# Severe acute respiratory syndrome coronavirus 2 transaminase elevation likely of non‐hepatic origin, with protection from older age and vaccination

## TL;DR

The study finds that SARS-CoV-2-related transaminase elevation is more severe in younger, unvaccinated patients and is likely linked to disease severity rather than liver damage.

## Contribution

The study identifies vaccination and older age as protective factors against transaminase elevation in pediatric SARS-CoV-2 patients.

## Key findings

- Transaminase elevation was more common in younger patients and those requiring hospitalization.
- Vaccination was associated with lower transaminase levels but not the presence of elevation.
- Transaminase elevation appears to reflect disease severity rather than direct hepatic injury.

## Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has known liver tropism. Multiple reports and studies demonstrated liver injury early in the pandemic. This retrospective cross‐sectional comparison evaluates predictors of transaminase elevation during acute SARS‐CoV2 infection, with particular interest in evaluating whether vaccination is associated with transaminase elevations. We extracted electronic medical record data for pediatric SARS‐CoV2 patients presenting at safety net hospitals in Brooklyn, NY, between March 2020 and March 2022 with a coincident comprehensive metabolic panel, without multisystem inflammatory syndrome in children, prior liver disease and sickle cell disease (n = 133): 79.2% Black and 87% non‐Hispanic. Transaminase elevation was more common among younger patients and patients requiring hospitalization or intensive care unit care. Vaccination was associated with lower quantitative levels of transaminase elevation but not the binary indicator for elevated transaminases. In aggregate, our results suggest transaminase elevation is a function of SARS‐CoV2 disease severity.

Past research suggests severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) causes liver injury and potentially liver failure.SARS‐CoV2 infection has had variations in severity and involved tissue types between variants and with expanding population immunity.

Past research suggests severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) causes liver injury and potentially liver failure.

SARS‐CoV2 infection has had variations in severity and involved tissue types between variants and with expanding population immunity.

Vaccinated and older pediatric patients have lower risks of transaminase elevation, but age and vaccination could not be decoupled due to age‐specific vaccine eligibility.Association between transaminase elevation and level of care, unvaccinated status, and younger age suggests it may be a function of disease severity.

Vaccinated and older pediatric patients have lower risks of transaminase elevation, but age and vaccination could not be decoupled due to age‐specific vaccine eligibility.

Association between transaminase elevation and level of care, unvaccinated status, and younger age suggests it may be a function of disease severity.