ArticleLiver international : official journal of the International Association for the Study of the Liver2021
Liver involvement in children with SARS-COV-2 infection: Two distinct clinical phenotypes caused by the same virus.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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28 citing papers in PubMed, 52 citations in OpenAlex.
- Clinical, Laboratory, and Imaging Characteristics of Liver Involvement in Hospitalized Children With COVID-19 in Iran During 2020-2021: A Cross-Sectional Study.Health science reports · 2026Article
- Hospitalization outcomes and laboratory correlations in pediatric MIS-C patients: a retrospective cross-sectional study in Tehran, Iran.BMC pediatrics · 2026Article
- Hepatitis is an underestimated complication among children with pneumonia associated with SARS-CoV-2 and influenza: a single center study.BMC pediatrics · 2026Article
- Severe acute respiratory syndrome coronavirus 2 transaminase elevation likely of non-hepatic origin, with protection from older age and vaccination.JPGN reports · 2025Article
- Article
- Safety of remdesivir in the treatment of acute SARS-CoV-2 infection in pediatric patients.BMC infectious diseases · 2024Observational
- COVID-19 presenting as severe acute hepatitis in a pediatric patient with thalassemia minor: A case report.Clinical case reports · 2024Article
- Liver abnormalities following SARS-CoV-2 infection in children 1 to 10 years of age.Family medicine and community health · 2024Article
- Hematological profile, inflammatory markers and serum liver enzymes in COVID 19 positive children vs. COVID 19 negative ones-a comparative study.Frontiers in pediatrics · 2024Article
- Non-A to E hepatitis in children: Detecting a novel viral epidemic during the COVID-19 pandemic.Microbial biotechnology · 2023Article
- Article
- COVID-19-induced liver injury in infants, children, and adolescents.World journal of clinical pediatrics · 2023Review
- COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations.World journal of hepatology · 2023Review
- Commentary on COVID-19-induced liver injury in various age and risk groups.World journal of virology · 2023Review
- Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments.World journal of gastroenterology · 2023Review
- Case report: Acute hepatitis in neonates with COVID-19 during the Omicron SARS-CoV-2 variant wave: a report of four cases.Frontiers in pediatrics · 2023Article
- Liver injury in COVID-19: A minireview.World journal of gastroenterology · 2022Review
- Unique hepatic manifestations of COVID-19-induced immune dysregulation in children.Clinical case reports · 2022Article
- Clinical and Laboratory Characteristics of Pediatric COVID-19 Population-A Bibliometric Analysis.Journal of clinical medicine · 2022Review
- A Case Series of Children with Acute Hepatitis and Human Adenovirus Infection.The New England journal of medicine · 2022Article
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsSevere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) associated acute liver injury (ALI) has been linked to poor outcomes in adults. Here we compare characteristics in children with elevated ALT (E-ALT) in two distinct manifestations of the infection, multisystem inflammatory syndrome-children (MIS-C) and coronavirus disease 2019 (COVID-19).
methodsThis is a retrospective study of patients ≤21 years of age with positive for SARS-CoV-2 PCR. E-ALT was defined as alanine aminotransferase (ALT) > 40 U/L. Bivariate analysis and multivariable logistic regression were obtained to describe differences in children with and without E-ALT in COVID-19 and MIS-C.
resultsE-ALT was detected in 36% of the 291 patients; 31% with COVID-19, and 51% with MIS-C. E-ALT in COVID-19 was associated with obesity (P < .001), immunocompromised status (P = .04), and chronic liver disease (P = .01). In the regression models, E-ALT in COVID-19 was associated with higher c-reactive protein (OR 1.08, P = .01) after adjusting for common independent predictors. Children with E-ALT and MIS-C were more often boys (P = .001), Hispanic (P = .04), or Black (P < .001). In MIS-C, male gender (OR 5.3, P = .02) and Black race (OR 4.4, P = .04) were associated with increased odds of E-ALT. Children with E-ALT in both cohorts had significantly higher multiorgan dysfunction, longer hospitalization, and ICU stay. Children with MIS-C had 2.3-fold increased risk of E-ALT compared to COVID-19. No association was found between E-ALT and mortality.
conclusionE-ALT with SARS-CoV-2 presents as elevated transaminases without hepatic synthetic dysfunction. Patients with either manifestation of SARS-CoV-2 infection and E-ALT experienced more severe disease.
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