infection in England from the United
Kingdom Health Security Agency (UKHSA) database between November 29, 2021 and January 9, 2022
were assessed
⚬ 1,516,702 patients (83% White, 5% Black, 3% Indian, 2% Pakistani or Bangladeshi) with confirmed or
likely SARS-CoV-2 Omicron (70%) or Delta (30%) variants were included in analysis
⚬ comparing Omicron vs. Delta variant
– death within 28 days after positive test in 0.11% vs. 0.27% (adjusted hazard ratio [HR] 0.31, 95% CI
0.26-0.37) (consistent results for all age subgroups ≥ 30 years)
– hospital admission within 14 days after positive test in 0.9% vs. 1.6% (adjusted HR 0.41, 95% CI
– presentation to hospital within 14 days after positive test in 2.1% vs. 3% (adjusted HR 0.56, 95% CI
⚬ consistent results in subgroup of 380,712 patients without vaccination
⚬ no significant differences in hospital attendance or admission in patients ≤ 19 years old (HR for death
not estimated for age subgroups < 30 years due to small numbers)
⚬ for both variants, past infection associated with
– reduced mortality in both vaccinated (HR 0.47, 95% CI 0.32-0.68) and unvaccinated (HR 0.18, 95%
CI 0.06-0.57) patients
– reduced hospital admission in unvaccinated persons (HR 0.55, 95% CI 0.48-0·63), but no additional
protection in vaccinated persons (HR 0.96, 95% CI 0.88-1.04)
⚬ for Omicron variant, 8-11 weeks after booster with mRNA vaccine associated with reduced hospital
admission compared to no vaccination (HR 0.22, 95% CI 0.20-0·24), with protection not dependent on
vaccine type for doses 1 and 2
⚬ Reference - Lancet 2022 Mar 16 early online , editorial can be found in Lancet 2022 Mar 16 early
online
⚬ consistent findings for SARS-CoV-2 Omicron variant compared to Delta variant for outcomes of
intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality in 3,728 patients
≥ 16 years old presenting to emergency department in Paris, France (Ann Intern Med 2022 Mar 15
early online )
RESUMEN
● DEL ESTUDIO
infección con la variante Omicron del SARS-CoV-2 asociada con un menor riesgo de hospitalización
en Sudáfrica
ESTUDIO DE COHORTE : Lancet 2022 29 de enero; 399 (10323): 437 | Texto completo
Detalles

⚬ 104,529 COVID-19 cases diagnosed in South Africa between October 1, 2021 and December 6, 2021
were evaluated
⚬ South African case data, laboratory test data, SARS-CoV-2 genome data, and COVID-19 hospital
admissions data from 4 national databases were used for data linkage analysis
⚬ among 31,133 patients who had TaqPath polymerase chain reaction (PCR) test were included in
analysis
– 29,721 patients (95.5%) had S gene target failure variant (SGTF, proxy for Omicron variant)
infection
– 1,412 patients (4.5%) had non-SGTF infection
⚬ SGTF infection rate increased from 3.2% in week of October 1 to 98% in week of December 4, 2021
⚬ hospitalization assessed in 11,495 patients with outcome data (followed up to December 21, 2021)
⚬ severe COVID-19 defined as meeting ≥ 1 of following criteria: death, intensive care unit admission,
acute respiratory distress syndrome, need for oxygen treatment, ventilation, or extracorporeal
membrane oxygenation
⚬ comparing SGTF infection vs. non-SGTF infection
– hospital admission in 2.4% vs. 13% (adjusted odds ratio 0.2, 95% CI 0.1-0.3)
– severe COVID-19 in 21% vs. 40% (adjusted odds ratio 0.7, 95% CI 0.3-1.4) in analysis of 317
hospitalized patients
⚬ SGTF infection associated with decreased risk of severe COVID-19 (adjusted odds ratio 0.3, 95% CI
0.2-0.5) comparing 244 hospitalized patients infected with SGTF variant (between October 1, 2021
and November 30, 2021) to 793 patients infected with Delta (B.1.617.2) variant (between April 1 and
November 9, 2021)
⚬ Reference - Lancet 2022 Jan 29;399(10323):437 full-text , editorial can be found in Lancet 2022
Jan 29;399(10323):412 full-text
RESUMEN
● DEL ESTUDIO
entre adultos no vacunados, la hospitalización con COVID-19 confirmado por laboratorio durante el
predominio de la variante Omicron se asoció con una gravedad más baja de COVID-19 en
comparación con la hospitalización durante el predominio de la variante Delta y la variante Alfa
ESTUDIO DE COHORTE : BMJ 2022 9 de marzo; 376: e069761 | Texto completo

Detalles

⚬ 5,728 adults hospitalized with laboratory-confirmed COVID-19 between March 11, 2021, and January
14, 2022, in the United States were followed up to January 31, 2022
⚬ exclusion criteria included receipt of COVID-19 vaccine other than mRNA vaccines (Pfizer-BioNTech
or Moderna)
⚬ 5,413 patients (94.5%) with complete outcome data were included in analysis and classified based on
variant period
– 1,060 patients included in Alpha period (hospitalized between March 11 and July 3, 2021, when
57.5% of sequenced cases identified as Alpha variant)
– 3,788 patients included in Delta period (hospitalized between July 4 and December 25, 2021, when
96.7% of sequenced cases identified as Delta variant)
– 565 patients included in Omicron period (hospitalized between December 26, 2021, and January
14, 2022, when 76.6% of sequenced cases identified as Omicron variant)
⚬ unvaccinated status in 89% of patients in Alpha period, 72% of patients in Delta period, and 48% of
patients in Omicron period
⚬ comparing Alpha period vs. Delta period vs. Omicron period among unvaccinated adults (no p value
reported)
– 28-day mortality 8.1% vs. 11.8% vs. 9.2%
– death or invasive mechanical ventilation in 23.1% vs. 27.3% vs. 19.9%
⚬ among unvaccinated patients, hospitalization during Omicron period associated with
– nonsignificant reduction in COVID-19 severity on WHO clinical progression scale compared to

hospitalization during Alpha period (adjusted odds ratio 0.79, 95% CI 0.62-1.01)
– reduced COVID-19 severity compared to hospitalization during Delta period (adjusted odds ratio
0.61, 95% CI 0.49-0.77)
⚬ Reference - BMJ 2022 Mar 9;376:e069761 full-text
RESUMEN
● DEL ESTUDIO
infección con variantes del SARS-CoV-2 Delta y N501Y-positivas (alfa, beta y gamma), cada una
asociada con un mayor riesgo de muerte, ingreso en la UCI y hospitalización en comparación con la
variante no Delta/no N501Y
ESTUDIO DE COHORTE : CMAJ 2021 25 de octubre; 193 (42): E1619 | Texto completo
Detalles

⚬ 212,326 persons in Ontario, Canada, who tested positive for SARS-CoV-2 infection between February
7 and June 27, 2021, and who had viral isolate screened for variants of concern (VOCs) from Ontario
Case and Contact Management database were assessed
⚬ exclusion criteria included living in long-term care residence
⚬ viral isolates
– 162,920 had N501Y mutation-positive strain (B.1.1.7 [Alpha], B.1.351 [Beta], or P.1 [Gamma])
identified by whole genome sequencing
– 5,989 had probable B.1.617 (Delta variant) identified by whole genome sequencing at any time
point or screening negative for N501Y and any other mutation starting on May 1, 2021
– 43,417 did not have Alpha, Beta, Delta, or Gamma variant (non-VOC)
⚬ outcomes by viral isolate
– mortality
● 0.7% with probable Delta variant (adjusted odds ratio [OR] 2.33, 95% CI 1.54-3.31 vs. non-VOC)
● 0.9% with N501Y-positive variant (adjusted OR 1.51, 95% CI 1.3-1.78 vs. non-VOC)
● 0.9% with non-VOC variant
– ICU admission
● 1.5% with probable Delta variant (adjusted OR 3.35, 95% CI 2.6-4.31 vs. non-VOC)
– hospitalization
● 5.8% with probable Delta variant (adjusted OR 2.08, 95% CI 1.78-2.4 vs. non-VOC)
⚬ Reference - CMAJ 2021 Oct 25;193(42):E1619 full-text
RESUMEN
● DEL ESTUDIO
infección por SARS-CoV-2 B.1.1.7 (variante alfa) asociada con una mayor mortalidad a los 28 días en
comparación con las variantes anteriores

Detalles

⚬ 941,518 adults > 30 years old with single positive TaqPath test for SARS-CoV-2 identified at United
Kingdom community test centers between October 1, 2020 and January 28, 2021 were assessed
– 394,943 patients were S gene negative (infection with VOC-202012/1)
– 469,714 patients were S gene positive (infection with previous variants)
⚬ 54,906 patients (mean age 46 years) infected with variant VOC-202012/1 were matched to 54,906
patients (mean age 46 years) infected with previously circulating variants based on age, sex, ethnicity,
location, index of multiple deprivation, and date of specimen collection
⚬ all patients were followed for ≥ 14 days, 85% were followed for ≥ 28 days
⚬ 367 patients (0.3%, mean age 66 years) died within 28 days
⚬ 28-day mortality 0.4% with variant VOC-202012/1 vs. 0.3% with previously circulating variants
(adjusted hazard ratio 1.64, 95% CI 1.32-2.04)
⚬ Reference - BMJ 2021 Mar 9;372:n579 full-text
RESUMEN
● DEL ESTUDIO
infección por SARS-CoV-2 variante B.1.1.7 (variante alfa) asociada con una mayor hospitalización y
mortalidad a los 28 días en comparación con la infección por SARS-CoV-2 de tipo salvaje
ESTUDIO DE COHORTE : BMJ 2021 15 de junio; 373: n1412 | Texto completo
Detalles

⚬ 839,278 patients (mean age 37 years, 84% ≥ 20 years old) with single positive TaqPath test for SARS-
CoV-2 identified in community test centers in England from November 2020 through January 2021
were assessed for S-gene target failure (SGTF) variant status
– 592,409 patients had SGTF variant infection (variant B.1.1.7)
– 246,869 patients had non-SGTF variant infection (wild-type)
⚬ 98.7% of patients who were admitted to hospital were included in analysis

⚬ comparing variant B.1.1.7 infection vs. wild-type SARS-CoV-2 infection
– hospital admission within 1-14 days of positive test in 4.7% vs. 3.5% (adjusted hazard ratio [HR]
1.52, 95% CI 1.47-1.57)
– 28-day mortality 0.44% vs. 0.36% (adjusted HR 1.59, 95% CI 1.44-1.74)
⚬ in subgroup analyses by 10-year age groups, SGTF variant associated with increased risk of
hospitalization for all adults ≥ 20 years old, but not in children < 10 years old or patients aged 10-19
years
⚬ Reference - BMJ 2021 Jun 15;373:n1412 full-text
Disparidades raciales y étnicas en los resultados de COVID-19
● mayores tasas de hospitalización y muerte debido a COVID-19 reportadas en minorías raciales y étnicas
en comparación con personas blancas no hispanas, facilitado por una compleja interacción de
⚬ tasas más altas de condiciones preexistentes, incluidas las enfermedades cardiovasculares
⚬ condiciones socioeconómicas
⚬ acceso desigual a la atención médica
⚬ Barreras a la información que conducen a una pobre alfabetización en salud.
⚬ sesgo clínico
⚬ Referencia - Curr Opin Cardiol 2021 May 1;36(3):360
RESUMEN
● DEL ESTUDIO
disminución de la esperanza de vida y aumento de la brecha de la esperanza de vida por nivel de
ingresos en California, Estados Unidos, entre 2019 y 2021, con el mayor aumento de la brecha entre
los hispanos
ESTUDIO DE COHORTE : JAMA 2022 7 de julio temprano en línea

Detalles

⚬ 1,988,606 individuals who died in California, United States between 2015 and 2021 were assessed
⚬ 654,997 individuals (32.9%) died during COVID-19 pandemic years (2020-2021)
⚬ median household income ranged from $21,279 to $232,261 across percentiles; overall median
household income $75,235
⚬ comparing 2019 vs. 2020 vs. 2021
– state life expectancy 81.4 years vs. 79.2 years vs. 78.37 years (no p values reported)
– gap in life expectancy between highest and lowest income percentiles 11.52 years vs. 14.67 years
vs. 15.51 years (no p values reported)
– slope of life expectancy and median household income in years per percentile (life expectancy-
income gradient) 0.075 vs. 0.103 vs. 0.107 (p < 0.05 for 2020 and 2021 each compared to 2019)
⚬ decline in life expectancy from 2019 to 2021
– 5.74 years among Hispanic individuals

– 3.84 years among Black individuals
– 2.04 years among Asian individuals
– 1.9 years among White individuals
⚬ compared to 2019, increase in life expectancy-income gradient (years per percentile)
– in 2020 (p < 0.05 for each gradient vs. 2019)
● 0.038 among Hispanic individuals (p < 0.001 vs. White individuals)

● 0.024 among Asian individuals (not significant vs. White individuals)
● 0.015 among Black individuals (not significant vs. White individuals)
● 0.011 among White individuals
– in 2021 (p < 0.05 for each gradient vs. 2019)
● 0.033 among Hispanic individuals (p < 0.001 vs. White individuals)

● 0.024 among Asian individuals (not significant vs. White individuals)
● 0.024 among Black individuals (p = 0.04 vs. White individuals)
● 0.013 among White individuals
⚬ no significant difference in slope of life expectancy and median household income comparing 2019
to each year in 2015-2018
⚬ Reference - JAMA 2022 Jul 7 early online
RESUMEN
● DEL ESTUDIO
en adultos hospitalizados con COVID-19, una mayor vulnerabilidad social del vecindario asociada
con una mayor gravedad de la enfermedad al momento de la presentación y la necesidad de
ventilación mecánica, pero puede no estar asociada con la mortalidad
ESTUDIO TRANSVERSAL : Ann Intern Med 2022 22 de febrero temprano en línea | Texto completo
Detalles
⚬ based on cross-sectional study

⚬ 2,309 adults hospitalized with COVID-19 in Michigan, United States, were assessed
⚬ Social Vulnerability Index (SVI) used as composite measure of neighborhood socioeconomic status,
household composition and disability, racial or ethnic minority status and language, and housing
type and transportation (range 0-1, with higher score indicating greater social vulnerability)
⚬ patient demographics
– in highest SVI quartile, median age 63 years, 72% Black, 16% White, 7% Hispanic
– in bottom 3 SVI quartiles, median age 65 years, 31% Black, 55% White, 9% Hispanic
⚬ for each quartile increase in SVI
– increasing SVI associated with increased
● organ dysfunction at presentation (+2.8%, 95% CI +0.3% to +5.2%)

● organ failure at presentation (+2.8%, 95% CI +0.4% to +5.2%)
● need for mechanical ventilation (+2.1%, 95% CI +0.3% to +4%)
– no significant association between SVI and
● mortality (+0.1%, 95% CI -1.7% to +1.9%)

● intensive care stay (+1.6%, 95% CI -0.5 to +3.7%)
● discharge to home (+1.1%, 95% CI -1% to +3.2%)
⚬ Reference - Ann Intern Med 2022 Feb 22 early online full-text

RESUMEN
● DEL ESTUDIO
la carga de la esperanza de vida asociada con COVID-19 parece desproporcionadamente mayor en
adultos más jóvenes que en adultos ≥ 65 años y aproximadamente 2-3 veces mayor en poblaciones
negras e hispanas que en poblaciones blancas
ESTUDIO DE MODELADO : Ann Intern Med 21 de septiembre de 2021 temprano en línea | Texto
completo
Detalles
⚬ based on modeling study

⚬ microsimulation modeling was used to estimate years of life lost (YLL) and quality-adjusted life-years
(QALYs) lost due to excess COVID-19 pandemic deaths from March 2020 to March 2021 for adults ≥
25 years old in United States
– life expectancy projected using 2 models assuming 0 excess deaths from COVID-19 pandemic
– total excess deaths and COVID-19-related deaths from study period estimated using weekly data
from United States Centers for Disease Control and Prevention
– YLLs for each age, sex, and race/ethnicity subgroup with excess deaths computed by multiplying
number of excess deaths in each subgroup by projected life expectancy estimates; QALYs lost
calculated similarly and adjusted by incorporating quality-of-life index
⚬ 740,247 excess deaths (33.2 excess deaths per 10,000 persons) occurred during study period,
including 545,324 COVID-related excess deaths (24.4 excess deaths per 10,000 persons)
⚬ in analysis by age, excess mortality was 9.9 times higher in adults ≥ 65 years old compared to adults
aged 25-64 years (102.6 vs. 10.4 excess deaths per 10,100 persons), but QALYs lost were only 2.6
times higher (552 vs. 213 per 10,000) and YLLs were 2.9 times higher (800 vs. 278 per 10,100)
⚬ QALYs lost per 10,000 persons by race/ethnicity
– for ages 25-64 years
● 251 for Black women and 531 for Black men

● 231 for Hispanic women and 533 for Hispanic men
● 93 for White women and 179 for White men
– for ≥ 65 years old
● 751 for Black women and 1,138 for Black men

● 794 for Hispanic women and 1,371 for Hispanic men
● 382 for White women and 561 for White men
⚬ Reference - Ann Intern Med 2021 Sep 21 early online full-text
RESUMEN
● DEL ESTUDIO
Los pacientes del sur de Asia pueden tener un mayor riesgo de hospitalización y muerte relacionada
con la COVID-19, y los pacientes negros pueden tener un mayor riesgo de hospitalización
relacionada con la COVID-19, pero un riesgo similar de muerte en comparación con los pacientes
blancos en Inglaterra
ESTUDIO DE COHORTE : Lancet 2021 8 de mayo; 397 (10286): 1711 | Texto completo
Detalles

⚬ 2 cohorts of adults living in England during first 2 waves of COVID-19 infections were assessed
through OpenSAFELY platform
⚬ wave 1 cohort assessed between February 1 and August 3, 2020 when testing was selectively skewed
towards healthcare workers and persons with severe or symptomatic disease and not summarized
here
⚬ wave 2 cohort included 17,636,366 adults (mean age 49 years, 50% women) assessed between
September 1 and December 31, 2020
– race/ethnicity (self-reported) included White (64.2%), unknown (24.8%) , South Asian (6%), Black
(2%), mixed (1%), other (1.9%)
– 2,647,756 adults had SARS-CoV-2 test, 2.9% had positive test
⚬ compared to White patients
– South Asian patients had
● increased risk of
⚬ COVID-19-related hospitalization (adjusted hazard ratio [HR] 1.89, 95% CI 1.79-2)

