Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Sep 20, 2025; 15(3): 107220
Published online Sep 20, 2025. doi: 10.5493/wjem.v15.i3.107220
Evaluation of short and long-term laboratory and instrumental findings in COVID-19 patients hospitalized in Tuscany
Caterina Silvestri, Cristina Stasi, Francesco Profili, Simone Bartolacci, Emiliano Sessa, Danilo Tacconi, Liliana Villari, Laura Carrozzi, Francesco Dotta, Elena Bargagli, Sandra Donnini, Luca Masotti, Laura Rasero, Federico Lavorini, Francesco Pistelli, Davide Chimera, Alessandra Sorano, Miriana D'alessandro, Martina Pacifici, Caterina Milli, Fabio Voller
Caterina Silvestri, Cristina Stasi, Francesco Profili, Simone Bartolacci, Emiliano Sessa, Martina Pacifici, Caterina Milli, Fabio Voller, Epidemiology Unit, Regional Health Agency of Tuscany, Florence 50141, Tuscany, Italy
Cristina Stasi, Department of Life Science, Health, and Health Professions, Link Campus University, Rome 00165, Italy
Danilo Tacconi, Infectious Diseases Unit, Department of Specialized and Internal Medicine, San Donato Hospital, Arezzo 52100, Tuscany, Italy
Liliana Villari, Division of Pneumology, "Ospedali Riuniti" AUSL Toscana Nord-Ovest, Livorno 57124, Italy
Laura Carrozzi, Francesco Pistelli, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa 56126, Italy
Laura Carrozzi, Francesco Pistelli, Davide Chimera, Respiratory Unit, Department of Cardiothoracic and Vascular, Pisa University Hospital, Pisa 56124, Italy
Francesco Dotta, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena 53100, Tuscany, Italy
Elena Bargagli, Miriana D'alessandro, Respiratory Diseases Unit, Department of Medical, Surgery and Neurological Sciences, University of Siena, Siena 53100, Tuscany, Italy
Sandra Donnini, Department of Life Sciences, University of Siena, Siena 53100, Tuscany, Italy
Luca Masotti, Internal Medicine II and Stroke Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, Empoli 50053, Tuscany, Italy
Laura Rasero, Department of Health Science, University of Florence, Firenze 50134, Italy
Federico Lavorini, Alessandra Sorano, Department of Experimental and Clinical Medicine, University of Florence, Firenze 50134, Italy
Author contributions: Silvestri C was responsible for project administration, supervision, funding acquisition; Stasi C was responsible for writing–review and editing, conceptualization; Profili F was responsible for formal analysis and methodology; Bartolacci S and Sessa E were responsible for data curation and software; Tacconi D, Villari L, Carrozzi L, Dotta F, Bargagli E, Donnini S, Masotti L, Rasero L, Lavorini F, Pistelli F, Chimera D, Sorano A, and D’Alessandro M were responsible for investigation and review; Pacifici M and Milli C were responsible for data curation; Voller F was responsible for supervision, validation, funding acquisition, and investigation; All authors have read and agreed to the published version of the manuscript.
Supported by Regione Toscana, No. D55H20000210002.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee as a part of the wider project entitled “prospective and retrospective study on outcomes and complications from COVID-19 in a cohort of hospitalized patients in Tuscany (SPRINT)”.
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The clinical and laboratory data are presented in this study.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cristina Stasi, MD, PhD, Associate Professor, Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, Florence 50141, Italy. cristina.stasi@ars.toscana.it
Received: March 25, 2025
Revised: April 17, 2025
Accepted: June 3, 2025
Published online: September 20, 2025
Processing time: 140 Days and 16.6 Hours
Abstract
BACKGROUND

The World Health Organization defined long coronavirus disease 2019 (COVID-19) as the continuation or development of new symptoms 3 months after the initial severe acute respiratory syndrome coronavirus 2 infection, with these symptoms lasting for at least 2 months with no other explanation.

AIM

To evaluate the potential laboratory and instrumental findings (short-term and long-term) resulting from COVID-19.

METHODS

This longitudinal observational COVID-19 cohort study (March 1, 2020-March 1, 2021) was carried out on patients ≥ 18 years old who were admitted to the University Hospitals of Pisa, Siena and Careggi and the Azienda USL Toscana Nord Ovest, Sud Est and USL Centro Toscana and were subjected to follow-up. Follow-up was conducted between 0 day and 89 days, 90 days and 179 days, 180 days and 269 days, 270 days and 359 days, and more than 360 days after hospitalization.

RESULTS

Of 2887 patients (58.5% males, average age 66.2 years) hospitalized in the study period (March 1, 2020-March 1, 2021) carrying out at least one follow-up examination within 12 months of discharge, a total of 1739 patients (705 males, average age 66 years) underwent laboratory tests, of whom 714 patients (470 males, average age 63 years) underwent spirometry. Some laboratory test results remained above the threshold even at follow-up beyond 360 days (C-reactive protein: 36%, fibrin degradation fragment: 48.8%, gamma-glutamyl transferase: 16.8%), while others showed a return to normal range more quickly in almost all patients. Alterations in liver enzymes, hematocrit, hemoglobin, lymphocytes and neutrophils were associated with the risk of requiring oxygen therapy or forced expiratory volume in one second/forced vital capacity alterations at follow-up.

CONCLUSION

Alterations in liver enzymes, hematocrit or hemoglobin, lymphocytes and neutrophils were associated with risk outcomes (need for oxygen therapy or spirometry alterations). These imbalanced conditions may contribute to pulmonary dysfunction.

Keywords: Long COVID-19; SARS-CoV-2; Transaminases; Fibrin degradation fragment; Gamma-glutamyl transferase; Spirometry

Core Tip: Long coronavirus disease 2019 (COVID-19) is a chronic condition that occurs after the initial severe acute respiratory syndrome coronavirus 2 infection. This longitudinal observational cohort study evaluates the short-term and long-term laboratory and instrumental findings in COVID-19 patients, and was conducted in hospitals in Tuscany between March 1, 2020, and March 1, 2021. The results indicated that alterations in liver enzymes, hematocrit or hemoglobin, lymphocytes and neutrophils were associated with a risk of requiring oxygen therapy or experiencing spirometry abnormalities during follow-up. These imbalanced conditions may contribute to pulmonary dysfunction and warrant further investigation to define potential pulmonary abnormalities.