Older Age and Vaccination Protect Against Transaminase Elevation in Pediatric SARS-CoV2

ObjectivesSARS-CoV2 infection is reported to induce transaminase elevations. There are case reports of severe liver injury in adult SARS-CoV2 patients and some have theorized that acute SARS-CoV2 infection may be a driver of severe liver injury in children. While pediatric hepatic injury has previously been described, clear shifts in immunogenic response secondary to prior immune exposure and vaccination since initial reports from 2020 warrant further evaluation. We sought to identify the impact of variant shifts and vaccination on this phenomenon in children. MethodsA retrospective, cross-sectional study of pediatric SARS-CoV2 patients seen at two hospital facilities in an urban neighborhood in New York City between March 2020 and March 2022 was conducted via chart review. Data was extracted relating to patients demographics, clinical presentation, including the level of care and the laboratory results of comprehensive metabolic panels (CMP). Results133 pediatric cases were identified as having positive SARS-CoV2 and CMP obtained in the same visit. Patients were predominantly Black (79.2%) and non-Hispanic (87%) with a mean age of 9.2 years. Risk of transaminase elevation was increased in younger patients and patients with higher level of care. BMI was not a risk factor noted for transaminase elevation. Vaccination decreased degree, not incidence, of transaminase elevation but given low rates of vaccination unable to determine significance of protective efficacy. ConclusionsOur study has identified a profound increased risk of transaminase elevation in younger patients, the absence of BMI as a correlating factor in our primarily Black patient population, a shift towards non-specific AST elevation with variant windows and a strong signal of vaccine protection. What is KnownO_LISARS-CoV2 can cause Transaminemia, and in rare cases, possible fulminant hepatic injury C_LIO_LIPediatric SARS-CoV2 infections are statistically milder than adult. C_LIO_LISARS-Cov2 case severity and complications like multisystem inflammatory syndrome in children have declined over time C_LI What is NewO_LIWith population immunity and variant shifts transaminase elevations increasingly may not be of hepatic origin C_LIO_LIRisk of transaminase elevation is substantially higher in younger patients, and decreases with age C_LIO_LIVaccines are protective against degree of transaminase elevation, and likely against incidence of transaminase elevation, although further study is needed. C_LI Article SummaryCross sectional study of an urban pediatric population demonstrates SARS-CoV2 transaminase elevation linked with younger age, unvaccinated status, and higher level of care.