Hepatitis is an underestimated complication among children with pneumonia associated with SARS-CoV-2 and influenza: a single center study

SARS-CoV-2 and influenza viruses can lead to liver involvement, although the extent and clinical significance remain unclear. We aimed to study liver involvement among children with pneumonia associated with SARS-CoV-2 and Influenza viruses. Pediatric patients who were diagnosed with pneumonia due to COVID-19 or influenza infection in our hospital were enrolled. Liver function tests were evaluated at admission and during the disease course. A total of 117 children were included: 69 with SARS-CoV-2 pneumonia and 48 with influenza pneumonia. Liver injury at admission was observed in 37.6% of SARS-CoV-2 cases and 29.2% of influenza cases (p = 0.429). During the disease course, liver injury increased to 55.1% and 37.5%, respectively (p = 0.09). Among children with normal liver function at admission, mild to moderate reversible liver injury developed in 30.2% of SARS-CoV-2 and 23.5% of influenza pneumonia cases (p = 0.6). CRP and LDH levels were significantly higher in COVID-19 patients, whereas hepatotoxic drug exposure and comorbid conditions contributed to the variability in liver injury patterns (p = 0.005 and p = 0.012, respectively). Mortality occurred only in the SARS-CoV-2 pneumonia group (14.4% vs. 0%, p = 0.005). Pulmonary, neurometabolic, and malignant comorbidities were independently associated with hepatotoxic progression, while shock and moderate-to-severe liver injury at admission were significant predictors of mortality. COVID-19 is associated with more frequent liver involvement and higher mortality than influenza (p = 0.005). The interplay between viral infection, systemic inflammation, shock, and drug-related hepatotoxicity likely contributes to the observed hepatic dysfunction. Further research is warranted to clarify the mechanisms of viral-induced liver injury.