⚬ being admitted to intensive care unit (ICU) for COVID-19 (adjusted HR 2.68, 95% CI 2.39-
3.01)
⚬ COVID-19-related death (adjusted HR 1.87, 95% CI 1·68-2.07)
⚬ testing positive for SARS-CoV-2 infection (adjusted HR 1.32, 95% CI 1.31-1.33)
● reduced likelihood of being tested for SARS-CoV-2 infection (adjusted HR 0.96, 95% CI 0.95-
0.96)
– Black patients had
● increased risk of COVID-19-related hospitalization (adjusted HR 1.23, 95% CI 1.11-1.37)

● increased risk of being admitted to ICU for COVID-19 (adjusted HR 1.67, 95% CI 1.37-2.05)
● reduced likelihood of being tested for SARS-CoV-2 infection (adjusted HR 0.83, 95% CI 0.82-
0.84)
● reduced risk of testing positive for SARS-CoV-2 infection (adjusted HR 0.85, 95% CI 0.84-0.87)
– no significant difference in risk of COVID-19-related death for Black patients (adjusted HR 0.92,
95% CI 0.73-1.16)
⚬ Reference - Lancet 2021 May 8;397(10286):1711 full-text
RESUMEN
● DEL ESTUDIO
La raza negra se asoció con un mayor riesgo de hospitalización por COVID-19 pero un riesgo similar
de muerte en el hospital en comparación con la raza blanca en Luisiana
ESTUDIO DE COHORTE : N Engl J Med 2020 Jun 25;382(26):2534 | Texto completo

Detalles

⚬ 522,679 patients received care in integrated health system in Louisiana, United States, within past 12
months (31% identified as Black non-Hispanic)
⚬ 3,626 adults (mean age 54 years) with laboratory-confirmed COVID-19 presenting to integrated
health system between March 1 and April 11, 2020, were assessed through May 7, 2020
⚬ 3,481 patients (mean age 54 years, 60% women) with complete data and who were not Hispanic or
Asian were included in analysis
– 70.4% were Black
– 29.6% were White
⚬ comparing Black vs. White race
– social and economic factors
● 15% vs. 5% had Medicaid

● 47.1% vs. 57.3% had commercial insurance
● 56.9% vs. 29% lived in low-income area
– test for COVID-19 performed in
● emergency department in 65.3% vs. 38%

● primary care in 13.7% vs. 21.6%
● urgent care in 8.8% vs. 19%
– comorbidities
● obesity in 53.9% vs. 39.5%

● hypertension in 33.8% vs. 23.9%
● diabetes in 18.5% vs. 10.9%
● chronic kidney disease in 9.4% vs. 4.6%
– hospitalization in 43.4% vs. 31% (adjusted odds ratio 1.96, 95% CI 1.62-2.37)
⚬ factors other than race associated with increased risk of hospitalization for COVID-19 included
increasing age, male sex, obesity, residence in low-income area, and insurance with either Medicare
or Medicaid
⚬ comparing Black vs. White race in analysis of 1,382 patients hospitalized for COVID-19
– in-hospital mortality 21.6% vs. 30.1% (adjusted hazard ratio 0.89, 95% CI 0.68-1.17)
– admission to ICU in 35.7% vs. 29.5% (no p value reported)
– ventilator use in 27.9% vs. 21% (no p value reported)
– acute renal failure in 15.3% vs. 10.7% (no p value reported)
– median length of hospital stay 6 days vs. 7 days (no p value reported)
⚬ factors associated with increased in-hospital mortality included increasing age, respiratory rate ≥ 24
breaths/minute, venous lactate > 2.2 mmol/L, creatinine > 1.5 mg/dL, procalcitonin > 0.25 ng/mL, and
lymphocyte count < 1,000/mcL
⚬ Reference - N Engl J Med 2020 Jun 25;382(26):2534 full-text
RESUMEN
● DEL ESTUDIO
La raza negra y vivir en un área de alta densidad de población se asoció con un mayor riesgo de
pruebas positivas para SARS-CoV-2 y hospitalización relacionada con COVID-19 entre pacientes a
los que se les hizo la prueba de SARS-CoV-2 en Michigan
ESTUDIO DE COHORTE : JAMA Netw Open 2020 Oct 1;3(10):e2025197 | Texto completo
Detalles

⚬ 5,698 patients (mean age 47 years, 62% female, 66% non-Hispanic White, 19% non-Hispanic Black)
with COVID-19 test results in University of Michigan Health System were analyzed
⚬ 1,139 patients (mean age 53 years, 53% female, 43% non-Hispanic White, 39% non-Hispanic Black)
tested positive for SARS-CoV-2
– 46% hospitalized
– 25% admitted to ICU
– 7.7% died
⚬ comparing non-Hispanic Black patients vs. non-Hispanic White patients
– positive SARS-CoV-2 test in 42% vs. 13% (p < 0.001)

– among patients testing positive for SARS-CoV-2
● hospital admission in 53% vs. 39% (p < 0.001)

● ICU admission in 30% vs. 20.5% (p < 0.001)
mortality 8.1% vs. 7.1% (not significant)
⚬ in multivariable
● analysis, Black race associated with
– increased risk of positive SARS-CoV-2 test (adjusted odds ratio [OR] 3.56, 95% CI 2.9-4.37)
– increased risk of hospital admission (adjusted OR 1.72, 95% CI 1.15-2.58)
– no significant difference in ICU admission or mortality
⚬ living in area with increased population density associated with increased risks of
– positive SARS-CoV-2 test (adjusted OR 1.07, 95% CI 1.03-1.11 per 1,000 persons/square mile) in
analysis of 4,417 patients tested for SARS-CoV-2
– COVID-19-related hospitalization (adjusted OR 1.1, 95% CI 1.01-1.19 per 1,000 persons/square
mile) in analysis of 756 patients testing positive for SARS-CoV-2
⚬ Reference - JAMA Netw Open 2020 Oct 1;3(10):e2025197 full-text
RESUMEN
● DEL ESTUDIO
La raza negra se asoció con un mayor riesgo de paro cardíaco intrahospitalario en comparación con
la raza blanca entre adultos ingresados en la UCI con COVID-19
ESTUDIO DE COHORTE : BMJ 2020 30 de septiembre; 371: m3513 | Texto completo

Detalles

⚬ 5,019 adults (mean age 63 years, 65% men) with laboratory-confirmed COVID-19 consecutively
admitted to ICU in the United States during March to June 2020 from STOP-COVID study were
assessed
⚬ 701 (14%) had in-hospital cardiac arrest defined as unexpected hemodynamic instability with
absence of palpable pulse for which cardiopulmonary resuscitation would normally be administered
(excluding patients whose death was expected due to progressive clinical deterioration)
⚬ Black race associated with in-hospital cardiac arrest (adjusted OR 1.58, 95% CI 1.23-2.02) compared
to non-Hispanic White ethnicity/race
⚬ Reference - BMJ 2020 Sep 30;371:m3513 full-text
RESUMEN
● DEL ESTUDIO
La raza negra se asoció con una mortalidad hospitalaria por todas las causas similar en comparación
con la raza blanca entre adultos hospitalizados con COVID-19 en los Estados Unidos entre febrero de
2020 y mayo de 2020
ESTUDIO DE COHORTE : JAMA Netw Open 2020 Aug 3;3(8):e2018039 | Texto completo
Detalles

⚬ 11,210 adults (median age 61 years, 50% male, 41% White, 37% Black) with confirmed COVID-19
presenting to Ascension hospitals (92 hospitals in 12 states) between February 19, 2020, and May 31,
2020, in the United States were followed until June 25, 2020
⚬ among 7,139 hospitalized patients (44% White, 39% Black), 40% admitted to ICU, 32% received
mechanical ventilation, and 20% died
⚬ comparing hospitalized Black patients vs. hospitalized White patients
– all-cause in-hospital mortality 19% vs. 23% (adjusted hazard ratio 0.93, 95% CI 0.8-1.09)
– ICU admission in 39% vs. 42% (no p value reported)
– invasive mechanical ventilation in 31% vs. 34% (no p value reported)
⚬ factors associated with increased all-cause in-hospital mortality included older age (vs. age 18-49
years), male sex, insurance with Medicare, chronic kidney disease, and coronary artery disease
⚬ Reference - JAMA Netw Open 2020 Aug 3;3(8):e2018039 full-text , editorial can be found in JAMA
Netw Open 2020 Aug 3;3(8):e2018696
RESUMEN
● DEL ESTUDIO
among adults hospitalized with COVID-19, Black adults may have higher in-hospital mortality
compared to White adults due to higher burden of comorbidities, and Hispanic adults may have
lower in-hospital mortality compared to non-Hispanic adults
COHORT STUDY: PLoS One 2021;16(7):e0254809 | Full Text

Details

⚬ 28,299 adults hospitalized with COVID-19 through August 2020 from Cerner’s COVID-19 database
were assessed
⚬ 19,584 patients (median age 52 years) with available discharge disposition included in analysis
– 51% White, 21.5% Black

– 29% Hispanic, 57.5% non-Hispanic
⚬ in-hospital mortality
– 21% overall
– 22.7% in Black patients
– 20.8% in White patients (p = 0.013 vs. Black patients)
– 12.7% in Hispanic patients
– 25% in non-Hispanic patients (p < 0.001 vs. Hispanic patients)
⚬ Black race associated with
– increased mortality in multivariable analysis adjusted for demographic factors (adjusted odds
ratio [OR] 1.13, 95% CI 1.01-1.27)
– no significant difference in mortality in multivariable analysis adjusted for demographic factors,
body mass index, and comorbidities (adjusted OR 1.07, 95% CI 0.93-1.23)
⚬ Hispanic ethnicity associated with decreased mortality in multivariable analysis adjusted for
– demographic factors (adjusted OR 0.74, 95% CI 0.65-0.83)

– demographic factors, body mass index, and comorbidities (adjusted OR 0.71, 95% CI 0.59-0.86)
⚬ Reference - PLoS One 2021;16(7):e0254809 full-text
STUDY
● SUMMARY
lower diet quality associated with increased risk of severe COVID-19 in adults in the United Kingdom
and the United States
COHORT STUDY: Gut 2021 Sep 6 early online

Details

⚬ 592,571 adults (median age 56 years, 68% female, 96% White) living in the United Kingdom (92%) or
the United States (8%) from smartphone-based COVID-19 Symptom Study and who were negative for
SARS-CoV-2 or symptoms of COVID-19 at baseline were followed from March 24 to December 2, 2020
⚬ diet information was collected for prepandemic period and grouped into quartiles using healthful
Plant-Based Diet Index score (range 14-70 points, with 14 points indicating lowest quality)
– highest-quality diet quartile had median score 56 points
– intermediate-quality quartiles had median score 51 points (combined intermediate quartiles)
– lowest-quality quartile had (median score 45 points)
⚬ severe COVID-19 defined as hospitalization with noninvasive or invasive respiratory support, or

antibiotics plus oxygen support
⚬ follow-up 3,886,274 person-months
⚬ percent wearing mask "most of time or always" among groups ranged from 71.6% to 76.4%
⚬ incidence rate of severe COVID-19 per 10,000 person-months (p for trend < 0.001)
– 1.6 for highest quartile (adjusted hazard ratio [HR] 0.59, 95% CI 0.47-0.74 vs. lowest quartile)
– 1.9 for intermediate quartiles (adjusted HR 0.77, 95% CI 0.66-0.91 vs. lowest quartile)
– 2.1 for lowest quartile
⚬ Reference - Gut 2021 Sep 6 early online
● systematic review of observational studies evaluating disparities by race/ethnicity in SARS-CoV-2

infection and COVID-19 hospitalizations and deaths in United States can be found in Ann Intern Med
2020 Dec 1 early online
● surveillance study reporting disparities by race and ethnicity in age-standardized excess all-cause (74%
COVID-19-related) and non-COVID-19-related deaths in the United States between March 2020 and
December 2020 compared to 2019 can be found in (Ann Intern Med 2021 Oct 5 early online full-text
), editorial can be found in Ann Intern Med 2021 Oct 5 early online
Risk Scores
For Predicting Mortality
STUDY
● SUMMARY
QCOVID3 risk score helps predict COVID-19-specific mortality and COVID-19-related hospital
admission in adults following 1-2 doses of Pfizer-BioNTech or AstraZeneca vaccine in England
DynaMed Level 1
PREDICTION RULE: BMJ 2021 Sep 17;374:n2244

Details
⚬ based on prognostic cohort study with independent derivation and validation cohorts
⚬ derivation cohort included 6,952,440 adults aged 19-100 years (mean age 52 years) from QResearch
database in England who received 1 or 2 doses of Pfizer-BioNTech BNT162b2 vaccine or AstraZeneca
ChAdOx1 nCoV-19 vaccine and were followed from 14 days after each dose until COVID-19-specific
death, hospital admission, or end of study
⚬ 74% received 2 doses, 58% had Oxford-AstraZeneca vaccine, and 42% had Pfizer-BioNTech vaccine
⚬ validation cohort included 626,656 similar adults (mean age 52 years, 75% received 2 doses)
⚬ COVID-19-specific mortality was 0.029% in derivation cohort and 0.028% in validation cohort
⚬ COVID-19-related hospital admission was 0.028% in derivation cohort and 0.029% in validation
cohort
⚬ QCOVID3 risk model derived using factors significantly associated with COVID-19-specific mortality
and hospital admission in derivation cohort
– age
– sex
– number of vaccine doses received
– ethnicity
– Townsend deprivation score (based on postal code, with higher score indicating higher level of
deprivation)
– body mass index
– comorbidities
– background SARS-CoV-2 infection rate at time of vaccination
⚬ in validation cohort, QCOVID3 risk model had
– strong discrimination for
● predicting COVID-19-specific mortality (c-statistic 0.925 overall, 0.904 for men, and 0.944 for
women)
● predicting COVID-19-related hospital admission (c-statistic 0.853 overall, 0.836 for men, and
0.868 for women)
– good-to-excellent calibration between predicted and observed risks of COVID-19-specific mortality

and hospital admission at 70 days
⚬ similar results in analysis restricted to first vaccine dose

⚬ online calculator reporting 90-day absolute risk of COVID-19-specific mortality and hospital
admission can be found at QCOVID3
⚬ Reference - BMJ 2021 Sep 17;374:n2244
STUDY
● SUMMARY
QCOVID risk score helps predict COVID-19-specific mortality and COVID-19-related hospital
admission in adults from general population DynaMed Level 1
REGLA DE PREDICCIÓN : BMJ 2020 Oct 20;371:m3731 | Texto completo

Detalles
⚬ derivation cohort included 6,083,102 adult primary care patients aged 19-100 years (mean age 48
years, 50.1% women) from QResearch database in England followed from January 24 to April 30,
2020
⚬ validation cohort included 2,173,056 similar adults followed from January 24 to April 30, 2020 (period
1) and from May 1 to June 30, 2020 (period 2)
⚬ COVID-19-specific mortality
– 0.07% in derivation cohort

– 1,722 patients died in period 1 of validation cohort
– 621 patients died in period 2 of validation cohort
⚬ COVID-19-related hospital admission

– in 3,703 patients in period 1 of validation cohort
– in 1,002 patients in period 2 of validation cohort
⚬ QCOVID risk model was developed using factors (age, body mass index, Townsend score, ethnicity,
and comorbidities) significantly associated with COVID-19-specific mortality and hospital admission
in derivation cohort
⚬ QCOVID had strong discrimination in validation cohort
– for predicting COVID-specific mortality (c-statistic 0.928 for men and 0.933 for women in period 1)
– for predicting COVID-specific hospital admission (c-statistic 0.86 for men and 0.847 for women in
period 1)
– similar findings in validation period 2
⚬ model had excellent calibration between predicted and observed risks of COVID-19-specific mortality
and hospital admission in both validation periods
⚬ online calculator reporting 90-day absolute risk of COVID-19-specific mortality and hospital
admission can be found at QCOVID
⚬ Reference - BMJ 2020 Oct 20;371:m3731 full-text
● la validación de la puntuación de riesgo QCOVID para la predicción de la mortalidad específica de

COVID-19 y el ingreso hospitalario relacionado con COVID-19 en un estudio de cohorte nacional en
Escocia durante marzo a junio de 2020 se puede encontrar en Thorax 2021 15 de noviembre temprano
en línea texto completo
RESUMEN
● DEL ESTUDIO
4C Mortality Score predice la mortalidad hospitalaria en adultos hospitalizados con COVID-19
Nivel DynaMed 1
REGLA DE PREDICCIÓN : BMJ 2020 Sep 9;370:m3339

Detalles
⚬ derivation cohort included 35,463 adults (mean age 73 years) hospitalized for ≥ 4 weeks with
laboratory-confirmed COVID-19 in United Kingdom from February to May 2020
⚬ validation cohort included 22,361 adults (mean age 76 years) hospitalized for ≥ 4 weeks with
laboratory-confirmed COVID-19 in United Kingdom from May to June 2020
⚬ in-hospital mortality was 32.2% in derivation cohort and 30.1% in validation cohort
⚬ comorbidities included chronic cardiac disease, chronic respiratory disease (excluding asthma),
chronic renal disease (estimated glomerular filtration rate ≤ 30 mL/minute), mild-to-severe liver
disease, dementia, chronic neurological conditions, connective tissue disease, diabetes mellitus, HIV
or AIDS, and malignancy plus obesity
⚬ 76% of adults in derivation cohort and 77% of adults in validation cohort had ≥ 1 comorbidity
⚬ 4C Mortality Score derived using 8 factors significantly associated with in-hospital mortality in
derivation cohort
– total score 0-21 points with higher scores indicating increased risk of in-hospital death
– increasing score with
● male sex at birth

● increasing age, number of comorbidities, respiratory rate, urea levels, and c-reactive protein
levels
● decreasing peripheral oxygen saturation on room air (SpO2) and Glasgow Coma Scale score
⚬ patients stratified to risk categories by risk score
– low-risk: 0-3 points

– intermediate-risk: 4-8 points
– high-risk: 9-14 points
– very high-risk: ≥ 15 points
⚬ in-hospital mortality by 4C Mortality Score risk category in validation cohort
– 1.2% of 1,650 adults with low risk

