Background and Aims: Coronavirus disease 2019 (COV-ID-19) is a global threat, affecting more than 100 million people and causing over 2 million deaths. Liver laboratory test abnormalities are an extrapulmonary manifestation of COVID-19, yet characterization of hepatic injury is incom-plete. Our objective was to further characterize and identify causes of liver injury in patients with COVID-19. Methods: We conducted a retrospective cohort study of 551 patients hospitalized with COVID-19 at NewYork-Presbyterian Hospi-tal/Columbia University Irving Medical Center between March 1, 2020 and May 31, 2020. We analyzed patient demograph-ics, liver laboratory test results, vital signs, other relevant test results, and clinical outcomes (mortality and intensive care unit admission). Results: Abnormal liver laboratory tests were common on hospital admission for COVID-19 and the incidence increased during hospitalization. Of those with elevated serum alanine aminotransferase and/or alkaline phosphatase activities on admission, 58.2％ had a choles-tatic injury pattern, 35.2％ mixed, and 6.6％ hepatocellular. Comorbid liver disease was not associated with outcome; however, abnormal direct bilirubin or albumin on admission were associated with intensive care unit stay and mortal-ity. On average, patients who died had greater magnitudes of abnormalities in all liver laboratory tests than those who survived. Ischemic hepatitis was a mechanism of severe hepatocellular injury in some patients. Conclusions: Liver laboratory test abnormalities are common in hospitalized patients with COVID-19, and some are associated with in-creased odds of intensive care unit stay or death. Severe hepatocellular injury is likely attributable to secondary ef-fects such as systemic inflammatory response syndrome, sepsis, and ischemic hepatitis.