Clinical, Laboratory, and Imaging Characteristics of Liver Involvement in Hospitalized Children With COVID‐19 in Iran During 2020–2021: A Cross‐Sectional Study

ABSTRACT Background and Aims Coronavirus disease 2019 (COVID‐19) affects multiple organs, including the liver. Although pediatric patients generally experience milder disease, liver involvement has been increasingly reported, and its impact on outcomes remains unclear. This study aimed to evaluate clinical, laboratory, and imaging characteristics of liver involvement in hospitalized children with COVID‐19. Methods We retrospectively analyzed 301 pediatric patients with confirmed COVID‐19 admitted to Mofid Children's Hospital, Tehran, Iran, from March 2020 to July 2021 who met the inclusion criteria. Patients were divided into two groups based on liver involvement. Liver involvement was defined as an alanine aminotransferase (ALT) level > 40 IU/L. Variables were compared between groups with and without liver involvement using both univariate and multivariable logistic regression analyses. A p < 0.05 was considered statistically significant. Results Elevated ALT was observed in 84 patients (27.9%). Liver involvement occurred significantly more often in children aged 10 years and older. Patients with hepatic involvement had higher rates of leukopenia, thrombocytopenia, elevated blood urea nitrogen (BUN), tachycardia, hypoxia, pulmonary infiltrations, and shock. The mean hospital stay was longer (7.27 vs. 6.07 days, p = 0.107). Intensive care unit (ICU) admission (29.7% vs. 15%; p = 0.003) and mortality (14.3% vs. 3.7%, p < 0.001) were both higher in the liver involvement group. Multivariate analysis showed that in children under 10 years of age, elevated BUN and pulmonary infiltrations independently predicted liver involvement, while in children ≥ 10 years, pre‐admission antibiotic use and normal hemoglobin (Hb) were associated factors with hepatic involvement. Conclusion Liver involvement is common among hospitalized pediatric COVID‐19 patients and is associated with worse clinical outcomes, including higher ICU admission and mortality rates. Early recognition and monitoring of hepatic dysfunction may improve management strategies in this population.