– 9.9% of 4,889 adults with intermediate risk
– 31.4% of 11,664 adults with high risk
– 61.5% of 4,158 adults with very high risk
⚬ in validation cohort, 4C Mortality Score had strong discrimination for predicting higher vs. lower risk
(c-statistic 0.77) and excellent calibration between predicted and observed risks
⚬ online calculator reporting both risk category and percent risk for in-hospital death can be found at
ISARIC 4C
⚬ Reference - BMJ 2020 Sep 9;370:m3339
RESUMEN
● DEL ESTUDIO
La puntuación COVID-19 SEIMC ayuda a estratificar el riesgo de muerte por todas las causas a los 30
días en pacientes hospitalizados con COVID-19 Nivel DynaMed 1
REGLA DE PREDICCIÓN : Tórax 2021 25 de febrero temprano en línea

Detalles
⚬ derivation cohort included 4,035 patients (median age 70 years, 61% male) admitted to hospital with
laboratory-confirmed COVID-19 in Spain from February 2, 2020 to March 17, 2020
⚬ validation cohort included 2,202 adults (median age 61 years, 52% women) admitted to hospital with
laboratory-confirmed COVID-19 in Spain from February 25, 2020 to April 19, 2020
⚬ 30-day all-cause mortality was 26.6% in derivation cohort and 15.5% in validation cohort
⚬ 3,358 patients (83%) in derivation cohort and 1,269 patients (57.6%) in validation cohort had
complete data and were included in analysis
⚬ COVID-19 SEIMC score derived using 6 factors significantly associated with all-cause mortality in
derivation cohort (total score 0-30 points with higher scores indicating increased risk of all-cause
death)
– age
● 0 points for < 40 years

● 1 point for 40-54 years
● 3 points for 55-64 years
● 21 points for ≥ 90 years
– neutrophil-to-lymphocyte ratio
● 0 points for < 3.22

● 1 point for 3.22-6.33
● 2 points for > 6.33
– estimated glomerular filtration rate by Chronic Kidney Disease Epidemiology Collaboration

equation
● 0 points for ≥ 60 mL/minute per 1.73 m2
● 2 points for 30-59 mL/minute per 1.73 m2
● 3 points for < 30 mL/minute per 1.73 m2
– dichotomous factors
● 1 point for male sex, otherwise 0

● 1 point for dyspnea, otherwise 0
● 2 points for low age-adjusted capillary oxygen saturation on room air (≤ 90% for patients > 50
years old and ≤ 93% for patients ≤ 50 years old), otherwise 0
⚬ outcomes
Table 6. 30-day All-cause Mortality in Derivation and Validation Cohort by COVID-
19 SEIMC Score
Risk Score Derivation Cohort Validation Cohort

Category
Number All-cause Number All-cause
of Mortality of Mortality
Patients Patients
Low 0-2 points 380 1.05% 192 0%
Moderate 3-5 points 699 5.3% 319 1.6%
High 6-8 points 672 14% 255 8.2%
Very high 9-30 1,607 44% 503 32%

points
Abbreviation: SEIMC, Spanish Society of Infectious Diseases and Clinical Microbiology.
⚬ COVID-19 SEIMC score had strong discrimination (c-statistic 0.845) for predicting higher vs. lower risk
and good calibration of predicted and observed risk in validation cohort
⚬ consistent results for discrimination in sensitivity analyses including all patients
⚬ Reference - Thorax 2021 Feb 25 early online
RESUMEN
● DEL ESTUDIO
La puntuación de riesgo ABC -SPH ayuda a predecir la mortalidad hospitalaria en adultos con
2
REGLA DE PREDICCIÓN : Int J Infect Dis 2021 Sep;110:281 | Texto completo

Detalles
⚬ based on prognostic cohort study with external validation

⚬ derivation cohort included 3,978 adults (median age 60 years, 54% male, 70% with ≥ 1 comorbidity)
admitted to hospital for laboratory-confirmed COVID-19 in March-July 2020 from Brazilian COVID-19
Registry study
⚬ validation cohorts included
– 1,054 similar patients (median age 62 years, 55% male, 71% with ≥ 1 comorbidity) admitted to
hospital in August-September 2020 from Brazilian COVID-19 Registry study (validation cohort 1)
– 856 similar patients (median age 62 years, 58.2% male) admitted to hospital in March-May 2020 in
Spain (validation cohort 2)
⚬ in-hospital mortality 20.3% in derivation cohort, 19.7% in validation cohort 1, and 20.1% in validation
cohort 2
⚬ ABC2-SPH risk score derived using 7 factors significantly associated with in-hospital mortality in
derivation cohort (range 0-20 points)
– age

– blood urea nitrogen
● 0 points for < 42 mg/dL

● 3 points for ≥ 42 mg/dL
– comorbidities
● 0 points for 0-1 comorbidity

● 1 point for ≥ 2 comorbidities
– C-reactive protein
● 0 points for < 100 mg/L

● 1 point for ≥ 100 mg/L
– SpO2 to fraction of inspired oxygen (FiO2) ratio
● 0 points for > 315%

● 1 point for > 235%-315%
● 3 points for > 150%-235%
● 6 points for ≤ 150%
– platelet count
● 0 points for > 150 × 109 cells/L

● 1 point for 100-150 × 109 cells/L
● 2 points for < 100 × 109 cells/L
– heart rate
● 0 points for ≤ 90 beats/minute

● 1 point for 91-130 beats/minute
● 2 points for ≥ 131 beats/minute
⚬ outcome
Table 7. In-hospital Mortality in Derivation Cohort and Validation Cohort 1 by

ABC2-SPH Risk Score
Score Derivation Cohort Validation Cohort 1
Number of In-hospital Number of In-hospital

Patients Mortality Patients Mortality
Low risk (0-1 1,133 2% 290 0.3%

point)
Score Derivation Cohort Validation Cohort 1
Intermediate 1,470 11.4% 394 11.9%

risk (2-4
points)
High risk (5-8 907 32% 252 29%

points)
Very high 468 69.4% 118 73.7%

risk (≥ 9
points)
⚬ ABC2-SPH risk score had strong discrimination in validation cohort 1 (c-statistic 0.86) and validation
cohort 2 (c-statistic 0.89)
⚬ online calculator can be found at ABC2-SPH Mortality Score
⚬ Reference - Int J Infect Dis 2021 Sep;110:281 full-text
RESUMEN
● DEL ESTUDIO
La puntuación SOARS ayuda a estratificar el riesgo de muerte hospitalaria en adultos con COVID-19
Nivel DynaMed 1
REGLA DE PREDICCIÓN : tórax 2021 10 de marzo temprano en línea | Texto completo

Detalles
⚬ derivation cohort included 983 adults (median age 70 years, 52.5% men) hospitalized with
laboratory-confirmed COVID-19 in West Hertfordshire, England were assessed
⚬ validation cohort included 14,231 adults (median age 73 years, 56% men) hospitalized with
laboratory-confirmed COVID-19 in the United Kingdom
⚬ in-hospital mortality was 29.9% in derivation cohort
⚬ SOARS score developed using factors significantly associated with in-hospital mortality in derivation
cohort (total score 0-8 points)
– SpO2 (oxygen saturation)
● 0 points for SpO2 > 92% on ambient air

● 1 point for SpO2 ≤ 92% on ambient air
– obesity (body mass index > 30 kg/m2)
● 0 points for absent

● 1 point if present
– age

– respiratory rate
● 0 points for ≤ 24/minute

● 1 point for > 24/minute
– stroke or cerebrovascular accident
● 0 points for absent

● 1 point if present
⚬ in-hospital mortality by categorized SOARS score in validation cohort
– 5.4% of 2,362 adults with low risk (0-1 points)

– 14.5% of 1,879 adults with moderate risk (2 points)
– 39.2% of 9,990 adults with high risk (≥ 3 points)
⚬ performance of SOARS for prediction of in-hospital mortality
– at score ≥ 1 point
– at score ≥ 3 points
⚬ in validation cohort, SOARS score had strong discrimination for predicting mortality (c-statistic 0.74)
⚬ Reference - Thorax 2021 Mar 10 early online full-text
RESUMEN
● DEL ESTUDIO
La puntuación COR+12 podría ayudar a predecir el riesgo de muerte hospitalaria en adultos
hospitalizados con COVID-19 Nivel DynaMed 2
REGLA DE PREDICCIÓN : J Allergy Clin Immunol 2020 Oct;146(4):799

Detalles
⚬ based on prognostic cohort study without independent validation

⚬ 611 adults (mean age 52 years, 63% men) hospitalized with laboratory-confirmed (71%) or clinically
suspected COVID-19 and who had measurement of interleukin-6 in Spain from March 10 to April 12,
2020, were assessed
⚬ 501 patients (median age 52 years, 63% men, 54% White race/ethnicity) who died or had been
discharged by April 20, 2020, were included in derivation cohort
– comorbidities included hypertension (27.7%), dyslipidemia (25%), diabetes mellitus (11.2%), and
chronic pneumopathy (including pulmonary fibrosis, chronic obstructive pulmonary disease
[COPD], bronchiectasis, and asthma) (10.8%)
– acute respiratory distress syndrome on test day classified as none in 56.1%, mild in 22.6%,
moderate in 7.2%, and severe in 13.4%
– treatment for COVID-19 included hydroxychloroquine (88.2%), azithromycin (77.2%),
lopinavir/ritonavir (36.7%), corticosteroid (24.6%), and interferon-beta (6.4%)
⚬ median time from hospital admission to biomarker assessment was 2 days

⚬ 7.2% died
⚬ COR+12 Score developed using factors significantly associated with mortality and included as
continuous variables
– SpO2:FiO2 ratio
– neutrophil to lymphocyte ratio
– lactate dehydrogenase units/L
– interleukin-6 pg/mL
– age (association with mortality not assessed but included in prediction rule)
⚬ 58 patients missing ≥ 1 factor were excluded from analysis of performance

⚬ performance of COR+12 score with cutoff 0.07 for prediction of death in 443 patients
– sensitivity 88%
– specificity 89%
⚬ Reference - J Allergy Clin Immunol 2020 Oct;146(4):799 full text
RESUMEN
● DEL ESTUDIO
El índice de gravedad de la neumonía (PSI) y CURB-65 ayudan a predecir la mortalidad hospitalaria
en adultos ingresados en el hospital con neumonía por COVID-19 Nivel DynaMed 1
ESTUDIO DE COHORTE : J Gen Intern Med 2021 11 de febrero temprano en línea

Detalles
⚬ based on prognostic cohort study

⚬ 10,238 adults (mean age 66 years, 58% men) admitted to hospital with COVID-19 pneumonia
between March and May 2020 in Spain were assessed with PSI, CURB-65, MuLBSTA, and quick
Sequential Organ Failure Assessment (qSOFA )
⚬ 8.9% were admitted to intensive care unit (ICU)
⚬ mean length of hospital stay 11 days
⚬ in-hospital mortality 20.9%
⚬ MuLBSTA is risk score developed from 6 clinical factors significantly associated with increased 90-day
mortality in patients with viral pneumonia; these factors included multilobar infiltrates, lymphocyte
count ≤ 0.8 x 109 cells/mL, bacterial infection, smoking status, hypertension, and age ≥ 60 years
⚬ for predicting in-hospital mortality
– PSI with cutoff ≥ 91 points had
● sensitivity 84.1% (95% CI 82.5%-85.8%)

● specificity 72.3% (95% CI 71.2%-73.3%)
– CURB-65 with cutoff ≥ 3 points had
● sensitivity 82.1% (95% CI 80.5%-83.8%)

● specificity 70.6% (95% CI 69.6%-71.6%)
– MuLBSTA with cutoff ≥ 12 points had
● sensitivity 27.5% (95% CI 25.6%-29.5%)

● specificity 91.2% (95% CI 90.6%-91.9%)
● positive predictive value 45.3% (95% CI 42.6%-48%)
– qSOFA with cutoff ≥ 2 points had
● sensitivity 26.6% (95% CI 24.7%-28.5%)

● specificity 95.7% (95% CI 95.3%-96.2%)
⚬ Reference - J Gen Intern Med 2021 Feb 11 early online
RESUMEN
● DEL ESTUDIO
La puntuación rápida de medicina de emergencia (REMS) puede ayudar a predecir el riesgo de
muerte hospitalaria en adultos en estado crítico con COVID-19 en el departamento de emergencias
Nivel DynaMed 2
REGLA DE PREDICCIÓN : Acad Emerg Med 2020 Jun;27(6):461 | Texto completo

Detalles
⚬ based on retrospective cohort study with possible selection bias and high rate of missing data
⚬ 138 critically ill adults (mean age 60 years) presenting to emergency department with COVID-19 from
February 7 to March 7, 2020, at 1 center in China were assessed using REMS and Modified Early
Warning score (MEWS) for prediction of mortality
⚬ REMS based on 6 factors (range 0-30 points, with higher score indicating greater risk of death)
– age

● 6 points for > 74 years
– Glasgow Coma Scale (GCS) score
● 1 point for score 11-13

● 2 points for score 8-10
– pulse
● 2 points for 55-69 beats/minute (bpm)

● 3 points for 40-54 bpm
● 4 points for ≤ 39 bpm
– respiratory rate
● 1 point for 10-11 breaths/minute or 25-34 breaths/minute (0 points for 12-24 breaths/minute)
● 2 points for 6-9 breaths/minute
● 3 points for 35-49 breaths/minute
● 4 points for ≤ 5 breaths/minute
– mean arterial pressure
● 2 points for 50-69 mm Hg (0 points for 70-109 mm Hg)

● 3 points for 130-159 mm Hg
● 4 points for ≤ 49 mm Hg
– peripheral oxygen saturation (SpO2)
● 1 point for 86%-89%

● 3 points for 75%-85%
● 4 points for < 75%
⚬ 105 patients (76%) who had complete data were included in analysis (GCS or oxygen saturation were
missing for excluded patients)
⚬ in-hospital death in 18%
⚬ optimum cutoff for prediction of in-hospital death with REMS was score ≥ 6 points
⚬ performance of REMS with cutoff ≥ 6 points for prediction of in-hospital death
– negative predictive value 96.8%
⚬ MEWS includes assessment of heart rate, systolic blood pressure, respiratory rate, body
temperature, and consciousness
⚬ MEWS with cutoff 2 points had sensitivity 68% and specificity 65% for predicting in-hospital death
⚬ Reference - Acad Emerg Med 2020 Jun;27(6):461 full-text
⚬ derivation of REMS score can be found in J Intern Med 2004 May;255(5):579 full-text
⚬ consistent results for REMS score in additional retrospective cohort study with 334 patients aged 58-
74 years (Resuscitation 2020 Sep 9;156:84 full-text )
RESUMEN
● DEL ESTUDIO
el nomograma podría ayudar a predecir la supervivencia hospitalaria de 14 y 21 días en adultos
hospitalizados con COVID-19 en China Nivel DynaMed 2
ESTUDIO DE COHORTE : Clin Infect Dis 2020 10 de julio temprano en línea | Texto completo
Detalles
⚬ based on prognostic cohort study without independent validation and without data to guide clinical
use
⚬ 628 adults (median age 61 years, 52% women) hospitalized with laboratory-confirmed COVID-19
from January 2020 to March 2020 in China and who were discharged or died were randomized to
derivation and validation cohorts
– 390 patients were included in derivation cohort and 238 patients were included in internal
validation cohort
– 26.6% had hypertension, 14.2% had diabetes, 14.2% coronary heart disease, and 6.4% had
chronic kidney disease
⚬ nomogram developed using 3 factors significantly associated with in-hospital mortality in derivation
cohort
– hypertension as comorbidity
– neutrophil-to-lymphocyte ratio
– N terminal pro-B-type natriuretic peptide (NT-proBNP) level
⚬ in validation cohort, nomogram had
– strong discrimination for predicting 14-day (c-statistic 0.922) and 21-day survival (c-statistic 0.881)
– good calibration based on visual inspection of plots of observed vs. predicted survival
⚬ nomogram for predicting 14-day and 21-day in-hospital survival can be found in figure 1 of full-text
⚬ Reference - Clin Infect Dis 2020 Jul 10 early online full-text

RESUMEN
● DEL ESTUDIO
La puntuación SOFA dentro de las 48 horas posteriores al ingreso en el hospital puede ayudar a
estratificar el riesgo de muerte hospitalaria en adultos hospitalizados con COVID-19 Nivel DynaMed 2
ESTUDIO DE COHORTE : Ann Am Thorac Soc 2021 Nov 16 temprano en línea

Detalles
⚬ based on prognostic cohort study with limited data to guide clinical usein patients with scores ≥ 6
points
⚬ 20,045 adults (median age 61 years) admitted to hospital from July 1, 2020 to April 1, 2021 in Florida,
United States were assessed by maximum SOFA score within 48 hours of hospitalization (range 0-24
points, with higher scores indicating worse prognosis)
⚬ race or ethnicity included Hispanic White (49%), non-Hispanic White (22%), non-Hispanic Black (19%),
and Hispanic Black (2.6%)
⚬ renal component of SOFA was based only on creatinine level (patients with active order for dialysis
were given maximal renal score), and partial pressure of arterial oxygen was estimated from oxygen
saturation by pulse oximetry when arterial blood gas was not available
⚬ 9.5% had positive test for SARS-CoV-2
⚬ in-hospital mortality by maximum SOFA score within 48 hours of hospitalization in 1,894 adults
(median age 62 years) with positive test for SARS-CoV-2
– 6.3% of 1,702 patients with score < 6 points
– 50.7% of 146 patients with score 6-8 points
– 65.6% of 32 patients with score 9-11 points
– 78.6% of 14 patients with score ≥ 12 points
⚬ maximum 48-hour SOFA score had strong discrimination for predicting in-hospital mortality in adults
with COVID-19 (c-statistic 0.835)
– c-statistic 0.948 for Hispanic Black adults
– c-statistic 0.894 for non-Hispanic White adults
– c-statistic 0.824 for Hispanic White adults
– c-statistic 0.8 for non-Hispanic Black adults
⚬ Reference - Ann Am Thorac Soc 2021 Nov 16 early online
● la evaluación de 22 modelos para predecir el deterioro clínico o la mortalidad en 411 pacientes con
COVID-19 se puede encontrar en Eur Respir J 2020 25 de septiembre temprano en línea texto completo
Para predecir la progresión clínica
RESUMEN
● DEL ESTUDIO
La puntuación OUTCoV puede ayudar a predecir el riesgo de progresión a la hospitalización dentro de
las 4 semanas posteriores a la prueba positiva para la infección por SARS-CoV-2 Nivel DynaMed 2
REGLA DE PREDICCIÓN : BMJ Open 2021 Jun 18;11(6):e044242 | Texto completo

