{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:31Z","timestamp":1792789651686,"version":"4.5.0"},"reference-count":67,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Majmaah University","award":["R-2026-411"],"award-info":[{"award-number":["R-2026-411"]}],"id":[{"id":"https:\/\/ror.org\/01mcrnj60","id-type":"ROR","asserted-by":"crossref"}]},{"award":["R-2026-411"],"award-info":[{"award-number":["R-2026-411"]}],"id":[{"id":"https:\/\/ror.org\/01mcrnj60","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Research, Development and Innovation Authority (RDIA), Kingdom of Saudi Arabia","award":["RDIA-NIH-MU-HW-2024-1"],"award-info":[{"award-number":["RDIA-NIH-MU-HW-2024-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Viral respiratory infections remain a major cause of global morbidity and mortality, with severe disease increasingly recognized to involve profound interactions between inflammation, endothelial dysfunction, coagulation activation, and immunothrombosis. D-dimer, a fibrin degradation product and established biomarker of fibrin turnover, has gained considerable attention because of its strong association with adverse outcomes in coronavirus disease 2019 (COVID-19). This narrative review compares the evidence for D-dimer in COVID-19 with that available for other respiratory viruses and deliberately separates three questions that are frequently conflated: whether D-dimer predicts severity or death (prognostic), whether it identifies or excludes venous thromboembolism (diagnostic), and whether it identifies patients who benefit from anticoagulation (treatment-predictive). In COVID-19, elevated D-dimer is reproducibly associated with disease severity, thromboembolic complications, intensive care unit admission, and mortality, and the association persists after adjustment; however, discrimination is only moderate, incremental value over routine clinical variables has rarely been tested, and randomized trials have not established D-dimer as a treatment-selection biomarker. Outside of COVID-19, the evidence is substantially weaker and uneven: influenza is supported mainly by comparative cohorts, adenovirus by a single unvalidated paediatric prediction model, and the only direct study of D-dimer and clinical severity in bronchiolitis was negative, while for MERS-CoV, parainfluenza, and human metapneumovirus, we identified no study relating D-dimer to a clinical outcome. Moreover, substantial heterogeneity in assay methodology, sampling strategies, and proposed cut-off values restricts standardization and cross-study comparisons. We therefore present COVID-19 as a mechanistic and methodological reference rather than a validated universal rule, and summarize the evidence in a structured table and a visual evidence map. Overall, D-dimer appears to represent an integrated biomarker of coagulation activation, endothelial injury, and systemic inflammation rather than thrombosis alone, supporting its role in risk stratification while underscoring the need for context-specific interpretation. The cross-viral propositions advanced here should be regarded as hypothesis-generating. Future prospective multicentre studies using standardized assays, serial biomarker assessment, and multimarker prediction models are required to establish pathogen-specific prognostic frameworks and define the role of D-dimer in precision medicine for viral respiratory infections.<\/jats:p>","DOI":"10.3390\/ijms27198525","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:07:54Z","timestamp":1790240874000},"page":"8525","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["D-Dimer in Viral Respiratory Infections: Established Evidence in COVID-19 and Emerging Evidence in Other Respiratory Viruses"],"prefix":"10.3390","volume":"27","author":[{"given":"Yahya","family":"Madkhali","sequence":"first","affiliation":[{"name":"Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4948-5574","authenticated-orcid":false,"given":"Ayman","family":"Mubarak","sequence":"additional","affiliation":[{"name":"Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4719-2655","authenticated-orcid":false,"given":"Bandar","family":"Alosaimi","sequence":"additional","affiliation":[{"name":"Research Center, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh 11525, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6947-7582","authenticated-orcid":false,"given":"Wael","family":"Alturaiki","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/S1473-3099(24)00176-2","article-title":"Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990\u20132021: A systematic analysis from the Global Burden of Disease Study 2021","volume":"24","author":"Bender","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1002\/ppul.26370","article-title":"RSV through the COVID-19 pandemic: Burden, shifting epidemiology, and implications for the future","volume":"58","author":"Stein","year":"2023","journal-title":"Pediatr. Pulmonol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s44337-025-00518-z","article-title":"A comparative review on the epidemiology of influenza, COVID-19 and respiratory syncytial viruses","volume":"2","author":"Shuaibu","year":"2025","journal-title":"Discov. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1111\/jth.14859","article-title":"D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19","volume":"18","author":"Zhang","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Poudel, A., Poudel, Y., Adhikari, A., Aryal, B.B., Dangol, D., Bajracharya, T., Maharjan, A., and Gautam, R. (2021). D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0256744"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/s41577-021-00536-9","article-title":"Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19","volume":"21","author":"Bonaventura","year":"2021","journal-title":"Nat. Rev. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1186\/s13054-020-03062-7","article-title":"The vascular endothelium: The cornerstone of organ dysfunction in severe SARS-CoV-2 infection","volume":"24","author":"Pons","year":"2020","journal-title":"Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2652","DOI":"10.1111\/jth.15509","article-title":"Tissue factor expression, extracellular vesicles, and thrombosis after infection with the respiratory viruses influenza A virus and coronavirus","volume":"19","author":"Mackman","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103812","DOI":"10.1016\/j.ebiom.2022.103812","article-title":"Endothelial thrombomodulin downregulation caused by hypoxia contributes to severe infiltration and coagulopathy in COVID-19 patient lungs","volume":"75","author":"Won","year":"2022","journal-title":"eBioMedicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"21888","DOI":"10.1038\/s41598-021-01462-5","article-title":"D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: A systematic review and meta-analysis of 100 studies","volume":"11","author":"Varikasuvu","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1161\/ATVBAHA.120.314514","article-title":"Coagulation abnormalities and thrombosis in patients infected with SARS-CoV-2 and other pandemic viruses","volume":"40","author":"Mackman","year":"2020","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/s12931-020-01428-7","article-title":"Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19","volume":"21","author":"Ye","year":"2020","journal-title":"Respir. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s40560-020-00466-z","article-title":"D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study","volume":"8","author":"Yao","year":"2020","journal-title":"J. Intensive Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11239-021-02527-y","article-title":"Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study)","volume":"53","author":"Favaloro","year":"2022","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00134-020-06062-x","article-title":"High risk of thrombosis in patients with severe SARS-CoV-2 infection: A multicenter prospective cohort study","volume":"46","author":"Helms","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_16","first-page":"489","article-title":"COVID-19 and coagulation: Bleeding and thrombotic manifestations of SARS-CoV-2 infection","volume":"136","author":"Leaf","year":"2020","journal-title":"Blood J. Am. Soc. Hematol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.ajem.2020.09.018","article-title":"Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis","volume":"39","author":"Gungor","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10760296211010976","DOI":"10.1177\/10760296211010976","article-title":"Diagnostic value of D-dimer in COVID-19: A meta-analysis and meta-regression","volume":"27","author":"Zhan","year":"2021","journal-title":"Clin. Appl. Thromb.\/Hemost."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s40164-021-00228-z","article-title":"Platelet-driven coagulopathy in COVID-19 patients: In comparison to seasonal influenza cases","volume":"10","author":"Zhang","year":"2021","journal-title":"Exp. Hematol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fanlo-Garcia, P., P\u00e9rez-Fern\u00e1ndez, X.L., Fuset-Cabanes, M.P., Corral-Ansa, L., Gumucio-Sanguino, V.D., Rigo-Bonnin, R., Gordillo-Benitez, M., Garc\u00eda-Zalo\u00f1a, A., Soley-Corderas, R., and Sabater-Riera, J. (2023). Prognostic value of d-dimer across four populations of critically ill patients (pulmonary embolism, influenza A pneumonia, COVID-19 and septic shock) [dataset]. Mendeley Data, V1.","DOI":"10.2139\/ssrn.4648531"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e23657","DOI":"10.1002\/jcla.23657","article-title":"Peripheral blood inflammatory markers in predicting prognosis in patients with COVID-19. Some differences with influenza A","volume":"35","author":"Zhao","year":"2021","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3122","DOI":"10.1038\/s41598-025-87690-5","article-title":"Elevated D-dimer on admission may predict poor prognosis in childhood influenza associated encephalopathy","volume":"15","author":"Wang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_23","first-page":"A4367854","article-title":"The impact of viral infection with SARS-CoV-2 and influenza on plasma endothelial, thrombotic and renal biomarkers","volume":"152","author":"Bakr","year":"2025","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/rth2.12496","article-title":"Risk of thrombotic complications in influenza versus COVID-19 hospitalized patients","volume":"5","author":"Stals","year":"2021","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1001\/jama.2022.13072","article-title":"Association of COVID-19 vs influenza with risk of arterial and venous thrombotic events among hospitalized patients","volume":"328","author":"Dutcher","year":"2022","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"104362","DOI":"10.1016\/j.jcv.2020.104362","article-title":"Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past","volume":"127","author":"Giannis","year":"2020","journal-title":"J. Clin. Virol."},{"key":"ref_27","first-page":"e168321","article-title":"Association of D-dimer levels with bronchiolitis severity in children","volume":"17","author":"Hosseini","year":"2026","journal-title":"J. Compr. