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

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.