ArticleBMC pediatrics2026
Hepatitis is an underestimated complication among children with pneumonia associated with SARS-CoV-2 and influenza: a single center study.
Article in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSARS-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.
methodsPediatric 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.
resultsA 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.
conclusionCOVID-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.
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