Abstract
BackgroundDifferent pathogens can cause community-acquired pneumonia (CAP); however, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has re-emphasized the vital role of respiratory viruses as a cause of CAP. The aim was to explore differences in metabolic profile, body composition, physical capacity, and inflammation between patients hospitalized with CAP caused by different etiology.MethodsA prospective study of Danish patients hospitalized with CAP caused by SARS-CoV-2, influenza, or bacteria. Fat (FM) and fat-free mass (FFM) were assessed with bioelectrical impedance analysis. Physical activity and capacity were assessed using questionnaires and handgrip strength. Plasma (p)-glucose, p-lipids, hemoglobin A1c (HbA1c), p-adiponectin, and cytokines were measured.ResultsAmong 164 patients with CAP, etiology did not affect admission levels of glucose, HbA1c, adiponectin, or lipids. Overall, 15.2% had known diabetes, 6.1% had undiagnosed diabetes, 51.3% had pre-diabetes, 81% had hyperglycemia, and 60% had low HDL-cholesterol, with no difference between groups. Body mass index, FM, and FFM were similar between groups, with 73% of the patients being characterized with abdominal obesity, although waist circumference was lower in patients with COVID-19. Physical capacity was similar between groups. More than 80% had low handgrip strength and low physical activity levels. Compared to patients with influenza, patients with COVID-19 had increased levels of interferon (IFN)-γ (mean difference (MD) 4.14; 95% CI 1.36–12.58; p = 0.008), interleukin (IL)-4 (MD 1.82; 95% CI 1.12–2.97; p = 0.012), IL-5 (MD 2.22; 95% CI 1.09–4.52; p = 0.024), and IL-6 (MD 2.41; 95% CI 1.02–5.68; p = 0.044) and increased IFN-γ (MD 6.10; 95% CI 2.53–14.71; p < 0.001) and IL-10 (MD 2.68; 95% CI 1.53–4.69; p < 0.001) compared to patients with bacterial CAP, but no difference in IL-1β, tumor necrosis factor-α, IL-8, IL-18, IL-12p70, C-reactive protein, and adiponectin.ConclusionDespite higher inflammatory response in patients with COVID-19, metabolic profile, body composition, and physical capacity were similar to patients with influenza and bacterial CAP.
Highlights
Community-acquired pneumonia (CAP) is the leading cause of hospitalization and death from infectious diseases [1]
Known diabetes was based on a diagnosis from patient files and/or the use of antidiabetic medicine
In patients without known diabetes, undiagnosed diabetes was defined as admission hemoglobin A1c (HbA1c) ≥48 mmol/mol (≥6.5%), and pre-diabetes was defined as the criteria and were included in the study (Fig. 1)
Summary
Community-acquired pneumonia (CAP) is the leading cause of hospitalization and death from infectious diseases [1]. Various pathogens cause CAP but is dominated by a range of bacteria and viruses [2]. The emergence of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) causing coronavirus disease 2019 (COVID-19) has re-emphasized the vital role of respiratory viruses as a cause of CAP. Numerous studies have identified age, male sex, and especially obesity, diabetes, hypertension, and cardiovascular disease as strong risk factors for severe COVID-19 [3]. Similar risk factors have been associated with severe outcomes from CAP caused by bacteria or influenza viruses [4, 5]. People with obesity have an increased susceptibility to severe bacterial and viral infections, probably due to an impaired immune response [11, 12]. Dysregulated and/or exaggerated cytokine responses to the infection may cause immunopathology [7, 13], which is well-
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