Detalles

⚬ 1,459 adolescents and adults ≥ 16 years old (mean age 41 years, 58% women) with positive test for
SARS-CoV-2 infection in ambulatory testing centers in Switzerland between March 2, 2020 and April
23, 2020 were followed for ≤ 4 weeks
– 53% had positive test within 3 days of symptom onset
– 27% had positive test 4-7 days after symptom onset
– 14% had positive test > 7 days after symptom onset
– 1.4% were asymptomatic at positive test
⚬ hospitalization for COVID-19 in 5.5%

⚬ OUTCoV score derived using 5 factors significantly associated with hospitalization for COVID-19 in
derivation cohort (total score 0-7.5 points)
– age
● 2.5 points for ≥ 65 years old

● 2 points for ages 55-64 years
● 1.5 points for ages 45-54 years
● 1 point for ages 35-44 years
● 0 points for < 35 years old
– 1.5 points for fever

– 1.5 points for hypertension
– 1 point for dyspnea
– 1 point for chronic respiratory disease
⚬ scores were categorized as low (0-2.5 points), intermediate (3-5 points), and high (5.5-7.5 points)
– 68% of patients had low risk, with hospitalization in 1.8%

– 1.4% had high risk, with hospitalization in 30%
⚬ for prediction of hospitalization for COVID-19
– OUTCoV score with ≥ 5.5 points had
● specificity 99%
– OUTCoV score with ≥ 3 points had
● specificity 71%
⚬ in internal validation using bootstrapping, OUTCoV score had good discrimination for predicting
hospitalization for COVID-19 (c-statistic 0.77)
⚬ Reference - BMJ Open 2021 Jun 18;11(6):e044242 full-text
RESUMEN
● DEL ESTUDIO
La puntuación del Predictor de riesgo adaptativo de COVID-19 grave (SCARP) puede ayudar a
predecir el riesgo de progresión a enfermedad grave o muerte dentro de los 7 días en adultos
hospitalizados con COVID-19 moderado Nivel DynaMed 2
REGLA DE PREDICCIÓN : Ann Intern Med 2021 Mar 2 temprano en línea

Detalles

⚬ 3,163 adults (mean age 61 years, 51% men) hospitalized for > 6 hours with moderate COVID-19
between March 5, 2020 and December 4, 2020 and at risk for progression to severe disease or death
were evaluated
all patients had laboratory-confirmed (any nucleic acid test) SARS-CoV-2 infection
⚬⚬ progression to severe disease or death defined as score ≥ 6 points assessed using World Health
Organization (WHO) COVID-19 ten-point severity scale (0 points = no viral RNA detected and
ambulatory mild disease, 10 points = death)
⚬ SCARP score developed using 105 factors (based on comorbidities, demographics, laboratory values,
and vital signs) associated with progression to severe disease or death
⚬ calculation of predicted risk for individual patient is adaptive and requires input of ≤ 8 variables using
online calculator found at John Hopkins School of Public Health (accessed 2021 Mar 18)
⚬ 228 (7%) had progression to severe disease or died between 6 hours and 1 day after hospitalization
⚬ in internal validation using cross validation, SCARP score had strong discrimination for prediction of
progression to severe disease or death within 1 day
– c-statistic 0.89 during first week of hospitalization
– c-statistic 0.89 during second week of hospitalization
⚬ 355 (11%) had progression to severe disease or died between 1 day and 7 days after hospitalization
⚬ in internal validation using cross validation, SCARP score had strong discrimination for prediction of
progression to severe disease or death within 7 days
– c-statistic 0.83 during first week of hospitalization
– c-statistic 0.87 during second week of hospitalization
⚬ in internal validation, model had good calibration between predicted and observed risks of
progression to severe disease or death within 7 days and excellent calibration between predicted
and observed risks of progression to severe disease or death within 1 day
⚬ Reference - Ann Intern Med 2021 Mar 2 early online full text
RESUMEN
● DEL ESTUDIO
El nomograma que usa 7 factores ayuda a predecir la progresión a una enfermedad grave en adultos
con COVID-19 no grave Nivel DynaMed 1
ESTUDIO DE COHORTE DE DIAGNÓSTICO : Clin Infect Dis 2020 16 de abril temprano en línea | Texto
completo
Detalles
⚬ 372 adults admitted to hospital with nonsevere laboratory-confirmed COVID-19 in China were
followed for > 15 days
– derivation cohort included 189 adults (median age 49 years)
– validation cohort 1 included 165 adults (median age 52 years)
– validation cohort 2 included 18 adults (median age 41 years)
⚬ progression to severe or critical COVID-19 defined as development of ≥ 1 of 3 criteria
– shortness of breath with respiratory rate ≥ 30 per minute

– resting arterial oxygen saturation ≤ 93%
– partial pressure of oxygen (PaO2) to FiO2 ratio ≤ 300 mm Hg
⚬ rates of progression to severe COVID-19

– 24.2% in validation cohort 1
– 22.2% in validation cohort 2
⚬ prediction nomogram developed using 7 baseline factors significantly associated with progression to
severe disease in derivation cohort (range 0-350)
– age
– serum lactate dehydrogenase
– C-reactive protein
– coefficient of variation of red blood cell distribution width
– blood urea nitrogen
– direct bilirubin
– albumin
⚬ performance of nomogram at cutoff > 188.6 points for prediction of severe COVID-19
– in derivation cohort
– in validation cohort 1
– in validation cohort 2
● sensitivity 75%
● specificity 100%
⚬ nomogram for prediction of progression to severe COVID-19 can be found in full-text

⚬ Reference - Clin Infect Dis 2020 Apr 16 early online full-text
RESUMEN
● DEL ESTUDIO
La puntuación de riesgo CALL puede ayudar a predecir el riesgo de progresión a enfermedad grave en
adultos hospitalizados con COVID-19 Nivel DynaMed 2
REGLA DE PREDICCIÓN : Clin Infect Dis 2020 9 de abril temprano en línea

Detalles

⚬ 208 adults (mean age 44 years) hospitalized with COVID-19 in China from January 2020 to February
2020 were followed until March 2020
– diagnosis of COVID-19 based on World Health Organization interim guidance for diagnosis and
National Health Commission of China guidance for coronavirus disease 2019
– 21.6% had ≥ 1 comorbidity, including hypertension, diabetes, cardiovascular disease, liver disease,
asthma, chronic lung disease, HIV infection, and malignancy for ≥ 6 months
– patients presenting with severe COVID-19 were excluded
⚬ progression to severe COVID-19 defined as either of
– ≥ 1 of the following: respiratory rate ≥ 30 breaths/minute, resting oxygen saturation ≤ 93%,

PaO2/FiO2 ≤ 300 mm Hg, or mechanical ventilation
– worsening of lung computed tomography findings
⚬ progression to severe disease in 19.2%

⚬ CALL score developed using 4 factors (Comorbidity, Age, Lymphocyte count, and Lactate
dehydrogenase) significantly associated with progression to severe disease (range 4-13 points)
– presence of comorbidity
● no comorbidity = 1 point
● ≥ 1 comorbidity = 4 points
– age
● ≤ 60 years old = 1 point

● ≥ 60 years old = 3 points
– lymphocyte count
● > 1 × 109 cells/L = 1 point

● ≤ 1 × 109 cells /L (lymphopenia) = 3 points
– lactate dehydrogenase
● ≤ 250 units/L = 1 point

● 250-500 units/L = 2 points
● > 500 units/L = 3 points
⚬ for prediction of progression to severe disease, CALL score with cutoff > 6 points had
– sensitivity 95%
– specificity 78%
– positive predictive values 50.7%
– negative predictive values 98.5%
⚬ additional nomogram for prediction of progression risk can be found in full text
⚬ Reference - Clin Infect Dis 2020 Apr 9 early online
RESUMEN
● DEL ESTUDIO
La puntuación de riesgo ELEGIDA puede ayudar a predecir la idoneidad para el alta en función del
riesgo de hipoxia, ingreso en cuidados intensivos y muerte dentro de los 14 días en adultos con
REGLA DE PREDICCIÓN : J Gen Intern Med 2020 3 de diciembre temprano en línea | Texto completo
Detalles
⚬ based on retrospective cohort study with possible selection bias

⚬ derivation cohort included 1,014 adults (mean age 58 years) with positive reverse-transcription
polymerase chain reaction (RT-PCR) test for SARS-CoV-2 who were hospitalized or presented to
emergency department at 1 hospital in United States who were followed for 14 days from positive
test or presentation, and validation cohort included 312 adults (57% > 64 years old) from same
hospital
– comorbidities including hypertension, diabetes, chronic kidney disease, and asthma in 65% of
derivation cohort and 66% of validation cohort
– patients with < 14 days of follow-up (36% of patients presenting during study period) were
excluded
⚬ in derivation cohort, 77% were admitted to hospital, 72% required oxygen, 38% were admitted to
intensive care unit (ICU), and 5% died (rates not reported for validation cohort)
⚬ 25% in derivation cohort and 20.8% in validation were judged suitable for discharge
⚬ CHOSEN risk score developed to predict suitability for discharge using 3 factors significantly
associated with composite of hypoxia (need for supplemental oxygen), admission to ICU, and death
in derivation cohort (total score 0-55 points)
– age
● 0 points for > 73 years old

– oxygen saturation
● 0 points for < 94%

● 9 points for 94%-96%
● 14 points for 97%-98%
● 21 points for > 98%
– albumin
● 0 points for < 2.8 g/dL

● 5 points for 2.8-3.3 g/dL
● 15 points for 3.4-3.7 g/dL
● 29 points for > 3.7 g/dL
⚬ performance of CHOSEN risk score with cutoff ≥ 30 points for prediction of suitability for discharge in
derivation cohort
– negative predictive value 93.6%
⚬ in validation cohort, CHOSEN risk score had strong discrimination for predicting higher vs. lower
suitability for discharge within 14 days (c-statistic 0.89) with acceptable calibration of predicted risk
⚬ Reference - J Gen Intern Med 2020 Dec 3 early online full-text
RESUMEN
● DEL ESTUDIO
La calculadora de riesgo de COVID-GRAM puede ayudar a predecir el riesgo de desarrollar una
enfermedad crítica en pacientes hospitalizados con COVID-19 Nivel DynaMed 2
REGLA DE PREDICCIÓN : JAMA Intern Med 2020 mayo temprano en línea | Texto completo
Detalles
⚬ based on prognostic cohort study without data to guide clinical use

⚬ derivation cohort included 1,590 patients (mean age 48 years, 57.3% men) hospitalized with
laboratory-confirmed COVID-19 in China reported through January 2020
– 1.5% had severe illness and 98.5% had mild illness according to American Thoracic Society
guidelines at admission
– 25.1% had ≥ 1 comorbidity, including COPD, hypertension, diabetes mellitus, cardiovascular
disease, chronic kidney disease, cancer, cerebrovascular disease, hepatitis B, and
immunodeficiency
⚬ 8.2% in derivation cohort had critical illness composite outcome, including admission to intensive
care unit, invasive ventilation, or death (3.2% overall mortality)
⚬ COVID-GRAM risk calculator developed using factors significantly associated with critical illness
outcome in derivation cohort
– abnormal chest x-ray
– age
– hemoptysis
– dyspnea
– unconsciousness
– number of comorbidities (COPD, hypertension, diabetes, coronary heart disease, chronic kidney
disease, cancer, cerebrovascular disease, hepatitis B, and immunodeficiency)
– cancer history
– neutrophil-lymphocyte ratio
– lactate dehydrogenase
– direct bilirubin
⚬ validation cohort included 710 similar patients (mean age 48 years, 53.8% men, 24.2% with ≥ 1
comorbidity) hospitalized for confirmed COVID-19 in centers other than those used for derivation
cohort, reported through January or February 2020
⚬ 12.3% in validation cohort developed critical illness composite outcome (1.1% died)
⚬ COVID-GRAM had strong discrimination for predicting development of critical illness
– c-statistic 0.88 (95% CI 0.85-0.91) in derivation cohort

– c-statistic 0.88 (95% CI 0.84-0.93) in validation cohort
⚬ COVID-GRAM risk calculator available online

⚬ Reference - JAMA Intern Med 2020 May early online full-text
RESUMEN
● DEL ESTUDIO
La puntuación nacional de alerta temprana (NEWS) y NEWS2 pueden ayudar a predecir el ingreso en
cuidados intensivos en adultos que se presentan en el departamento de emergencias (ED) por
REGLA DE PREDICCIÓN : Reanimación 2020 9 de septiembre;156:84 | Texto completo

Detalles
⚬ based on retrospective cohort study with possible selection bias

⚬ 334 adults (median age 66 years, 64.4% men) admitted to ED with confirmed COVID-19 in March and
April 2020 at 1 center in Italy were assessed with multiple prediction scores using data collected on
admission
⚬ 176 patients with COVID-19 presenting during study period were excluded for missing data
⚬ intensive care admission rates
– 14.9% admitted within 48 hours

– 17% admitted within 7 days
⚬ performance for prediction of intensive care admission within 7 days
– NEWS with cutoff > 4 points
– NEWS2 with cutoff > 4 points
⚬ consistent results for both scores for predicting intensive care admission within 48 hours
⚬ Reference - Resuscitation 2020 Sep 9;156:84 full-text
⚬ see DynaMed calculator for NEWS2
RESUMEN
● DEL ESTUDIO
La puntuación de gravedad de la radiografía de tórax puede tener una utilidad limitada para predecir
el ingreso hospitalario y la intubación en adultos ≤ 50 años con COVID-19 Nivel DynaMed 2
REGLA DE PREDICCIÓN : Radiología 2020 Oct;297(1):E197

Detalles
⚬ based on retrospective cohort study with wide confidence intervals and without independent
validation
⚬ 338 adults aged 21-50 years with laboratory-confirmed COVID-19 presenting to emergency
department were assessed with chest x-ray imaging
⚬ chest x-ray severity score
– 1 point given for presence of opacity in each of 3 zones for each lung range 0-6 points
– lower zone from costophrenic sulcus to inferior hilar markings, middle zone from inferior hilar
markings to superior hilar markings, and upper zone from superior hilar markings to apices
⚬ 145 patients (43%) were admitted to hospital and 19% of admitted patients were intubated
⚬ prognostic performance of chest x-ray severity score
– for prediction of admission with cutoff ≥ 2 points
● sensitivity 66% (95% CI 58%-74%)

● specificity 79% (95% CI 73%-85%)
– for prediction of intubation in admitted patients with cutoff ≥ 3 points
● sensitivity 68% (95% CI 48%-84%)

● specificity 67% (95% CI 57%-75%)
⚬ Reference - Radiology 2020 Oct;297(1):E197
Control de infección
● las medidas de control de infecciones continúan evolucionando y los requisitos pueden diferir
regionalmente
● La guía general de la comunidad para el control de infecciones incluye
⚬ usar una máscara en lugares públicos cerrados con alta transmisión comunitaria (se prefiere N95 o
equivalente)
⚬ evitando el contacto cercano (dentro de 6 pies)
⚬ evitando aglomeraciones y espacios mal ventilados
⚬ pruebas para evitar la propagación
⚬ lavarse las manos a menudo
⚬ cubrirse la tos y los estornudos
⚬ limpiar y desinfectar diariamente las superficies que se tocan con frecuencia
⚬ monitoreando la salud
● se recomienda la cuarentena para las personas con contacto cercano que no estén al día con las
vacunas o que no se hayan recuperado de COVID-19 dentro de los 90 días
● se recomienda el aislamiento para personas con COVID-19 confirmado o probable,

independientemente del estado de vacunación
● consulte Control y prevención de infecciones por COVID-19 para obtener más información.
Prevención y Detección
● La vacunación es la forma más efectiva de prevenir el COVID-19
⚬ 38 vacunas están aprobadas, autorizadas, licenciadas, otorgadas para uso de emergencia o puestas
a disposición para su uso fuera del marco de un ensayo clínico en todo el mundo y 10 vacunas están
incluidas en la lista para uso de emergencia de la Organización Mundial de la Salud (OMS)
⚬ Los tipos de vacunas COVID-19 incluyen vacunas de ARN mensajero (ARNm), vacunas de vector de
adenovirus, vacunas a base de proteínas, vacunas de virus completo inactivado, vacunas de ADN y
vacunas de partículas similares a virus
● Se han probado combinaciones de anticuerpos monoclonales para la profilaxis.
⚬ tixagevimab más cilgavimab (Evusheld) se recomienda como profilaxis previa a la exposición en

pacientes de ≥ 12 años y un peso de ≥ 40 kg que no tienen infección por SARS-CoV-2 y que no han
estado expuestos recientemente ADEMÁS
– no puede ser vacunado debido a un historial documentado de reacción adversa grave a la vacuna
COVID-19 o sus componentes
– inmunodepresión de moderada a grave con posible respuesta inadecuada a la vacunación
⚬ casirivimab más imdevimab (REGEN-COV) y bamlanivimab más etesevimab fueron autorizados

previamente para la profilaxis posterior a la exposición a COVID-19, sin embargo, ninguna
combinación de anticuerpos monoclonales conserva la actividad contra la variante de Omicron y
tampoco se recomienda actualmente donde Omicron es la variante dominante de SARS-CoV-2 (
incluyendo los Estados Unidos)
● las pruebas de detección identifican a las personas con COVID-19 que son asintomáticas y no tienen
exposición conocida o sospechada al SARS-CoV-2
⚬ la detección puede incluir pruebas de estudiantes, maestros y personal en las escuelas, empleados
en un lugar de trabajo, personas antes o después del viaje y para la vigilancia pública
⚬ Las pruebas de amplificación de ácidos nucleicos (NAAT) y las pruebas rápidas de antígenos se usan
comúnmente
● consulte Control y prevención de infecciones por COVID-19 para obtener más información.
Directrices y recursos
Pautas
Pautas internacionales
● La orientación técnica de la Organización Mundial de la Salud (OMS) para la enfermedad por

coronavirus (COVID-19) se puede encontrar en Orientación técnica y por países de la OMS -
Enfermedad por coronavirus (COVID-19)
● Directrices vivas de la OMS sobre
⚬ Terapéutica y COVID-19 se pueden encontrar en la OMS 2022 16 de septiembre

⚬ el manejo clínico de COVID-19 se puede encontrar en la OMS 2021 Nov 23
⚬ Los medicamentos para prevenir el COVID-19 se pueden encontrar en OMS 2021 Mar 2 o en BMJ
2021 Mar 1;372:n526
● La orientación actualizada del Grupo de Trabajo Internacional de la Sociedad Torácica

