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Síntomas de encefalomielitis miálgica/síndrome de fatiga crónica en pacientes con COVID prolongado. Una revisión sistemática
Symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome among long COVID patients. A systematic review
DOI:
https://doi.org/10.15446/revfacmed.v74.118516Palabras clave:
Síndrome Post Agudo de COVID-19, Síndrome de Fatiga Crónica, Encefalomielitis Miálgica (es)Post-Acute COVID-19 Syndrome, Fatigue Syndrome, Chronic, Myalgic encephalomyelitis (en)
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Introducción. El COVID prolongado es un problema de salud global emergente que comprende múltiples desenlaces adversos, siendo frecuente la aparición de novo de varias condiciones, entre ellas la encefalomielitis miálgica/síndrome de fatiga crónica (EM/SFC).
Objetivo. Analizar la prevalencia de síntomas de EM/SFC (duración >6 meses) en pacientes con COVID prolongado.
Materiales y métodos. Esta revisión sistemática se adhirió a las directrices PRISMA 2020 (número de registro en PROSPERO: CDR42024557707). En mayo de 2024 se realizaron búsquedas sistemáticas en Medline, EBSCOhost, Scopus y Web of Science para identificar estudios que reportaran datos sobre la presencia de síntomas de EM/SFC en pacientes con COVID prolongado (>6 meses desde la infección). También se realizaron búsquedas manuales en Google Scholar. La calidad de los estudios se evaluó con la escala Newcastle-Ottawa. Los síntomas de EM/SFC se clasificaron según lo establecido en los criterios diagnósticos del Instituto de Medicina (IOM) 2015.
Resultados. Se incluyeron 11 estudios en la revisión: 10 de cohorte (7 prospectivos y 3 retrospectivos) y 1 transversal. El tamaño muestral agregado fue de 453 586 personas con COVID prolongado. Los síntomas más frecuentes de EM/SFC en estos pacientes fueron fatiga (56.99%), problemas cognitivos (44.54%), malestar post-esfuerzo (41.55%), sueño no restaurativo (41.08%), jaquecas de intensidad no experimentada antes de la infección por SARS-CoV-2 (31.21%) y mialgia (20.59%). Por el contrario, la inflamación o sensibilidad de los ganglios linfáticos, la sensibilidad a la luz y sonido y las náuseas fueron los síntomas menos prevalentes (5.38%, 4.75% y 0.17%, respectivamente). En ningún estudio hubo pacientes con escalofríos, sudor nocturno y alergia o sensibilidad alimentaria.
Conclusión. Una proporción considerable de pacientes con COVID prolongado cumplió con los criterios IOM 2015 de EM/SFC, siendo fatiga, problemas cognitivos, malestar post-esfuerzo, sueño no restaurativo y cefaleas de intensidad no experimentada antes de la infección por SARS-CoV-2 los síntomas más frecuentes, con prevalencias >41% en los estudios individuales. La heterogeneidad metodológica observada resalta la necesidad de realizar estudios multicéntricos longitudinales para precisar la prevalencia de EM/SFC y de sus síntomas en esta población y, de esta forma, poder orientar intervenciones terapéuticas.
Introduction: Long COVID is an emerging global health issue characterized by multiple adverse outcomes, frequently resulting in the onset of several conditions, including Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).
Objective: To analyze the prevalence of ME/CFS symptoms (duration >6 months) among patients with long COVID.
Materials and methods: This systematic review adhered to the PRISMA 2020 guidelines (PROSPERO registration: CDR42024557707). In May 2024, a systematic search was conducted in Medline, EBSCOhost, Scopus, and Web of Science to identify studies reporting data on the presence of ME/CFS symptoms in long COVID patients (>6 months post-infection). Manual searches were also performed in Google Scholar. Study quality was assessed using the Newcastle-Ottawa scale. ME/CFS symptoms were classified according to the Institute of Medicine (IOM) 2015 diagnostic criteria.
Results: Eleven studies were included in the review: 10 cohorts (7 prospective, 3 retrospective) and 1 cross-sectional study. The aggregate sample size was 453 586 persons with long COVID. The most frequent ME/CFS symptoms in these patients were fatigue (56.99%), cognitive impairment (44.54%), post-exertional malaise (41.55%), unrefreshing sleep (41.08%), new-onset severe headaches following SARS-CoV-2 infection (31.21%), and myalgia (20.59%). Conversely, the least prevalent symptoms were lymph node tenderness or swelling (5.38%), sensitivity to light and sound (4.75%), and nausea (0.17%). No studies reported patients with chills, night sweats, or food allergies or sensitivities.
Conclusion: A considerable proportion of patients with long COVID met the IOM 2015 criteria for ME/CFS. Fatigue, cognitive impairment, post-exertional malaise, unrefreshing sleep, and new-onset severe headaches following SARS-CoV-2 infection were the most frequent symptoms, with prevalences >41% in individual studies. The observed methodological heterogeneity highlights the need for multicenter longitudinal studies to determine the prevalence of ME/CFS and its symptoms in this population and, thus, to guide therapeutic interventions.
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