{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:01:29Z","timestamp":1789970489829,"version":"4.0.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronavirus disease 2019 (COVID-19) is frequently accompanied by extrapulmonary manifestations, including abnormal liver biochemistry. Although inflammatory markers are widely used in clinical assessment, their associations with hepatic biochemical abnormalities in hospitalized patients with COVID-19 remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional secondary analysis included adults admitted with RT-PCR-confirmed COVID-19 at King Fahad Hospital Hofuf, Al-Ahsa, Saudi Arabia, from August through October 2020. Abnormal liver biochemistry was defined as alanine aminotransferase (ALT) &amp;gt;40 U\/L, aspartate aminotransferase (AST) &amp;gt;40 U\/L, or total bilirubin &amp;gt;21 \u03bcmol\/L. C-reactive protein (CRP), ferritin, and D-dimer were evaluated as exposure variables. Group comparisons used nonparametric tests, correlations were assessed using Spearman coefficients, and marker-specific multivariable logistic regression models adjusted for age, sex, diabetes mellitus, hypertension, and chronic kidney disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 631 hospitalized patients (mean age 54.4 \u00b1 14.4 years; 64.1% male), abnormal liver biochemistry was present in 59.2%. Ferritin levels were significantly higher in patients with abnormal than normal liver biochemistry (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), whereas CRP and D-dimer did not differ significantly. Ferritin correlated positively with ALT, AST, and total bilirubin. In adjusted analysis, ferritin remained associated with abnormal liver biochemistry (adjusted odds ratio 3.59 per ten-fold increase; 95% CI 2.19\u20135.90;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). CRP and D-dimer were not independently associated; these null findings should be interpreted cautiously because these markers had substantially more missing data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Abnormal liver biochemistry was common in this cohort of hospitalized patients with COVID-19. Ferritin showed the most consistent association with hepatic biochemical abnormalities, supporting its potential value as a marker of inflammation-related liver involvement in this population. Prospective studies with standardized laboratory assessment are needed to confirm temporality and clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1892718","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:34:52Z","timestamp":1789968892000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of inflammatory markers with abnormal liver biochemistry in hospitalized patients with COVID-19: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Omar","family":"Al-Omair","sequence":"first","affiliation":[{"name":"College of Medicine, King Faisal University","place":["Al-Ahsa, Saudi 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