Estadounidense/Sociedad Respiratoria Europea (ATS/ERS) sobre el manejo de COVID-19 se puede
encontrar en Eur Respir Rev 2020 Oct 5;29(157):200287 texto completo
● Confederación Mundial de Fisioterapia/Confederación Internacional de Fisioterapeutas

Cardiorrespiratorios/Asociación Australiana de Fisioterapia/Asociación Canadiense de
Fisioterapia/Associazione Riabilitatori dell'Insufficienza Respiratoria/Asociación de Fisioterapeutas
Colegiados en Atención Respiratoria (WCPT/ICCrPt/APTA/CPA/ArIR/ACPRC) recomendaciones
actualizadas para guiar la práctica clínica sobre el manejo de fisioterapia para COVID-19 en el entorno
hospitalario agudo se puede encontrar en J Physiother 2022 Jan;68(1):8 texto completo
● La declaración de consenso multinacional de la Fleischner Society sobre el papel de las imágenes de

tórax en el manejo de pacientes durante la pandemia de COVID-19 se puede encontrar en Chest 2020
Jul;158(1):106 texto completo
● La guía de práctica clínica de la Asociación para el Avance de la Sangre y las Bioterapias (AABB) sobre
plasma convaleciente de COVID-19 se puede encontrar en Ann Intern Med 2022 Sep;175(9):1310
texto completo , el editorial se puede encontrar en Ann Intern Med 2022 Sep ;175(9):1332
● Comité Internacional de Enlace sobre Reanimación (ILCOR)
⚬ La guía de ILCOR sobre el riesgo de infección por COVID-19 para los rescatistas de pacientes con
paro cardíaco se puede encontrar en ILCOR 2021 Mar 12
⚬ La guía práctica de ILCOR COVID-19 para la implementación se puede encontrar en ILCOR 2022 Jun
14
● La Sociedad Internacional de Ultrasonido en Obstetricia y Ginecología (ISUOG) actualizó la guía

provisional sobre la nueva infección por coronavirus de 2019 durante el embarazo y el puerperio: se
puede encontrar información para profesionales de la salud en Ultrasound Obstet Gynecol 2020
Jun;55(6):848 texto completo , comentario puede ser encontrado en Ultrasonido Obstet Gynecol
2020 Dec;56(6):965
● Las directrices y recomendaciones de la Sociedad Internacional de Endoscopia Ginecológica (ISGE)

sobre endoscopia ginecológica durante las fases evolutivas de la pandemia de SARS-CoV-2 se pueden
encontrar en Eur J Obstet Gynecol Reprod Biol 2020 Oct;253:133 texto completo
● Recomendaciones pragmáticas del Grupo de trabajo COVID-LMIC para
⚬ identification and triage of patients with COVID-19 in low- and middle-income countries can be
found in Am J Trop Med Hyg 2021 Jan 6;104(3_Suppl):3 full-text
⚬ therapeutics of hospitalized patients with COVID-2019 in low- and middle-income countries can be
found in Am J Trop Med Hyg 2020 Dec 29;104(3_Suppl):48 full-text
⚬ management of anticoagulation and venous thrombotic disease for hospitalized patients with
COVID-2019 in low- and middle-income countries can be found in Am J Trop Med Hyg 2021 Jan
11;104(3_Suppl):99 full-text
⚬ management of patients with COVID-19 with shock in low- and middle-income countries can be
found in Am J Trop Med Hyg 2020 Dec 21;104(3_Suppl):72 full-text
⚬ prevention and treatment of acute kidney injury in patients with COVID-19 in low- and middle-
income countries can be found in Am J Trop Med Hyg 2021 Jan 11;104(3_Suppl):87 full-text
⚬ use of diagnostic testing and prognostic models in hospitalized patients with COVID-2019 in low- and
middle-income countries can be found in Am J Trop Med Hyg 2021 Jan 22;104(3_Suppl):34 full-text
⚬ safety while caring for hospitalized patients with COVID-2019 in low- and middle-income countries
can be found in Am J Trop Med Hyg 2020 Dec 22;104(3 Suppl):12 full-text
⚬ Las prácticas de prevención y control de infecciones para centros de atención médica en países de
ingresos bajos y medianos durante la pandemia de COVID-19 se pueden encontrar en Am J Trop
Med Hyg 2021 Jan 6;104(3 Supl):25 texto completo
⚬ el manejo de la insuficiencia respiratoria aguda y la ventilación mecánica en pacientes con COVID-
2019 en países de ingresos bajos y medianos se puede encontrar en Am J Trop Med Hyg 2021 Jan
13;104(3_Suppl):60 texto completo
⚬ traqueotomía, alta y rehabilitación en pacientes hospitalizados que se recuperan de COVID-2019 en
países de ingresos bajos y medianos se pueden encontrar en Am J Trop Med Hyg 2021 Jan
13;104(3_Suppl):110 texto completo
● El mapa vivo internacional de eCOVID-19 de recomendaciones financiado por el Instituto Canadiense de

Investigación en Salud (CIHR) se puede encontrar en Mapa de recomendaciones de CIHR COVID-19
● Las declaraciones de consenso de expertos para el SARS-CoV-2 sobre el control de infecciones en la

unidad de cuidados intensivos se pueden encontrar en Lancet Infect Dis 2022 Mar;22(3):e74 texto
completo
Directrices de los Estados Unidos

Directrices de los Centros para el Control y la Prevención de Enfermedades (CDC)
● Puede encontrar orientación general sobre COVID-19 en CDC COVID-19 o en chino , coreano ,
español , vietnamita
● Evaluación y manejo
⚬ Puede encontrar orientación en la descripción general de las pruebas para SARS-CoV-2 (COVID-19)
en CDC 2022 Sep 28
⚬ Puede encontrar orientación sobre el rastreo de contactos para COVID-19 en CDC 2022 10 de
febrero
⚬ las consideraciones clínicas para el cuidado de niños y adultos con enfermedad por coronavirus
confirmada (COVID-19) se pueden encontrar en CDC 2022 Oct 19
⚬ la guía provisional sobre las pruebas de anticuerpos COVID-19 en entornos clínicos y de salud
pública se puede encontrar en CDC 2022 24 de enero
⚬ La guía provisional para la prueba de antígeno para SARS-CoV-2 para proveedores de atención
médica que realizan pruebas a personas en la comunidad se puede encontrar en CDC 2022 4 de
abril
⚬ la información para proveedores de atención médica pediátrica se puede encontrar en CDC 2022
Oct 19
⚬ Las pautas provisionales para la recolección y el manejo de muestras clínicas para la prueba de
COVID-19 se pueden encontrar en CDC 2022 Jul 15
⚬ Las pautas provisionales de bioseguridad de laboratorio para el manejo y procesamiento de
muestras asociadas con la enfermedad por coronavirus 2019 (COVID-19) se pueden encontrar en
CDC 2021 Dec 13
⚬ Puede encontrar orientación provisional sobre el manejo de la enfermedad por coronavirus 2019
(COVID-19) en centros correccionales y de detención en CDC 2022 3 de mayo o en español
⚬ se puede encontrar orientación sobre salud mental, uso de sustancias e ideación suicida durante la
pandemia de COVID-19 en MMWR Morb Mortal Wkly Rep 2020 Aug 14;69(32):1049 full text ,
comentario se puede encontrar en MCN Am J Matern Child Enfermería 2021 julio;46(4):237
● prevención y control de infecciones

⚬ Las recomendaciones provisionales de prevención y control de infecciones para el personal de
atención médica durante la pandemia de la enfermedad por coronavirus 2019 (COVID-19) se pueden
encontrar en CDC 2022 23 de septiembre
⚬ Puede encontrar orientación sobre cómo mantenerse al día con las vacunas COVID-19, incluidos los
refuerzos, en CDC 2022 Nov 1 o en español
⚬ Puede encontrar orientación sobre aislamiento y precauciones para personas con Covid-19 en CDC
2022 Aug 11 o en español
⚬ Puede encontrar orientación sobre cómo protegerse a sí mismo y a los demás en CDC 2022 Oct 19
o en español
⚬ las consideraciones para los entornos de atención médica obstétrica para pacientes hospitalizados
se pueden encontrar en CDC 2021 Nov 19
⚬ orientación sobre viajes nacionales durante COVID-19: la información para personas que viajan
dentro de los Estados Unidos y los territorios de los Estados Unidos se puede encontrar en CDC
2022 24 de agosto o en español
● Evaluación de riesgos
⚬ Puede encontrar orientación provisional sobre el manejo del personal de atención médica con
infección por SARS-CoV-2 o exposición al SARS-CoV-2 en CDC 2022 23 de septiembre
⚬ La guía de salud pública para la posible exposición al COVID-19 asociada con los viajes se puede
encontrar en CDC 2022 Sep 8 o en español
● guía para centros de salud
⚬ Puede encontrar orientación sobre la gestión de las operaciones de atención médica durante el
COVID-19 en CDC 2021 8 de febrero
⚬ Puede encontrar orientación sobre estrategias para mitigar la escasez de personal de atención
médica en CDC 2022 Sep 23
● orientación provisional para los departamentos de salud
⚬ Puede encontrar orientación sobre la implementación de estrategias de prevención de COVID-19 en

el contexto de niveles variables de transmisión comunitaria y cobertura de vacunación en MMWR
Morb Mortal Wkly Rep 2021 Jul 27;70(30):1044 texto completo
⚬ Puede encontrar orientación para proveedores de servicios directos en CDC 2021 Sep 13 o en
español
⚬ la información para los departamentos de salud sobre la notificación de casos de COVID-19 se
puede encontrar en CDC 2022 25 de mayo
⚬ Puede encontrar orientación provisional sobre personas sin hogar sin protección en CDC 2022 10 de
febrero o en español
⚬ Los escenarios de planificación para la pandemia de COVID-19 se pueden encontrar en CDC 2021
Mar 19
● orientación para las escuelas y la educación
⚬ Puede encontrar orientación sobre escuelas y programas de cuidado infantil en CDC 2022 Oct 25
o en español
⚬ La orientación operativa para las escuelas K-12 y los programas de cuidado y educación temprana
para apoyar el aprendizaje seguro en persona se puede encontrar en CDC 2022 Oct 5 o en
español
● La recomendación del Comité Asesor sobre Prácticas de Inmunización de los CDC (CDC ACIP, por sus
siglas en inglés) sobre el uso de la vacuna Moderna contra el COVID-19 en adultos de ≥18 años y las
consideraciones sobre intervalos prolongados para la administración de dosis primarias de la serie de
vacunas contra el COVID-19 de ARNm se pueden encontrar en MMWR Morb Mortal Wkly Rep 2022 18
de marzo; 71 (11): 416 texto completo
Otras pautas de los Estados Unidos
● La guía de la Academia Estadounidense de Alergia, Asma e Inmunología (AAAAI) sobre procedimientos

pulmonares durante la pandemia de COVID-19 se puede encontrar en J Allergy Clin Immunol Pract 2022
Jun;10(6):1474 texto completo
● La guía de tratamiento de COVID-19 de los Institutos Nacionales de Salud (NIH) se puede encontrar en
NIH 2022 Nov 10
● Directrices de la Sociedad de Enfermedades Infecciosas de América (IDSA) sobre
⚬ el tratamiento y manejo de pacientes con COVID-19 se puede encontrar en IDSA 2022 Nov 21
⚬ La prevención de infecciones para el personal de atención médica que atiende a pacientes con
COVID-19 presunto o conocido se puede encontrar en IDSA 2021 Nov 4
⚬ diagnóstico de COVID-19: las pruebas de diagnóstico molecular se pueden encontrar en IDSA 2020
23 de diciembre
⚬ diagnóstico de COVID-19: las pruebas de antígeno se pueden encontrar en IDSA 2021 27 de mayo
⚬ diagnóstico de COVID-19: las pruebas serológicas se pueden encontrar en IDSA 2020 18 de agosto
● La guía de la Campaña de Sepsis Sobreviviente de la Sociedad de Medicina de Cuidados Críticos (SCCM)

sobre el manejo de adultos con enfermedad por coronavirus 2019 (COVID-19) en la unidad de cuidados
intensivos se puede encontrar en Crit Care Med 2021 Mar 1;49(3):e219 , comentario puede se
encontrará en Crit Care Med 2022 1 de enero; 50 (1): e95
● Las recomendaciones de SCCM sobre el manejo inicial de pacientes hipóxicos con COVID-19 se pueden
encontrar en SCCM 2021 PDF
● Los puntos de práctica del American College of Physicians (ACP) sobre el uso de remdesivir para el
tratamiento de pacientes con COVID-19 (versión 2) se pueden encontrar en Ann Intern Med 2021
Dec;174(12):W116 texto completo
● La guía del American College of Rheumatology (ACR) sobre la vacunación contra el COVID-19 en
pacientes con enfermedades reumáticas y musculoesqueléticas versión 5 se puede encontrar en ACR
2022 Aug 12 PDF
● El informe del panel de expertos del American College of Chest Physicians/American Association for
Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program
Directors (ACCP/AABIP/AIPPD) sobre el uso de la traqueotomía durante la pandemia de COVID-19 se
puede encontrar en Chest 2020 Oct;158( 4): 1499 texto completo , el comentario se puede
encontrar en Chest 2021 Jan; 159 (1): 455
● La guía de la Surgical Infection Society (SIS) sobre la atención quirúrgica y perioperatoria de pacientes
adultos infectados por el síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2) se puede
encontrar en Surg Infect (Larchmt) de mayo de 2020;21(4) :301
● La política de aplicación de la FDA para ventiladores y accesorios y otros dispositivos respiratorios

durante la emergencia de salud pública del coronavirus 2019 (COVID-19) se puede encontrar en FDA
2020 Mar PDF
● La guía de la Administración de Seguridad y Salud Ocupacional (OSHA) sobre cómo mitigar y prevenir la
propagación de COVID-19 en el lugar de trabajo se puede encontrar en OSHA 2021 Aug 13 o en
español
● El asesoramiento práctico del Colegio Estadounidense de Obstetras y Ginecólogos (ACOG) sobre las
consideraciones de vacunación contra el COVID-19 para la atención obstétrica y ginecológica se puede
encontrar en ACOG 2022 16 de noviembre
● La guía provisional del Departamento de Salud y Servicios Humanos de los Estados Unidos (DHHS)
sobre COVID-19 y las personas con VIH se puede encontrar en HIVinfo 2022 22 de febrero
● Asociación Estadounidense del Corazón/Academia Estadounidense de Pediatría/Asociación

Estadounidense de Atención Respiratoria/Colegio Estadounidense de Médicos de Emergencia/Sociedad
de Anestesiólogos de Cuidados Críticos/Sociedad Estadounidense de Anestesiólogos
(AHA/AAP/AARC/ACEP/SOCCA/ASA) orientación provisional sobre El soporte vital en adultos, niños y
recién nacidos con sospecha o confirmación de COVID-19 se puede encontrar en Circ Cardiovasc Qual
Outcomes 2022 Apr;15(4):e008900
● Las recomendaciones de la Sociedad Estadounidense de Anestesiólogos (ASA) para realizar

procedimientos en pacientes con COVID-19 conocido o sospechoso se pueden encontrar en ASA 20 de
marzo de 2020
● Las recomendaciones de medicamentos de cuidados intensivos de ASA para COVID-19 durante tiempos
de escasez de medicamentos se pueden encontrar en ASA 2020 Jun 25
● La guía de la Academia Estadounidense de Medicina del Dolor (AAPM) sobre las mejores prácticas para
el manejo del dolor de organizaciones multiespecializadas durante la pandemia de COVID-19 y las crisis
de salud pública se puede encontrar en Pain Med 2020 Nov 7;21(7):1331 texto completo ,
editorial puede ser encontrado en Pain Med 2020 Nov 7;21(7):1324
● Guía de los Centros de Servicios de Medicare y Medicaid (CMS) sobre
⚬ visitas a hogares de ancianos - COVID-19 se puede encontrar en CMS 2022 23 de septiembre PDF
⚬ control y prevención de infecciones relacionadas con la enfermedad por coronavirus (COVID-19): las
preguntas frecuentes y las consideraciones para el triaje, la colocación y el alta hospitalaria de los
pacientes se pueden encontrar en CMS 2021 Mar 10 PDF
● Las actualizaciones de coronavirus de la Academia Estadounidense de Oftalmología (AAO) para

oftalmólogos se pueden encontrar en AAO 2021 May 14
● La guía de la American Neurotology Society/American Otological Society/American Academy of

Otolaryngology - Head and Neck Foundation (ANS/AOS/AAO-HNF) para mejorar la atención otológica y
neurotológica durante la pandemia de COVID-19 se puede encontrar en Otol Neurotol 2020 Oct;41(
9):1163 , el editorial se puede encontrar en Otol Neurotol 2020 Oct;41(9):1159
● La guía del American College of Chest Physicians/American Association for Bronchology and
Interventional Pulmonology (ACCP/AABIP) y el informe del panel de expertos sobre el uso de la
broncoscopia durante la pandemia de COVID-19 se pueden encontrar en Chest 2020 Sep;158(3):1268
texto completo
● La declaración de posición de la American Geriatrics Society (AGS) sobre estrategias de asignación de

recursos y consideraciones relacionadas con la edad en la era COVID-19 y más allá se puede encontrar
en J Am Geriatr Soc 2020 Jun;68(6):1136 texto completo
● Revisión rápida y guía de la American Gastrointestinal Association (AGA) para la prueba de SARS-CoV2 y
la endoscopia posterior a la vacunación: la actualización de 2021 se puede encontrar en
Gastroenterology 2021 Sep;161(3):1011 texto completo
Directrices del Reino Unido
Directrices del Instituto Nacional para la Excelencia en Salud y Atención (NICE)
● Directrices rápidas COVID-19 del Instituto Nacional para la Excelencia en Salud y Atención (NICE) sobre
⚬ la entrega de tratamientos anticancerosos sistémicos se puede encontrar en NICE 2020 Mar: NG161,
última actualización 2022 Aug
⚬ El trasplante de células madre hematopoyéticas se puede encontrar en NICE 2020 Abr: NG164,
última actualización 2022 Jul
⚬ la gestión de COVID-19 se puede encontrar en NICE 2021 Mar: NG191, última actualización 2022 Jul
⚬ la gestión de los efectos a largo plazo de COVID-19 se puede encontrar en NICE 2020 Dic:NG188,
última actualización 2021 Nov
⚬ La trombocitopenia y la trombosis inducidas por vacunas (VITT) se pueden encontrar en NICE 2021
Jul:NG200, última actualización 2022 Jun
⚬ la vitamina D se puede encontrar en NICE 2020 Dic:NG187, última actualización 2022 Jul
Otras pautas del Reino Unido
● La información de Public Health England (PHE) sobre COVID-19 se puede encontrar en PHE COVID-19
2022 May 27
● La guía sobre el manejo de los efectos a largo plazo de COVID-19 se puede encontrar en SIGN 2021
Nov.
● Royal College of Obstetricians and Gynecologists/Royal College of Midwives/Royal College of Paediatrics

and Child Health/Public Health England/Health Protection Scotland (RCOG/RCM/RCPCH/PHE/HPS)
orientación para profesionales de la salud sobre el coronavirus (COVID-19), el embarazo y la salud de la
mujer se pueden encontrar en RCOG 2022
● Directrices de la Asociación de Anestesistas de Gran Bretaña e Irlanda (AAGBI) sobre
⚬ la planificación de desastres durante un brote de COVID-19 se puede encontrar en AAGBI 2020 Apr 2
⚬ el manejo anestésico de pacientes durante un brote de COVID-19 se puede encontrar en AAGBI 2020
Apr 2
● La guía de la Scottish Intercollegiate Guidelines Network (SIGN) sobre la evaluación de COVID-19 en la

atención primaria se puede encontrar en SIGN 2022 Mar 28 PDF
● La guía del Royal College of Physicians (RCP) sobre el manejo de pacientes traqueostomizados con
trastornos prolongados de la conciencia durante COVID-19 se puede encontrar en RCP 2020 Apr 22
● Guía de la Asociación Británica de Tiroides/Sociedad de Endocrinología (BTA/SfE)
⚬ La declaración sobre problemas específicos de la disfunción tiroidea durante la pandemia de COVID-