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/S0140-6736(24)01716-1","article-title":"Severe respiratory syncytial virus infection in children: Burden, management, and emerging therapies","volume":"404","author":"Mazur","year":"2024","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13052-024-01771-1","article-title":"Risk factor analysis and prediction model construction for severe adenovirus pneumonia in children","volume":"50","author":"Liang","year":"2024","journal-title":"Ital. J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s13613-019-0559-y","article-title":"Human metapneumovirus as cause of severe community-acquired pneumonia in adults: Insights from a ten-year molecular and epidemiological analysis","volume":"9","author":"Vidaur","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1016\/S0140-6736(21)01203-4","article-title":"Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): An open-label, multicentre, randomised, controlled trial","volume":"397","author":"Lopes","year":"2021","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1056\/NEJMoa2105911","article-title":"Therapeutic anticoagulation with heparin in noncritically ill patients with Covid-19","volume":"385","author":"Attacc","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"ehac544-2703","DOI":"10.1093\/eurheartj\/ehac544.2703","article-title":"D-dimer-driven versus standard prophylactic anticoagulation with fondaparinux in critically ill patients with COVID-19 and coagulopathy: An open-label, randomized controlled trial","volume":"43","author":"Adrian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1007\/s00392-023-02240-1","article-title":"Initial therapeutic anticoagulation with rivaroxaban compared to prophylactic therapy with heparins in moderate to severe COVID-19: Results of the COVID-PREVENT randomized controlled trial","volume":"112","author":"Puccini","year":"2023","journal-title":"Clin. Res. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gong, W., Gao, K., Shan, Z., Yang, L., Fang, P., Li, C., Yang, J., and Ni, J. (2024). Research progress of biomarkers in evaluating the severity and prognostic value of severe pneumonia in children. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1417644"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1177\/1358863X20932640","article-title":"COVID\u201319-associated coagulopathy: An exploration of mechanisms","volume":"25","author":"Colling","year":"2020","journal-title":"Vasc. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Len, P., Iskakova, G., Sautbayeva, Z., Kussanova, A., Tauekelova, A.T., Sugralimova, M.M., Dautbaeva, A.S., Abdieva, M.M., Ponomarev, E.D., and Tikhonov, A. (2022). Meta-analysis and systematic review of coagulation disbalances in COVID-19: 41 studies and 17,601 patients. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.794092"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1038\/s41579-021-00542-7","article-title":"Influenza virus and SARS-CoV-2: Pathogenesis and host responses in the respiratory tract","volume":"19","author":"Flerlage","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1016\/S2213-2600(20)30216-2","article-title":"COVID-19 cytokine storm: The interplay between inflammation and coagulation","volume":"8","author":"Jose","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1007\/s11239-020-02171-y","article-title":"Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: A retrospective analysis","volume":"50","author":"Yu","year":"2020","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1161\/CIRCRESAHA.120.317703","article-title":"Platelets can associate with SARS-CoV-2 RNA and are hyperactivated in COVID-19","volume":"127","author":"Zaid","year":"2020","journal-title":"Circ. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1111\/jth.14960","article-title":"Fibrinolysis and COVID-19: A plasmin paradox","volume":"18","author":"Medcalf","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100745","DOI":"10.1016\/j.blre.2020.100745","article-title":"Coagulation dysfunction in COVID-19: The interplay between inflammation, viral infection and the coagulation system","volume":"46","author":"Lazzaroni","year":"2021","journal-title":"Blood Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e671","DOI":"10.1016\/S2352-3026(20)30217-9","article-title":"Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: A retrospective cohort study","volume":"7","author":"Liao","year":"2020","journal-title":"Lancet Haematol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.advms.2021.07.009","article-title":"INR and COVID-19 severity and mortality: A systematic review with meta-analysis and meta-regression","volume":"66","author":"Zinellu","year":"2021","journal-title":"Adv. Med. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1038\/s41569-021-00665-7","article-title":"Current and novel biomarkers of thrombotic risk in COVID-19: A consensus statement from the international COVID-19 thrombosis biomarkers colloquium","volume":"19","author":"Gorog","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1097\/CCM.0000000000004458","article-title":"Coagulopathy of coronavirus disease 2019","volume":"48","author":"Iba","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Grobler, C., Maphumulo, S.C., Grobbelaar, L.M., Bredenkamp, J.C., Laubscher, G.J., Lourens, P.J., Steenkamp, J., Kell, D.B., and Pretorius, E. (2020). Covid-19: The rollercoaster of fibrin (ogen), d-dimer, von willebrand factor, p-selectin and their interactions with endothelial cells, platelets and erythrocytes. Int. J. Mol. Sci., 21.","DOI":"10.20944\/preprints202007.0142.v1"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1515\/cclm-2022-0633","article-title":"D-dimer: Old dogmas, new (COVID-19) tricks","volume":"61","author":"Lippi","year":"2023","journal-title":"Clin. Chem. Lab. Med. (CCLM)"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"00260","DOI":"10.1183\/23120541.00260-2020","article-title":"D-dimer as an indicator of prognosis in SARS-CoV-2 infection: A systematic review","volume":"6","author":"Vidali","year":"2020","journal-title":"ERJ Open Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"13155","DOI":"10.1038\/s41598-022-16915-8","article-title":"Coagulation parameters abnormalities and their relation to clinical outcomes in hospitalized and severe COVID-19 patients: Prospective study","volume":"12","author":"Esmaeel","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.ijid.2020.09.021","article-title":"Meta-analysis of coagulation parameters associated with disease severity and poor prognosis of COVID-19","volume":"100","author":"Zhang","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Li, Y., Deng, Y., Ye, L., Sun, H., Du, S., Huang, H., Zeng, F., Chen, X., and Deng, G. (2021). Clinical significance of plasma D-dimer in COVID-19 mortality. Front. Med., 8.","DOI":"10.3389\/fmed.2021.638097"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1515\/cclm-2020-0573","article-title":"Reporting of D-dimer data in COVID-19: Some confusion and potential for misinformation","volume":"58","author":"Favaloro","year":"2020","journal-title":"Clin. Chem. Lab. Med. (CCLM)"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1055\/s-0044-1791700","article-title":"D-dimer\u2014An International Assessment of the Quality of Laboratory Testing: Implications for D-dimer Use in the Real World","volume":"51","author":"Elbaz","year":"2025","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1080\/17474086.2020.1831383","article-title":"D-dimer level in COVID-19 infection: A systematic review","volume":"13","author":"Rostami","year":"2020","journal-title":"Expert Rev. Hematol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1111\/imj.14322","article-title":"Elevated D-dimer levels predict adverse outcomes in hospitalised elderly patients with chronic heart failure","volume":"49","author":"Yan","year":"2019","journal-title":"Intern. Med. J."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Belo, L., Valente, M.J., Rocha, S., Coimbra, S., Catarino, C., Lousa, I., Bronze-Da-Rocha, E., Rocha-Pereira, P., Sameiro-Faria, M.D., and Oliveira, J.G. (2024). Age-Related changes in clinical and analytical variables in chronic hemodialyzed patients. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25063325"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Zhao, R., Su, Z., Komissarov, A.A., Liu, S.-L., Yi, G., Idell, S., Matthay, M.A., and Ji, H.-L. (2021). Associations of D-dimer on admission and clinical features of COVID-19 patients: A systematic review, meta-analysis, and meta-regression. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.691249"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"144","DOI":"10.14336\/AD.2021.0704","article-title":"Coagulation disorders and thrombosis in COVID-19 patients and a possible mechanism involving endothelial cells: A review","volume":"13","author":"Chen","year":"2022","journal-title":"Aging Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jamcollsurg.2020.05.007","article-title":"Fibrinolysis shutdown correlation with thromboembolic events in severe COVID-19 infection","volume":"231","author":"Wright","year":"2020","journal-title":"J. Am. Coll. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"117788","DOI":"10.1016\/j.lfs.2020.117788","article-title":"The role of biomarkers in diagnosis of COVID-19\u2013A systematic review","volume":"254","author":"Kermali","year":"2020","journal-title":"Life Sci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1055\/a-1477-3829","article-title":"Platelet count rose while D-dimer levels dropped as deaths and thrombosis declined\u2014An observational study on anticoagulation shift in COVID-19","volume":"121","author":"Warnqvist","year":"2021","journal-title":"Thromb. Haemost."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s43168-023-00221-6","article-title":"d-dimer as a biomarker for COVID-19-associated pulmonary thromboembolism: A narrative review from molecular pathways to the imaging findings","volume":"17","author":"Beidollahkhani","year":"2023","journal-title":"Egypt. J. Bronchol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"37","DOI":"10.29271\/jcpsp.2022.01.37","article-title":"Mortality in patients of COVID-19 infection: Biochemical markers and its cut-off values for predicting outcome","volume":"32","author":"Yousaf","year":"2022","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s43678-022-00440-8","article-title":"Prognostic association between d-dimer thresholds and 30-day pulmonary embolism diagnosis among emergency department patients with suspected SARS-CoV-2 infection: A Canadian COVID-19 Emergency Department Rapid Response Network study","volume":"25","author":"Lin","year":"2023","journal-title":"Can. J. Emerg. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e39665","DOI":"10.1097\/MD.0000000000039665","article-title":"Prospective cohort study on the clinical significance of interferon-\u03b3, D-dimer, LDH, and CRP tests in children with severe Mycoplasma pneumonia","volume":"103","author":"Zhang","year":"2024","journal-title":"Medicine"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/19\/8525\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:24:39Z","timestamp":1790396679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/19\/8525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":67,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["ijms27198525"],"URL":"https:\/\/doi.org\/10.3390\/ijms27198525","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}