NEW YORK -- New York Yankees starter Nestor Cortes was taken out of the do-or-die Game 4 of the American League Championship Series against the Houston Astros in the third inning because of a left groin injury.

On a windy and cool Sunday night, and with the game starting after an hour-and-a-half rain delay, Cortes struggled with his command, taking six of the first 10 batters he faced to a three-ball count.

Cortes appeared to slip on the mound at the start of the third inning while facing Jose Altuve, but he gave a thumbs up to the Yankees' dugout before manager Aaron Boone and head athletic trainer Tim Lentych came to check up on him.

Cortes issued his second walk of the inning to Altuve -- the first time he walked consecutive batters this year -- before hanging an 82 mph slider to Jeremy Pena, which the rookie shortstop barreled 408 feet to tie the game. Lentych and Boone escorted Cortes out of the game after that at-bat.

Cortes did not pitch between Aug. 21 and Sept. 8 because of a strained left groin, then returned to make five starts in the regular season and two against Cleveland in AL Division Series. In Game 4 of the ALCS on Sunday night, his fastball and slider velocity were both down about 1.5 mph from their season average.

Cortes was replaced by lefty reliever Wandy Peralta.

Speaking in-between innings during the TBS broadcast, Boone said the left groin was something Cortes had "kind of been dealing with really since the first game of the playoffs." Boone added that he had been able to pitch well despite the issue, but "it just started acting up more there."

Cortes ended up throwing just 28 of 55 pitches for strikes, allowing two hits and three walks in two innings. The outing was his shortest of 2022.

The Associated Press contributed to this story.