The Etiology of Pediatric Hypertransaminasemia Before, During, and After the COVID-19 Pandemic: A Single-Center Experience from Türkiye.

OBJECTIVE: This study aimed to evaluate changes in the etiological distribution of pediatric hypertransaminasemia before, during, and after the COVID-19 pandemic and to assess their association with clinical presentation and biochemical severity. METHODS: This retrospective study evaluated temporal changes in the etiology of pediatric hypertransaminasemia before, during, and after the COVID-19 pandemic. A total of 607 children (aged 3 months to 18 years) with alanine aminotransferase (ALT) >45 IU/L and/or aspartate aminotransferase (AST) >50 IU/L persisting for ≥2 months were analyzed across 3 defined periods. Demographic data, clinical findings, and etiological diagnoses were compared. RESULTS: The most common causes of hypertransaminasemia were idiopathic (22.2%), abdominal trauma (17.4%), and other viral infections (14.2%). The distribution of etiologies showed variation across the 3 periods, with abdominal trauma predominating during the pandemic and autoimmune hepatitis emerging as the leading cause of severe hypertransaminasemia (ALT>1000 IU/L) post-pandemic. Asymptomatic cases and incidental enzyme elevations increased over time. CONCLUSION: The observed temporal shifts were primarily associated with indirect pandemic-related behavioral changes and healthcare utilization patterns rather than direct COVID-19-related liver involvement. These findings highlight how pandemic-related behavioral changes and population-level vaccination context may have influenced the diagnostic landscape of pediatric liver injury.