Clinical course of community-acquired pneumonia of coronavirus etiology in patients with metabolic dysfunction-associated steatotic liver disease
DOI:
https://doi.org/10.14739/2310-1210.2026.2.340409Keywords:
community-acquired pneumonia, acute coronavirus disease, metabolic dysfunction-associated steatotic liver disease, steatotic liver disease, metabolic dysfunction, obesityAbstract
Aim. To determine the clinical features of moderate community-acquired pneumonia (CAP) associated with COVID-19 in patients without comorbidities compared to those with comorbid metabolic dysfunction-associated steatotic liver disease (MASLD).
Material and methods. A retrospective analysis was performed including 200 hospitalized patients with moderate CAP associated with SARS-CoV-2. Two groups (n = 100 each) were defined: Group 1 included patients with CAP without liver comorbidity and with normal body weight; Group 2 comprised patients with CAP and comorbid MASLD associated with being overweight or having class I–II obesity.
Results. Patients in Group 2 demonstrated a significantly higher prevalence of intense chest pain (1.7-fold), fever (1.7-fold), anosmia (2.3-fold), sore throat with odynophagia (2.0-fold), and progressive inspiratory dyspnea (1.7-fold) compared to Group 1 (p < 0.05). Systemic and gastrointestinal symptoms were also more frequent in Group 2, including myalgia (4.2-fold), asthenia and headache (both 1.6-fold), syncope (2.5-fold), nausea (2.3-fold), and diarrhea (3.9-fold) (p < 0.05). Hyperthermia >38.5 °C (1.6-fold), tachycardia >90/min (2.0-fold), tachypnea >25/min (2.2-fold), and oxygen saturation (SpO2) of 90–92 % (1.8-fold) were significantly more common in the comorbid group (p < 0.05). Laboratory findings in Group 2 revealed a higher incidence of leukopenia (52.0 % vs. 39.0 %), lymphopenia (77.0 % vs. 37.0 %, p < 0.05), and thrombocytopenia (61.0 % vs. 29.0 %, p < 0.05), alongside pronounced hyperfibrinogenemia and hyperferritinemia. Radiologically, Group 2 patients predominantly exhibited bilateral lung involvement (67.0 % vs. 38.0 %, p < 0.05), consolidation, ground-glass opacities, fibrotic changes, and pleuritis. Co-infections and superinfections were significantly more frequent in Group 2 (45.0 % vs. 18.0 %), with S. pneumoniae (27.0 %), K. pneumoniae (17.0 %), S. aureus (18.0 %), Aspergillus spp. (10.0 %), and Candida spp. (6.0 %) identified as the primary pathogens.
Conclusions. The presence of MASLD is associated with a more severe clinical course of COVID-19-related CAP. Patients with MASLD exhibit more pronounced respiratory and systemic manifestations, significant immune disturbances, higher rates of secondary co-infections, and more extensive bilateral radiological lung involvement (p < 0.05).