19 se puede encontrar en BTA 2020 Mar 25 PDF
⚬ advice regarding resource-limited treatment of thyrotoxicosis during the COVID-19 pandemic can be
found at BTA 2020 Mar 25 PDF
⚬ advice for patients with thyroid cancer during the COVID-19 pandemic can be found at BTA 2020 Mar
23 PDF
Canadian Guidelines
● Goverment of Canada
⚬ information on coronavirus infection can be found at canada.ca COVID-19: Outbreak update or in

French
⚬ interim guidance for acute healthcare settings on infection prevention and control for coronavirus
disease (COVID-19) can be found at canada.ca 2022 Jan 25 or in French
⚬ interim guidance on continuity of immunization programs during the COVID-19 pandemic can be
found at canada.ca 2020 May 13 or in French
⚬ interim guidance for long-term care homes on infection prevention and control for coronavirus
disease (COVID-19) can be found at canada.ca 2022 Jan 25 or in French
⚬ interim guidance on infection prevention and control for COVID-19 in home care settings can be
found at canada.ca 2022 Jan 25 or in French
⚬ interim guidance on infection prevention and control for COVID-19 for outpatient and ambulatory
settings can be found at canada.ca 2022 Jan 25 or in French
● National Advisory Committee on Immunization (NACI) summary of the COVID-19 vaccine chapter in the
Canadian Immunization Guide can be found at NACI 2022 Nov 3 or in French
● Ontario Ministry of Health guidance
⚬ para el sector de la salud sobre COVID-19 se puede encontrar en Health.gov.on.ca 2022 Oct 20 o
en francés
⚬ para la atención aguda de COVID-19 se puede encontrar en Health.gov.on.ca 2022 Jun 11 PDF
● Ontario COVID-19 Drugs and Biologics Clinical Practice Guidelines Working Group La guía de práctica
clínica sobre medicamentos y productos biológicos recomendados en pacientes adultos con COVID-19
se puede encontrar en covid-19-sciencetable.ca 2022 Apr 1 PDF
● La declaración de posición de la Canadian Thoracic Society (CTS) sobre ayudar a los proveedores de
atención médica canadienses a optimizar el manejo de la respiración con trastornos del sueño para sus
pacientes durante la pandemia de COVID-19 se puede encontrar en CTS 2020 Jul 12 PDF
● Guía del Centro para el Control de Enfermedades de la Columbia Británica (BCCDC) sobre
⚬ la gestión de salud pública de COVID-19 se puede encontrar en BCCDC 2022

⚬ Las pruebas de atención primaria y el cuidado de pacientes con sospecha o confirmación de COVID-
19 se pueden encontrar en BCCDC 2022 Mar 7
● La información de Alberta Health Services (AHS) para el personal y los profesionales de la salud de AHS
se puede encontrar en AHS 2022 Nov 8
● La orientación y los recursos del Gobierno de New Brunswick (GNB) sobre COVID-19 se pueden
encontrar en GNB 2022 Jan o en francés
● La declaración de consenso de la Sociedad Canadiense de Radiología Torácica/Asociación Canadiense

de Radiólogos (CSTR/CAR) con respecto a las imágenes de tórax en pacientes con sospecha y
confirmación de COVID-19 se puede encontrar en Can Assoc Radiol J 2020 Nov;71(4):470 , la
corrección se puede encontrar en Can Assoc Radiol J 2020 Nov;71(4):NP1
● La guía de la Asociación Canadiense de Radiología Intervencionista/Asociación Canadiense de

Radiólogos (CAIR/CAR) sobre procedimientos de radiología intervencionista para pacientes con
sospecha o confirmación de COVID-19 se puede encontrar en Can Assoc Radiol J 2020 Nov;71(4):514
● La declaración de consenso de expertos de Canadian Internal Medicine Ultrasound (CIMUS) sobre el

uso de ultrasonido pulmonar para la evaluación de pacientes hospitalizados con enfermedad por
coronavirus conocida o sospechada 2019 se puede encontrar en J Ultrasound Med 2021 Sep;40(9):1879
texto completo
Directrices europeas
Directrices del Centro Europeo para la Prevención y el Control de Enfermedades (ECDC)
● La información del Centro Europeo para la Prevención y el Control de Enfermedades (ECDC) sobre
COVID-19 se puede encontrar en ECDC COVID-19
⚬ La declaración del Centro Europeo para la Prevención y el Control de Enfermedades/Agencia
Europea de Medicamentos (ECDC/EMA) sobre la vacunación de refuerzo con vacunas bivalentes
COVID-19 adaptadas de Omicron se puede encontrar en ECDC 2022 Sep 6 PDF
⚬ la guía para las consideraciones preliminares de salud pública para las estrategias de vacunación
contra el COVID-19 en la segunda mitad de 2022 se puede encontrar en ECDC 2022 Jul 18
⚬ Puede encontrar orientación sobre consideraciones operativas para la vigilancia de virus
respiratorios en Europa en ECDC 2022 Jul 18
⚬ la guía para el monitoreo antigénico del SARS-CoV-2 se puede encontrar en ECDC 2022 Jun 7
⚬ Protocolo de seguridad de la salud de la aviación COVID-19: las pautas operativas para la gestión de
pasajeros aéreos y personal de aviación en relación con la pandemia de COVID-19 se pueden
encontrar en ECDC 2022 May 11
⚬ Puede encontrar orientación para la prevención y el control de COVID-19 en centros de acogida
temporales en el contexto de un gran número de personas que huyen de Ucrania en ECDC 2022 Mar
18
⚬ Las consideraciones para el uso de pruebas de anticuerpos para SARS-CoV-2 se pueden encontrar
en ECDC 2022 Feb 10
⚬ Las consideraciones para el uso de máscaras faciales en la comunidad en el contexto de la variante
preocupante Omicron del SARS-CoV-2 se pueden encontrar en ECDC 2022 Feb 7
⚬ Puede encontrar orientación sobre la cuarentena de los contactos cercanos a los casos de COVID-19
y el aislamiento de los casos de COVID-19 en la situación epidemiológica actual en ECDC 2022 Jan 7
⚬ Puede encontrar orientación sobre métodos para la detección e identificación de variantes del SARS-
CoV-2 en ECDC 2022 Aug 2
⚬ Las recomendaciones de la Agencia Europea de Medicamentos (EMA) y el ECDC sobre los cursos de
vacunación heterólogos contra COVID-19 se pueden encontrar en ECDC 2021 Dec 7
⚬ Las consideraciones provisionales de salud pública para la vacunación contra la COVID-19 de niños
de 5 a 11 años se pueden encontrar en ECDC 2021 Dec 1
⚬ Puede encontrar orientación sobre la vigilancia de COVID-19 en centros de atención a largo plazo en
la UE/EEE en ECDC 2021 Nov 29
⚬ La orientación sobre el rastreo de contactos: la gestión de la salud pública de las personas, incluidos
los trabajadores de la salud, que han tenido contacto con casos de COVID-19 en los países de la
UE/EEE y el Reino Unido se puede encontrar en ECDC 2021 Oct 28
⚬ guidance on options for use of rapid antigen tests for COVID-19 in the European Union/European
Economic Area and the United Kingdom can be found at ECDC 2021 Oct 26
⚬ COVID-19 surveillance guidance on transition from COVID-19 emergency surveillance to routine
surveillance of respiratory pathogens can be found at ECDC 2021 Oct 18
⚬ interim public health considerations for provision of additional COVID-19 vaccine doses can be found
at ECDC 2021 Sep 1
⚬ guidance on COVID-19 in children and the role of school settings in transmission can be found at
ECDC 2021 Jul 8
⚬ considerations for reducing COVID 19 transmission and strengthening vaccine uptake among
migrant populations in the European Union/European Economic Area (EU/EEA) can be found at
ECDC 2021 Jun 3
⚬ interim public health considerations for COVID-19 vaccination of adolescents in the EU/EEA can be
found at ECDC 2021 Jun 1
⚬ guidance on representative and targeted genomic SARS-CoV-2 monitoring can be found at ECDC
2021 May 3
⚬ considerations for use of saliva as sample material for COVID-19 testing can be found at ECDC 2021
May 3
⚬ guidance on infection prevention and control and preparedness for COVID-19 in healthcare settings
can be found at ECDC 2021 Feb 9
⚬ guidance on COVID-19 vaccination and prioritisation strategies in the EU/EEA can be found at ECDC
2020 Dec 22
⚬ case definition for COVID-19 can be found at ECDC 2020 Dec 3
⚬ guideline on implementation of non-pharmaceutical interventions against COVID-19 can be found at
ECDC 2020 Sep 24
⚬ guidance on infection prevention and control of COVID-19 in migrant and refugee reception and
detention centres in the EU/EEA and the United Kingdom can be found at ECDC 2020 Jun 15
⚬ considerations for infection, prevention, and control measures on public transport in the context of
COVID-19 can be found at ECDC 2020 Apr 29
⚬ guidance on disinfection of environments in healthcare and nonhealthcare settings potentially
contaminated with SARS-CoV-2 can be found at ECDC 2020 Mar 26
⚬ guidance on health system contingency planning during widespread transmission of SARS-CoV-2
with high impact on healthcare services can be found at ECDC 2020 Mar 17
⚬ guidance on wearing and removing personal protective equipment in healthcare settings for care of
patients with suspected or confirmed COVID-19 can be found at ECDC 2020 Feb 28
⚬ checklist for hospitals preparing for reception and care of coronavirus 2019 (COVID-19) patients can
be found at ECDC 2020 Feb 26
⚬ Puede encontrar orientación sobre las necesidades de equipo de protección personal (PPE) en
entornos de atención médica para el cuidado de pacientes con nuevo coronavirus sospechoso o
confirmado (2019-nCoV) en ECDC 2020 Feb 7
Otras Directrices Europeas
● La guía Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) sobre

SARS-CoV-2 prä-expositionsprophylaxe (profilaxis previa a la exposición al SARS-CoV-2) se puede
encontrar en AWMF 2022 May 9 [alemán]
● La guía del Instituto Nacional Holandés de Salud Pública y Medio Ambiente (Rijksinstituut voor
Volksgezondheid en Milieu [RIVM]) sobre la vacunación contra el COVID-19 se puede encontrar en RIVM
2022 6 de septiembre [holandés]
● La guía de la Federación Holandesa de Especialistas Médicos (Federatie Medisch Secialisten) (FMS)

sobre COVID-19 se puede encontrar en FMS 2021 24 de septiembre, última actualización 2022 7 de julio
[holandés]
● Allgemeinmedizin und Familienmedizin/Deutsche Gesellschaft f. Psychosomatische Medizin und

Ärztliche Psychotherapie/Deutsche Gesellschaft f. Neurología/Deutsche Gesellschaft f. Kardiologie –
Herz- und Kreislaufforschung/Deutsche Gesellschaft f. Neurorrehabilitación/Berufsverband der
Pneumologen/Deutsche Gesellschaft f. Gastroenterologie, Verdauungs- und
Stoffwechselerkrankungen/Gesellschaft für Pädiatrische Pneumologie/Paul Ehrlich Gesellschaft für
Chemotherapie eV/Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie
eV/Österreichische Gesellschaft für Pneumologie/Deutsches Kollegium für Psychosomatische Medizin) (
DGP/DGUV/DEGAM/DGPM/DGN/DGK/DGNR/BdP/DGVS/DGPP/PEG/DGHNO-KHC/OGP/DKPM) sobre
post-COVID/long-COVID se puede encontrar en Arbeitsgemeinschaft der Wissenschaftlichen
Medizinischen Fachgesellschaften Psychosomatische Medizin und Ärztliche Psychotherapie/Deutsche
Gesellschaft f. Neurología/Deutsche Gesellschaft f. Kardiologie – Herz- und
Kreislaufforschung/Deutsche Gesellschaft f. Neurorrehabilitación/Berufsverband der
Medizinischen Fachgesellschaften Psychosomatische Medizin und Ärztliche Psychotherapie/Deutsche
Gesellschaft f. Neurología/Deutsche Gesellschaft f. Kardiologie – Herz- und
Medizinischen Fachgesellschaften Neurología/Deutsche Gesellschaft f. Kardiologie – Herz- und
Medizinischen Fachgesellschaften Neurología/Deutsche Gesellschaft f. Kardiologie – Herz- und
Medizinischen Fachgesellschaften Neurorrehabilitación/Berufsverband der Pneumologen/Deutsche
Gesellschaft f. Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen/Gesellschaft für
Pädiatrische Pneumologie/Paul Ehrlich Gesellschaft für Chemotherapie eV/Deutsche Gesellschaft für
Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie eV/Österreichische Gesellschaft für
Pneumologie/Deutsches Kollegium für Psychosomatische Medizin) (
Medizinischen Fachgesellschaften Neurorrehabilitación/Berufsverband der Pneumologen/Deutsche
Gesellschaft f. Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen/Gesellschaft für
Pädiatrische Pneumologie/Paul Ehrlich Gesellschaft für Chemotherapie eV/Deutsche Gesellschaft für
Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie eV/Österreichische Gesellschaft für
Pneumologie/Deutsches Kollegium für Psychosomatische Medizin) (
Medizinischen Fachgesellschaften(AWMF) 2022 17 de agosto PDF [alemán]
● La guía de la Sociedad Alemana de Medicina General y Medicina Familiar (Deutsche Gesellschaft für
Allgemeinmedizin und Familienmedizin eV) (DEGAM) sobre información y ayuda práctica sobre SARS-
CoV-2/COVID-19 para médicos generales se puede encontrar en AWMF 2022 Feb PDF [Alemán]
● Se pueden encontrar las directrices de la Sociedad Alemana de Ciencias de la Enfermería (Deutsche

Gesellschaft für Pflegewissenschaft) (DGP) sobre atención domiciliaria, participación social y calidad de
vida de las personas que necesitan atención en el contexto de la atención ambulatoria en las
condiciones de la pandemia de COVID-19 en AWMF 2021 Abr PDF [Alemán]
● La guía del Grupo de Trabajo sobre Políticas de Antibióticos (SWAB) sobre tratamiento farmacológico
para pacientes con infecciones por COVID-19 (SARS-CoV-2) se puede encontrar en SWAB 2022 Oct 3
[holandés]
● Sociedad Respiratoria Europea (ERS)
⚬ La guía de ERS sobre el manejo de adultos hospitalizados con enfermedad por coronavirus-19
(COVID-19) se puede encontrar en Eur Respir J 2021 Apr;57(4):doi:10.1183/13993003.00048-2021
texto completo , la corrección se puede encontrar en Eur Respir J 2022
agosto;60(2):doi:10.1183/13993003.50048-2021
⚬ La declaración de ERS sobre el seguimiento prolongado de COVID-19 se puede encontrar en Eur
Respir J 2022 Aug;60(2):doi:10.1183/13993003.02174-2021 full-text
● La actualización de 2021 de la Liga Europea contra el Reumatismo (EULAR) de los puntos a considerar
sobre el uso de terapias inmunomoduladoras en COVID-19 se puede encontrar en Ann Rheum Dis 2022
Jan;81(1):34 full text
● Sociedad Europea de Microbiología Clínica y Enfermedades Infecciosas (ESCMID)
⚬ La guía viva de COVID-19 sobre el tratamiento farmacológico y el manejo clínico se puede encontrar
en Clin Microbiol Infect 2022 Feb;28(2):222 texto completo , el comentario se puede encontrar
en Clin Microbiol Infect 2022 Apr;28(4):619
⚬ la guía sobre pruebas de diagnóstico para SARS-CoV-2 se puede encontrar en Clin Microbiol Infect
2022 Jun;28(6):812 texto completo
⚬ la guía sobre la prueba de SARS-CoV-2 en personas asintomáticas para prevenir la transmisión en el
entorno de atención médica se puede encontrar en Clin Microbiol Infect 2022 May;28(5):672 texto
completo , el comentario se puede encontrar en Ann Intern Med 2022 Jul ;175(7):JC75
⚬ la guía rápida sobre evaluación y manejo de COVID prolongado se puede encontrar en Clin Microbiol
Infect 2022 Jul;28(7):955 texto completo
● La guía de la Sociedad de Médicos de Rehabilitación de Estonia (ESRD) sobre la rehabilitación de

pacientes con COVID-19 se puede encontrar en ESRD 2021 PDF [estonio]
● La guía de la Asociación de Medicina Paliativa Geriátrica (Fachgesellschaft für Palliative Geriatrie [FGPG])
para la pandemia de COVID-2019 sobre cuidados paliativos para pacientes ancianos y frágiles en el
hogar y en residencias y hogares de ancianos se puede encontrar en Swiss Med Wkly 2020 Mar
23;150:w20235 full -texto
● Congreso Nacional de Cirujanos Hospitalarios Italianos/Sociedad Italiana de Cardiología/Sociedad