References
Chen VL, Hawa F, Berinstein JA, Reddy CA, Kassab I, Platt KD, et al. Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19. Dig Dis Sci. 2021;66(9):3192-8. doi: https://doi.org/10.1007/s10620-020-06618-3
Marjot T, Moon AM, Cook JA, Abd-Elsalam S, Aloman C, Armstrong MJ, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2021;74(3):567-77. doi: https://doi.org/10.1016/j.jhep.2020.09.024
Nseir WB, Mograbi JM, Amara AE, Abu Elheja OH, Mahamid MN. Non-alcoholic fatty liver disease and 30-day all-cause mortality in adult patients with community-acquired pneumonia. QJM. 2019;112(2):95-9. doi: https://doi.org/10.1093/qjmed/hcy227
Wang G, Wu S, Wu C, Zhang Q, Wu F, Yu B, et al. Association between non-alcoholic fatty liver disease with the susceptibility and outcome of COVID-19: A retrospective study. J Cell Mol Med. 2021;25(24):11212-20. doi: https://doi.org/10.1111/jcmm.17042
Younossi ZM, Stepanova M, Lam B, Cable R, Felix S, Jeffers T, et al. Independent Predictors of Mortality Among Patients With NAFLD Hospitalized With COVID-19 Infection. Hepatol Commun. 2022;6(11):3062-72. doi: https://doi.org/10.1002/hep4.1802
Preveden T. Bacterial infections in patients with liver cirrhosis. Med Pregl. 2015;68(5-6):187-91. doi: https://doi.org/10.2298/mpns1506187p
Xu L, Ying S, Hu J, Wang Y, Yang M, Ge T, et al. Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models. Respir Res. 2018;19(1):242. doi: https://doi.org/10.1186/s12931-018-0934-5
Vrsaljko N, Samadan L, Viskovic K, Mehmedović A, Budimir J, Vince A, et al. Association of Nonalcoholic Fatty Liver Disease With COVID-19 Severity and Pulmonary Thrombosis: CovidFAT, a Prospective, Observational Cohort Study. Open Forum Infect Dis. 2022;9(4):ofac073. doi: https://doi.org/10.1093/ofid/ofac073
Herrero R, Sánchez G, Asensio I, López E, Ferruelo A, Vaquero J, et al. Liver-lung interactions in acute respiratory distress syndrome. Intensive Care Med Exp. 2020;8(Suppl 1):48. doi: https://doi.org/10.1186/s40635-020-00337-9
Adaptovana klinichna nastanova, zasnovana na dokazakh “Nehospitalna pnevmoniia u doroslykh osib: etiolohiia, patohenez, klasyfikatsiia, diahnostyka, antybakterialna terapiia ta profilaktyka” [Adapted evidence-based clinical guideline “Communicable disease pneumonia in adults: etiology, pathogenesis, classification, diagnosis, antimicrobial therapy and prevention”]. Kyiv; 2019. Ukrainian.
Zhdan VM, Babanina MY, Boriak KR, Kiriyan EA, Tkachenko MV. [Features of pathogenesis, course and therapy of pneumonia under Covid-19 (Literature Review)]. Actual problems of the modern medicine: Bulletin of Ukrainian medical stomatological academy. 2022;22(3-4):220-5. Ukrainian. doi: https://doi.org/10.31718/2077-1096.22.3.4.220
Ministry of Health of Ukraine. [On approval of the protocol “Providing medical care for the treatment of coronavirus disease (COVID-19)”. Order dated 2020 Apr 2 No. 762] [Internet]. 2020 [cited 2025 Dec 21]. Ukrainian. Available from: https://zakon.rada.gov.ua/rada/show/v0762282-20?lang=en#Text
Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Crit Care. 2020;24(1):154. doi: https://doi.org/10.1186/s13054-020-02880-z
Ghilotti F, Bellocco R, Ye W, Adami HO, Trolle Lagerros Y. Obesity and risk of infections: results from men and women in the Swedish National March Cohort. Int J Epidemiol. 2019;48(6):1783-94. doi: https://doi.org/10.1093/ije/dyz129
Hilliard KL, Allen E, Traber KE, Yamamoto K, Stauffer NM, Wasserman GA, et al. The Lung-Liver Axis: A Requirement for Maximal Innate Immunity and Hepatoprotection during Pneumonia. Am J Respir Cell Mol Biol. 2015;53(3):378-90. doi: https://doi.org/10.1165/rcmb.2014-0195OC
Gjurašin B, Jeličić M, Kutleša M, Papić N. The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes. Life (Basel). 2022;13(1):36. doi: https://doi.org/10.3390/life13010036
Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J, et al. Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respir Res. 2016;17(1):80. doi: https://doi.org/10.1186/s12931-016-0397-5
Manzhalii EG. [Nonalcoholic fatty liver disease. New nomenclature. Review]. Modern Gastroenterology. 2023;(4):91-7. Ukrainian. doi: https://doi.org/10.30978/MG-2023-4-91
Solomentseva TA. [New criteria for metabolic dysfunction-associated fatty liver disease: advantage or question? Review]. Modern Gastroenterology. 2023;(4):84-90. Ukrainian. doi: https://doi.org/10.30978/MG-2023-4-84
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 O. S. Khukhlina, I. V. Rachynska
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 