Italiana de Trauma y Cirugía de Emergencia/Sociedad Italiana de Oncología Quirúrgica/Sociedad Italiana
de Cirugía para Ancianos/Sociedad Italiana de Fisiopatología Quirúrgica/Sociedad Italiana de Cirugía
Endoscópica/Sociedad Italiana de Anestesia Analgesia Las directivas operativas de Reanimación y
Cuidados Intensivos (ACOI/SIAARTI/SIC/SICUT/SICO/SICG/SIFIPAC/SICE/SIAARTI) sobre cirugía en
pacientes con COVID-19 se pueden encontrar en World J Emerg Surg 2020 Apr 7;15(1):25 texto
completo
● La adaptación de las directrices de la Asociación Europea de Urología (EAU) a la era de la enfermedad

por coronavirus 2019 se puede encontrar en Eur Urol 2020 Jul;78(1):21 texto completo , el
comentario se puede encontrar en Eur Urol Focus 2020 Sep 15;6(5 ):1135
● Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva/European Airway Management

Society (SIAARTI/EAMS) Brote italiano de enfermedad por coronavirus en 2019: las recomendaciones de
la práctica clínica se pueden encontrar en Anesthesia 2020 Jun;75(6):724
● El documento de posición de la Sociedad Italiana de Enfermedades Infecciosas y Tropicales (SIMIT)

sobre estrategias terapéuticas para la COVID-19 grave se puede encontrar en Clin Microbiol Infect 2021
Mar;27(3):389 texto completo
● La guía clínica provisional del grupo de trabajo belga para adultos con diagnóstico confirmado de
COVID-19 en Bélgica se puede encontrar en Sciensano 2022 Oct PDF
● La guía de la Sociedad Alemana de Medicina General y Medicina Familiar (DEGAM) sobre información y
ayuda práctica sobre el SARS-CoV-2/COVID-19 para médicos generales se puede encontrar en AWMF
2022 Feb PDF [Alemán]
● Haut Conseil de la Sante Publique (HCSP) COVID-19: recomendaciones de tratamiento: los antagonistas
de IL1 e IL6 se pueden encontrar en HCSP 2021 Jun 17 [Francés]
● Guía nacional de la Dirección de Salud de Noruega sobre coronavirus: las decisiones y

recomendaciones se pueden encontrar en Helsedirektoratet 2022 15 de noviembre [noruego]
● El apoyo y la orientación de la Junta Nacional de Salud de Suecia para la atención médica en el contexto
de COVID-19 se pueden encontrar en Socialstyrelsen 2022 Aug 18 [sueco, inglés]
Pautas asiáticas
● La información sobre la enfermedad del coronavirus del Centro Chino para el Control y la Prevención
de Enfermedades se puede encontrar en los CDC chinos [Chino]
● Instituto Nacional Japonés de Enfermedades Infecciosas (NIID)
⚬ la guía sobre el control de infecciones para nuevas infecciones por coronavirus se puede encontrar
en NIID 2022 6 de agosto [japonés]
⚬ El manual de detección de patógenos se puede encontrar en NIID 2022 16 de noviembre
[japonés]
⚬ El manual de prueba serológica se puede encontrar en NIID 2020 Jun 2 PDF [japonés]
● La información de la Asociación Japonesa de Enfermedades Infecciosas (JAID) sobre la infección por

COVID-19 se puede encontrar en JAID 2022 Oct 20 [Japonés]
● Los Centros para el Control y la Prevención de Enfermedades de Taiwán (2019) pueden encontrar
información sobre los totales de enfermedades en Taiwán, números globales y enlaces a recursos en 7
idiomas en Taiwán CDC 2022 18 de noviembre
● La guía de práctica clínica basada en evidencia de la Asociación Internacional de Intercambio y

Promoción para la Atención Médica y de la Salud de China/Asociación de Hospitales de Investigación de
China (CPAM/CRHA) sobre quimioprofilaxis, diagnóstico, tratamientos y manejo de altas de COVID-19 se
puede encontrar en Mil Med Res 2020 Sep 4;7(1):41 texto completo
Directrices de América Central y del Sur
● Los documentos técnicos de la Organización Panamericana de la Salud (OPS) sobre la enfermedad por
coronavirus (COVID-19) se pueden encontrar en OPS 2022 o en español
⚬ Las consideraciones sobre el uso de antivirales, anticuerpos monoclonales y otras intervenciones
para el manejo de pacientes con COVID-19 en América Latina y el Caribe se pueden encontrar en
OPS 2022 24 de mayo
⚬ La actualización viva en curso de las posibles opciones terapéuticas de COVID-19 se puede encontrar
en PAHO 2022 Nov 7
⚬ La guía sobre profilaxis y manejo de pacientes con COVID-19 leve y moderado en América Latina y el
Caribe se puede encontrar en el PDF del 22 de octubre de 2021 de la OPS o en PDF en francés ,
PDF en portugués , PDF en español
⚬ La salud digital que facilita la telerehabilitación se puede encontrar en el PDF del 19 de enero de
2021 de la OPS o en el PDF en español
⚬ El programa de inmunización en el contexto de la pandemia de COVID-19 se puede encontrar en el
PDF del 10 de junio de 2020 de la OPS o en PDF en francés , PDF en portugués , PDF en español
⚬ La guía para la atención de pacientes adultos críticos con COVID-19 en las Américas se puede
encontrar en el PDF del 4 de junio de 2021 de la OPS o en PDF en francés , PDF en español
⚬ Las consideraciones de rehabilitación durante el brote de COVID-19 se pueden encontrar en el PDF

del 19 de mayo de 2020 de la OPS o en PDF en portugués , PDF en español
⚬ La guía provisional de bioseguridad en el laboratorio sobre el manejo y transporte de muestras
asociadas con el nuevo coronavirus 2019 (2019-nCoV) se puede encontrar en el PDF del 5 de mayo
de 2020 de la OPS o en PDF en español
⚬ promoción de la equidad en salud, la igualdad de género y étnica, y los derechos humanos en las
respuestas a la COVID-19: las consideraciones clave se pueden encontrar en el PDF del 5 de mayo de
2020 de la OPS o en PDF en español
⚬ Las consideraciones regulatorias sobre la autorización del uso de plasma convaleciente (PC) para
atender la emergencia de COVID-19 se pueden encontrar en OPS 2020 Apr 22 PDF o en
portugués PDF , español PDF
⚬ Las especificaciones técnicas de los dispositivos médicos para el manejo de casos de COVID-19 en
entornos de atención médica se pueden encontrar en el PDF de la OPS del 8 de abril de 2020 o en
PDF en español .
⚬ Los requisitos y especificaciones técnicas del equipo de protección personal (EPP) para el nuevo
coronavirus (2019-ncov) en entornos de atención médica se pueden encontrar en PAHO 2020 Feb 6
PDF
⚬ La guía de laboratorio sobre la detección y el diagnóstico de la infección por el nuevo coronavirus
(2019-nCoV) se puede encontrar en el PDF del 1 de febrero de 2020 de la OPS o en PDF en
español
Directrices de Australia y Nueva Zelanda
● Las pautas nacionales de la Red de Enfermedades Transmisibles de Australia (CDNA) para las unidades
de salud pública sobre el coronavirus 2019 (COVID-19) se pueden encontrar en CDNA 2022 Oct 14
● Salud de Queensland
⚬ La información sobre COVID-19 para los médicos de Queensland se puede encontrar en Queensland
Health 2022 May 17
⚬ Las pautas clínicas de COVID-19 se pueden encontrar en Queensland Health 2022 Nov 3
● La guía de la Red de Laboratorios de Salud Pública (PHLN) sobre pruebas de laboratorio para SARS-CoV-
2 (el virus que causa COVID-19) se puede encontrar en PHLN 2022 Jan 28
● La información del Departamento de Salud de Nueva Gales del Sur (NSWH) sobre COVID-19 se puede
encontrar en NSWH 2022 Nov 11
● La declaración de consenso de Safe Airway Society (SAS) sobre los principios del manejo de las vías
respiratorias y la intubación traqueal específica para el grupo de pacientes adultos con COVID-19 se
puede encontrar en SAS 2020 Mar o en Med J Aust 2020 Jun;212(10):472 texto completo ,
corrección se puede encontrar en Med J Aust 2020 Oct; 213 (7): 312 , el comentario se puede
encontrar en Med J Aust 2021 Jan; 214 (1): 45
● La información del Departamento de Salud del Gobierno de Australia para brindar servicios de atención
a personas mayores durante el COVID-19 se puede encontrar en Health.gov.au 9 de noviembre de 2022
● La guía de la Sociedad de Cuidados Intensivos de Australia y Nueva Zelanda (ANZICS) sobre COVID-19
versión 4 se puede encontrar en ANZICS 2021 Sep 23 PDF
● La información del Ministerio de Salud del Gobierno de Nueva Zelanda sobre COVID-19 se puede
encontrar en NZ MOH 2022 Nov 16
● El gobierno de Nueva Zelanda, Unite Against COVID-19, se puede encontrar en Covid19.gov.nz 2022
Nov 16
● Las recomendaciones del Consejo de Resucitación de Nueva Zelanda (NZRC) sobre la reanimación de
personas con COVID-19 en entornos de atención médica se pueden encontrar en NZRC 2021 Dec 15
● La guía de recursos clínicos del Colegio de Anestesistas de Australia y Nueva Zelanda (ANZCA) sobre
coronavirus/COVID-19 se puede encontrar en ANZCA 2022 Nov 7
● La guía del Panel de Asesoramiento Estratégico del Departamento de Emergencias de Queensland/Red

Clínica Estatal de Cuidados Intensivos/Red Clínica Estatal de Anestesia y Cuidados Perioperatorios
(QEDSAP/SICCN/SWAPNET) sobre el manejo de la insuficiencia respiratoria en la respuesta a COVID-19
se puede encontrar en Queensland Health 2020 PDF
● La guía australiana del Grupo de Trabajo Nacional de Evidencia Clínica de COVID-19 sobre la atención
clínica de las personas con COVID-19 se puede encontrar en Magicapp 2022 Nov 7
Directrices de Oriente Medio
● La directriz V3.0 del Centro Saudita para la Prevención y el Control de Enfermedades por coronavirus
COVID-19 se puede encontrar en covid19.cdc.gov.sa versión 3.0 2022 4 de enero PDF
Revisar articulos
● Las reseñas se pueden encontrar en
⚬ Front Med 2020 Abr;14(2):126 texto completo

⚬ Patógenos 20 de marzo de 2020;9(3):doi:10.3390/pathogens9030231 texto completo
⚬ Clin Med (Londres) 2020 Mar;20(2):124 texto completo
⚬ Indian J Med Res 2020 Feb & Mar;151(2 & 3):147 texto completo
● se puede encontrar una revisión de COVID-19 grave en N Engl J Med 2020 Dec 17;383(25):2451
● revisión de COVID-19 grave: la inmunosupresión o la hiperinflamación se pueden encontrar en Shock

2021 Aug 1;56(2):188
● revisión de largo COVID - mecanismos, factores de riesgo y manejo se puede encontrar en BMJ 2021 Jul
26;374: n1648
● la revisión de COVID prolongado se puede encontrar en Am Fam Physician 2022 Nov; 106 (5): 523
● La revisión de la epidemiología y las características clínicas de COVID-19 en niños, embarazo y recién

nacidos se puede encontrar en Pediatr Infect Dis J 2020 Jun;39(6):469
● la revisión de COVID-19 en niños se puede encontrar en J Med Virol 2020 Jul;92(7):747 texto
completo
● la revisión de la epidemiología, el diagnóstico, la terapéutica y las vacunas para COVID-19 se puede

encontrar en J Microbiol Biotechnol 2020 Mar 28;30(3):313 texto completo
● revisión de epidemias de coronavirus zoonóticos: SARS, MERS y COVID-19 se pueden encontrar en Ann
Allergy Asthma Immunol 2021 Apr;126(4):321 texto completo
● la revisión del nuevo coronavirus y las lecciones de SARS-CoV y MERS-CoV se pueden encontrar en Int J
Infect Dis 2020 May;94:119 texto completo
● la revisión de los mecanismos moleculares y la epidemiología de la COVID-19 desde la perspectiva de

un alergólogo se puede encontrar en J Allergy Clin Immunol 2020 Aug;146(2):285 full-text
● se puede encontrar una revisión de la interpretación de las pruebas de diagnóstico del SARS-CoV-2 en
Am Fam Physician 2021 Apr 15;103(8):465
● se puede encontrar una revisión de cómo interpretar y usar las pruebas serológicas e inmunológicas de
COVID-19 en Clin Microbiol Infect 2021 Jul;27(7):981 full-text
● revisión de los hallazgos de tomografía computarizada en pacientes con COVID-19 se puede encontrar
en Eur Radiol 2020 ago;30(8):4381 texto completo
● la revisión de la manifestación cutánea durante la pandemia de COVID-19 se puede encontrar en

Pediatr Allergy Immunol 2020 Nov;31 Suppl 26:89 texto completo
● la revisión de la evidencia patológica de los fenómenos trombóticos pulmonares en la COVID-19 grave

se puede encontrar en J Thromb Haemost 2020 Jun;18(6):1517 texto completo
● La revisión de la oximetría de pulso para monitorear pacientes con COVID-19 en el hogar se puede
encontrar en Ann Am Thorac Soc 2020 Sep;17(9):1040 texto completo
● la revisión de la aplicación de la ecografía pulmonar durante la pandemia de COVID-19 se puede

encontrar en Anesth Analg 2020 Aug;131(2):345
● La revisión del manejo de las vías respiratorias en el quirófano y las salas de intervención en pacientes
adultos con COVID-19 confirmado o sospechoso se puede encontrar en Anesth Analg 2020
Sep;131(3):677
● La revisión de los efectos potenciales de los coronavirus en el sistema cardiovascular se puede

encontrar en JAMA Cardiol 2020 Jul 1;5(7):831
● revisión de las pruebas de anticuerpos contra el SARS-CoV-2: las preguntas que se deben hacer se
pueden encontrar en J Allergy Clin Immunol 2020 Jul;146(1):35
● review of outpatient management of COVID-19 can be found in Am Fam Physician 2020 Oct
15;102(8):478
● review of how to use convalescent plasma therapies for COVID-19 can be found in Blood 2021 Mar
25;137(12):1573 full-text
● review of therapeutic strategies for severe COVID-19 can be found in Clin Microbiol Infect 2021
Mar;27(3):389
● review of anti-inflammatory therapy for COVID-19: colchicine can be found in Ann Rheum Dis 2021
May;80(5):550 full-text
● review of neurologic manifestations and complications of COVID-19 can be found in J Clin Neurosci
2020 Jul;77:8 full-text
● la revisión de los posibles mecanismos de anafilaxia a las vacunas de ARNm de COVID-19 se puede
encontrar en J Allergy Clin Immunol 2021 Jun;147(6):2075 texto completo
● la revisión de la inmunidad del SARS-CoV-2 y las aplicaciones para el desarrollo de vacunas se puede
encontrar en Lancet 2020 Nov 14;396(10262):1595 texto completo
● la revisión del desarrollo de vacunas contra el SARS-CoV-2 se puede encontrar en Vacunas (Basilea)
2020 Mar 29;8(2):doi:10.3390/vaccines8020153 full-text
● Puede encontrar una revisión de la comprensión del eje renina-angiotensina-aldosterona-SARS-CoV en

Eur Respir J 2020 Jul 9;56(1):2000912 texto completo
● la revisión de la traqueotomía en la era COVID-19 se puede encontrar en Lancet Respir Med 2020
Jul;8(7):717 texto completo
● la revisión de las estrategias de diagnóstico para la infección por SARS-CoV-2 y la interpretación de los
resultados microbiológicos se pueden encontrar en Clin Microbiol Infect 2020 Sep;26(9):1178 texto
completo
● La revisión de la detección, la carga viral y la infectividad del SARS-CoV-2 durante el curso de una
infección se puede encontrar en J Infect 2020 Sep;81(3):357 texto completo
● la revisión de la tiroiditis subaguda después de Covid-19 se puede encontrar en Am J Trop Med Hyg
2022 Sep 6 early onlien
Búsqueda en MEDLINE
● para buscar en MEDLINE (COVID-19) con búsqueda dirigida (Consultas clínicas), haga clic en terapia ,
diagnóstico o pronóstico
Información de viaje
● información de los Centros para el Control y la Prevención de Enfermedades (CDC) de los Estados
Unidos
⚬ la información general para viajeros se puede encontrar en CDC 2022 Sep 8 o en español
⚬ orientación sobre viajes nacionales durante COVID-19: la información para personas que viajan
dentro de los Estados Unidos y los territorios de los Estados Unidos se puede encontrar en CDC
2022 24 de agosto o en español
⚬ los viajes internacionales se pueden encontrar en CDC 2022 24 de agosto o en español
⚬ para embarcaciones marítimas sobre mitigación y gestión de COVID-19 se puede encontrar en CDC
2022 Nov 3
● Los consejos de viaje del Gobierno de Canadá sobre la enfermedad por coronavirus (COVID-19) se
pueden encontrar en Canada.ca 2022 Oct 27 o en francés
● Puede encontrar información sobre viajes durante la pandemia de coronavirus de la Comisión Europea
en ec.europa.eu 2022 Mar 2
● La información del Departamento de Salud del Gobierno de Australia sobre viajes para viajeros
internacionales se puede encontrar en Health.gov.au 2022 Oct 14
● Información del Ministerio de Salud de Nueva Zelanda sobre viajes para
⚬ las personas que viajan, ingresan o salen de Nueva Zelanda se pueden encontrar en NZ MOH 2022
Oct 18
⚬ Los sectores de aviación y marítimo se pueden encontrar en NZ MOH 2022 Nov 9
● La información sobre la enfermedad por coronavirus (2019) de los Centros para el Control y la
Prevención de Enfermedades de Taiwán sobre avisos de viaje, totales de enfermedades en Taiwán,
números globales y enlaces a recursos en 7 idiomas se puede encontrar en Taiwán CDC 2022 23 de
noviembre
Información del paciente

● folletos de la Biblioteca de Salud de EBSCO sobre
⚬ COVID-19 or in Spanish
⚬ discharge instructions for COVID-19 (suspected or confirmed) or in Spanish
● EBSCO Clinical Decisions aid on COVID-19 Vaccine: Is It the Right Choice for Me? PDF
● information from World Health Organization or in Arabic , Chinese , French , Russian ,

Spanish
● information from Centers for Disease Control and Prevention on
⚬ COVID-19 vaccines
⚬ stay up to date with your vaccines including boosters or in Spanish
⚬ how to protect yourself and others or in Spanish
⚬ use of masks to slow the spread of COVID-19 Spanish
⚬ breastfeeding and caring for newborns if you have COVID-19
⚬ understanding risk for specific groups of people, including people at increased risk for severe illness
or in Spanish
⚬ American Sign Language (ASL) videos (YouTube)
● handouts from Community Health Literacy Project (38 languages)
● information on COVID-19 vaccines, pregnancy, and breastfeeding from Royal College of Obstetricians
and Gynaecologists
● information from Patient Info (UK)
● information from Government of Canada on COVID-19
⚬ symptoms and treatment of coronavirus disease, what to do if you feel sick or in French
⚬ vaccines for COVID-19 or in French
● information from Australian Government Department of Health on COVID-19
⚬ COVID-19 disease,and symptoms (page also includes link to interactive symptom checker)
⚬ COVID-19 informational videos in multiple languages (YouTube)
● information from New Zealand Ministry of Health on
⚬ COVID-19: health advice for the public

● information from the Dutch Ministry of Health C-support foundation on dealing with long COVID
References
General References Used
The references listed below are used in this DynaMed topic primarily to support background information and for
guidance where evidence summaries are not felt to be necessary. Most references are incorporated within the
text along with the evidence summaries.
1. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis,
and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020 Aug 25;324(8):782-793
2. Gupta A, Madhavan MV, Sehgal K, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020
Jul;26(7):1017-1032
Recommendation Grading Systems Used
● Society of Critical Care Medicine (SCCM) recommendation grading system
⚬ strength of recommendation
– Strong - desirable effects of adherence to recommendation will clearly outweigh undesirable

effects
– Weak - desirable effects of adherence to recommendation will probably outweigh undesirable
effects, but panel is not confident about trade-offs (either because benefits and downsides are
closely balanced, or some evidence is low-quality and thus uncertainty remains regarding
benefits and risks)
– Best practice statement - ungraded strong recommendation where evidence is hard to
summarize or assess using GRADE methodology
⚬ Reference - (SCCM) Surviving Sepsis Campaign guideline on management of adults with coronavirus
disease 2019 (COVID-19) (Crit Care Med 2021 Mar 1;49(3):e219 )
● Infectious Diseases Society of America (IDSA) grading system for recommendations
– Strong recommendation - most people should receive recommended course of action

– Conditional recommendation - be prepared to help people make a decision that is consistent with
their own values/decision aids and shared decision making
– Knowledge gap - additional research needed for recommendation
⚬ certainty of evidence
– High - very confident that the true effect lies close to that of the estimate of the effect
– Moderate - moderately confident in the effect estimate: true effect is likely to be close to the
estimate of the effect, but there is a possibility that it is substantially different
– Low - confidence in the effect estimate is limited: true effect may be substantially different from
the estimate of the effect
– Very low - very little confidence in the effect estimate: true effect is likely to be substantially
different from the estimate of effect
⚬ References
– IDSA guideline on treatment and management of patients with COVID-19 can be found at IDSA
2021 May 27
– IDSA guideline on infection prevention in patients with suspected or known COVID-19 can be
found at IDSA 2020 Apr 30
– IDSA guideline on diagnosis of COVID-19: molecular diagnostic testing can be found at IDSA 2020
Dec 23
– IDSA guideline on diagnosis of COVID-19: antigen testing can be found at IDSA 2021 May 27
– IDSA guideline on diagnosis of COVID-19: serologic testing can be found at IDSA 2020 Aug 18
● National Institutes of Health (NIH) recommendation rating scheme
– A - strong recommendation for the statement

– B - recomendación moderada para la declaración
– C - recomendación débil para la declaración
⚬ calidad de la evidencia para la recomendación
– I - ≥ 1 ensayos aleatorizados sin mayores limitaciones

– IIa: otros ensayos aleatorios o análisis de subgrupos de ensayos aleatorios
– IIb: ensayos no aleatorizados o estudios de cohortes observacionales
– III - dictamen pericial
⚬ Referencia - Pauta de tratamiento NIH COVID-19 ( NIH 2022 Apr 29 )
● Sistema de clasificación de recomendaciones del Colegio Estadounidense de Médicos del

Tórax/Asociación Estadounidense de Broncología y Neumología Intervencionista/Asociación de
Directores de Programas de Neumología Intervencionista (ACCP/AABIP/AIPPD)
⚬ Fuerte consenso - ≥ 80% de acuerdo por el panel de expertos
⚬ Consenso - ≥70% de acuerdo por el panel de expertos
⚬ Referencia: informe del panel de expertos de ACCP/AABIP/AIPPD sobre el uso de la traqueotomía
durante la pandemia de COVID-19 ( Chest 2020 Oct;158(4):1499 full-text )
● Sistema de clasificación de recomendaciones de la Organización Mundial de la Salud (OMS) 2020
⚬ fuerza de las recomendaciones

– Fuerte: seguro de que los efectos deseables del cumplimiento de la recomendación superan las
consecuencias indeseables.
– Condicional: menos seguro sobre el equilibrio entre los beneficios y los daños o las desventajas
de implementar una recomendación
– Declaración de mejores prácticas: considerada importante por el grupo de desarrollo de la guía
pero sin calificación de la calidad de la evidencia
⚬ certeza de la evidencia
– Alto: muy seguro de que el efecto verdadero se aproxima al de la estimación del efecto
– Moderado: moderadamente seguro en la estimación del efecto; Es probable que el efecto
verdadero esté cerca de la estimación del efecto, pero existe la posibilidad de que sea
sustancialmente diferente
– Baja: la confianza en la estimación del efecto es limitada; el efecto real puede ser sustancialmente
diferente de la estimación del efecto
– Muy bajo: muy poca confianza en la estimación del efecto; Es probable que el efecto verdadero
sea sustancialmente diferente de la estimación del efecto.
⚬ Referencias -
– Orientación de la OMS sobre corticosteroides para COVID-19 ( OMS 2020 Sep 2 )

– Directrices provisionales de la OMS sobre el manejo clínico de la COVID-19 ( PDF del 23 de
noviembre de 2021 de la OMS )
● Clasificación de recomendaciones del Departamento de Salud y Servicios Humanos de los Estados

Unidos (DHHS)
⚬ grados de recomendación
– Grado A - recomendación fuerte

– Grado B - recomendación moderada
– Grado C - recomendación opcional
⚬ niveles de evidencia
– Nivel I: ≥ 1 ensayo aleatorizado con resultados clínicos y/o criterios de valoración de laboratorio
validados
– Nivel I*: para recomendación pediátrica con datos de ensayos aleatorizados de alta calidad en
adultos y datos pediátricos de evidencia de nivel II
– Nivel II: ≥ 1 ensayo bien diseñado, no aleatorizado o estudios observacionales de cohortes con
resultados clínicos a largo plazo
– Nivel II*: para recomendación pediátrica con ensayos bien diseñados no aleatorizados o estudios
de observación de cohortes en adultos e información coherente de respaldo de estudios más
pequeños en niños
– Nivel III - opinión de expertos
⚬ Referencia: orientación provisional del DHHS sobre la COVID-19 en personas con VIH ( infoVIH, 26 de
febrero de 2021 )
Sistema de clasificación de recomendaciones sintetizadas para contenido de DynaMed
● El equipo de DynaMed monitorea sistemáticamente la evidencia clínica para proporcionar

continuamente una síntesis de la evidencia relevante más válida para respaldar la toma de decisiones
clínicas (ver Metodología basada en evidencia de 7 pasos ).
● Las recomendaciones de las guías resumidas en el cuerpo de un tema de DynaMed se proporcionan

con el sistema de clasificación de recomendaciones utilizado en las guías originales y permiten a los
usuarios ver rápidamente dónde concuerdan las guías y dónde difieren entre sí y con la evidencia
actual.
● En el contenido de DynaMed, sintetizamos la evidencia actual, las pautas actuales de las principales
autoridades y la experiencia clínica para brindar recomendaciones que respalden la toma de decisiones
clínicas en la sección Descripción general y recomendaciones .
● Utilizamos el Grado de Evaluación, Desarrollo y Evaluación de Recomendaciones (GRADE) para

clasificar las recomendaciones sintetizadas como Fuertes o Débiles.
⚬ Las recomendaciones sólidas se usan cuando, según la evidencia disponible, los médicos (sin
conflictos de intereses) tienen un alto grado de confianza de que las consecuencias deseables
(beneficios para la salud, reducción de costos y cargas) superan las consecuencias indeseables
(daños, costos, cargas) .
⚬ Las recomendaciones débiles se utilizan cuando, con base en la evidencia disponible, los médicos
creen que las consecuencias deseables e indeseables están finamente equilibradas, o existe una
incertidumbre apreciable sobre la magnitud de las consecuencias esperadas (beneficios y daños).
Las recomendaciones débiles se utilizan cuando los médicos no están de acuerdo con los juicios
sobre beneficios y daños relativos, o tienen una confianza limitada en sus juicios. Las
recomendaciones débiles también se usan cuando el rango de valores y preferencias del paciente
sugiere que es probable que los pacientes informados tomen decisiones diferentes.
● Las recomendaciones sintetizadas de DynaMed (en la sección Resumen y recomendaciones ) se

determinan con una metodología sistemática:
⚬ Las recomendaciones son redactadas inicialmente por editores clínicos (incluidos ≥ 1 con
experiencia metodológica y ≥ 1 con experiencia en el dominio del contenido) conscientes de la mejor
evidencia actual sobre beneficios y daños, y las recomendaciones de las guías.
⚬ Las recomendaciones están redactadas para que coincidan con la fuerza de la recomendación. Las
recomendaciones fuertes usan frases de "debería hacer", o frases que implican una expectativa de
realizar la acción recomendada para la mayoría de los pacientes. Las recomendaciones débiles
utilizan frases como "considerar" o "sugerido".
⚬ Las recomendaciones se etiquetan explícitamente como Recomendaciones fuertes o
Recomendaciones débiles cuando un grupo calificado ha deliberado explícitamente sobre hacer tal
recomendación. La deliberación del grupo puede ocurrir durante el desarrollo de la guía. Cuando la
deliberación del grupo ocurre a través de grupos iniciados por DynaMed Team:
– Las preguntas clínicas se formularán utilizando el marco PICO (Población, Intervención,
Comparación, Resultado) para todos los resultados de interés específicos de la recomendación
que se desarrollará.
– Se realizarán búsquedas sistemáticas para cualquier pregunta clínica donde las búsquedas
sistemáticas aún no se hayan completado a través del desarrollo de contenido de DynaMed.
– La evidencia se resumirá para la revisión del panel de recomendaciones, incluido para cada
resultado, la importancia relativa del resultado, los efectos estimados que comparan la
intervención y la comparación, el tamaño de la muestra y la calificación de calidad general para el
cuerpo de evidencia.
– Los miembros del panel de recomendaciones se seleccionarán para incluir al menos 3 miembros
que juntos tengan suficiente experiencia clínica en los temas pertinentes a la recomendación,
experiencia metodológica para la evidencia que se está considerando y experiencia en el
desarrollo de guías.
– Todos los miembros del panel de recomendación deben revelar cualquier posible conflicto de
intereses (profesional, intelectual y financiero) y no serán incluidos en el panel específico si existe
un conflicto significativo para la recomendación en cuestión.
– Los miembros del panel harán recomendaciones Fuertes si y solo si hay un acuerdo consistente
con un alto nivel de confianza en la probabilidad de que las consecuencias deseables superen las
consecuencias indeseables en la mayoría de los valores y preferencias esperados del paciente.
Los miembros del panel harán recomendaciones Débiles si existe una confianza limitada (o una
evaluación inconsistente u opiniones discrepantes) de que las consecuencias deseables superan
las consecuencias indeseables en la mayoría de los valores y preferencias esperados del
paciente. No se hará ninguna recomendación si no hay suficiente confianza para hacer una
recomendación.
– Todos los pasos de este proceso (incluidos los resúmenes de evidencia que se compartieron con
el panel y la identificación de los miembros del panel) serán transparentes y accesibles para
respaldar la recomendación.
⚬ Las recomendaciones son verificadas por ≥ 1 editor con experiencia metodológica, que no participa
en la redacción o el desarrollo de recomendaciones, con confirmación explícita de que las
recomendaciones Fuertes están respaldadas adecuadamente.
⚬ Las recomendaciones se publican solo después de que se establece el consenso con acuerdo en la
redacción y la fuerza de la recomendación por parte de todos los editores.
⚬ Si no se puede llegar a un consenso, la recomendación se puede publicar con una anotación de
"comentario disidente" y el comentario disidente se incluye en los detalles del tema.
⚬ Si las recomendaciones se cuestionan durante la revisión por pares o la publicación posterior por
parte de una persona calificada, o si se justifica una reevaluación en función de la nueva información
detectada a través de la vigilancia sistemática de la literatura, la recomendación está sujeta a una
revisión interna adicional.
Proceso editorial de DynaMed
● Los temas de DynaMed son creados y mantenidos por el equipo editorial y el proceso de DynaMed .
● Todos los miembros del equipo editorial y los revisores han declarado que no tienen intereses
financieros ni de otro tipo relacionados con este tema, a menos que se indique lo contrario.
● El contenido de DynaMed incluye actualizaciones de cambio de práctica, con el apoyo de nuestros

socios, McMaster University y F1000.
Agradecimientos especiales
● Los temas de DynaMed se escriben y editan a través de los esfuerzos de colaboración de las personas
mencionadas anteriormente. Los editores adjuntos, los editores de sección y los editores de temas
están activos en la práctica médica clínica o académica. Los editores de recomendaciones participan
activamente en el desarrollo y/o evaluación de las guías.
● Definiciones de funciones del equipo editorial
Los editores de temas definen el alcance y el enfoque de cada tema formulando un

conjunto de preguntas clínicas y sugiriendo pautas importantes, ensayos clínicos y
otros datos que deben abordarse dentro de cada tema. Los editores de temas
también sirven como consultores para el equipo editorial interno de DynaMed
durante el proceso de redacción y edición, y revisan los borradores finales de los
temas antes de su publicación.
Los editores de sección tienen responsabilidades similares a las de los editores de

temas, pero tienen un rol más amplio que incluye la revisión de múltiples temas, la
supervisión de los editores de temas y la vigilancia sistemática de la literatura médica.
Los editores adjuntos son empleados de DynaMed y supervisan los grupos editoriales
internos de DynaMed. Cada uno es responsable de todo el contenido publicado
dentro de ese grupo, incluida la supervisión del desarrollo del tema en todas las
etapas del proceso de redacción y edición, la revisión final de todos los temas antes
de la publicación y la dirección de un equipo interno.
Published by EBSCO Information Services. Copyright © 2022, EBSCO Information Services. All rights reserved. No part of this
may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or
by any information storage and retrieval system, without permission.
EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is
merely intended as a general informational overview of the subject for the healthcare professional.

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COVID-19 (Nuevo coronavirus)

Descripción general y recomendaciones

● Las características clínicamente importantes de la patogénesis del SARS-CoV-2 incluyen:

● El COVID-19 se declaró pandemia mundial el 11 de marzo de 2020. Hasta el 13 de noviembre de 2022,

● Los síntomas pueden incluir:

● Prueba de amplificación de ácido nucleico SARS-CoV-2

⚬ es actualmente la prueba de elección para confirmar el diagnóstico ( Recomendación fuerte ).

● Para pacientes no hospitalizados

– Terapias alternativas si las terapias preferidas no están disponibles, no son factibles de

● Recomendaciones de tratamiento de los Institutos Nacionales de Salud (NIH) para pacientes

– No se recomienda la dexametasona u otros corticosteroides sistémicos a menos que los

● Dosis terapéutica de heparina recomendada para pacientes no embarazadas con niveles de

⚬ Prophylactic dose of heparin recommended for patients without evidence of venous

⚬ For hospitalized patients requiring invasive ventilation or ECMO

– Initiate 1 of the following:

● Prophylactic dose of heparin recommended for patients without evidence of venous

⚬ considerations for patients hospitalized with COVID-19 who are immunocompromised:

Infection Control and Prevention

● additional related DynaMed topics

⚬ Severe Acute Respiratory Syndrome (SARS)

● global pandemic of acute respiratory disease caused by a novel coronavirus (SARS-CoV-2) 1 , 2

● common signs of COVID-19 include fever, cough, and shortness of breath 1

● there is no specific antiviral treatment for COVID-19 1

Illustration of SARS-CoV-2 particle.

Image courtesy of KTSDesign/Science Photo Library.

● coronavirus disease 2019

⚬ suspected case either

● clinical criteria either

⚬ acute onset of fever and cough OR

● epidemiological criteria includes either

⚬ contact with a probable or confirmed case, OR

⚬ probable case any of

⚬ confirmed case any of

– positive SARS-CoV-2 nucleic acid amplification test

⚬ Reference - WHO COVID-19 Case definition 2022 Jul 22

⚬ WHO severity definitions

● oxygen saturation < 90% on room air

⚬ National Institutes of Health (NIH) COVID-19 severity definitions

– asymptomatic or presymptomatic infection: positive SARS-CoV-2 nucleic acid amplification or

Who is most affected

⚬ based on retrospective cohort study

– 0.9% in patients aged 0-9 years

⚬ based on population-based surveillance study

Age Group Percent Percent Percent Percent

0-9 years 2.3% 3.3% 3.9% 4%

10-19 years 5.1% 7.5% 10.1% 11.5%

20-29 years 15.5% 20.2% 23.2% 21%

30-39 years 16.9% 17.6% 17.8% 16.5%

40-49 years 16.4% 16% 15.2% 14.9%

50-59 years 16.4% 14.6% 13.4% 13.9%

60-69 years 11.9% 9.9% 8.7% 9.4%

70-79 years 7% 5.5% 4.6% 5.2%

≥ 80 years 8.5% 5.5% 3.1% 3.7%

● Evidence • Updated 17 Nov 2022

Table 2. WHO Weekly Epidemiological Update

Europe 262,602 696,911 -21% 2,125,4 2,341 -41%

Americ 180,816 418,334 12% 2,861,9 3,051 -10%

Wester 95,670, 1,163,3 18% 278,833 643 14%

South- 60,538, 50,214 15% 800,857 353 -80%

Eastern 23,174, 10,841 -12% 348,805 61 7%

Africa 9,376,2 5,894 -8% 174,811 8 -86%

Global 632,179 2,345,5 2% 6,590,7 7,457 -30%

⚬ Reference - WHO Weekly Epidemiological Update 2022 Nov 16