A Narrative Review on the Significance of Ferritin, D-Dimer, and C-Reactive Protein in the Severity and Mortality of COVID-19 Patients

Authors

DOI:

https://doi.org/10.62482/pmj.42

Keywords:

Biomarkers, COVID-19, C-reactive protein, D-dimer, ferritin

Abstract

Ferritin, the principal intracellular iron-storage protein, performs multiple physiological functions in the human body, including a significant role in inflammatory processes. COVID-19 pathogenesis is marked by a profound inflammatory response and disruption of iron homeostasis. Patients with COVID-19 have consistently been reported with altered iron levels. In this literature review, we aim to examine the association of ferritin, along with D-dimer and C-reactive protein, with hospitalization, disease severity, and mortality in COVID-19 patients. As a primary biomarker, ferritin, particularly when evaluated in combination with the other markers, may play a crucial role in improving risk stratification and enabling timely clinical interventions to prevent progression to severe respiratory or systemic failure.

References

Kotla NK, Dutta P, Parimi S, Das NK. The Role of Ferritin in Health and Disease: Recent Advances and Understandings. Metabolites. 2022;12:609. https://doi.org/10.3390/metabo12070609

Arosio P, Cairo G, Bou-Abdallah F. A Brief History of Ferritin, an Ancient and Versatile Protein. Int J Mol Sci. 2024;26(1):206. https://doi.org/10.3390/ijms26010206

Jamal M, Bangash HI, Habiba M, Lei Y, Xie T, Sun J, Wei Z, Hong Z, Shao L, Zhang Q. Immune dysregulation and system pathology in COVID-19. Virulence. 2021;12(1):918-936. https://doi.org/10.1080/21505594.2021.1898790

Nazerian Y, Ghasemi M, Yassaghi Y, Nazerian A, Hashemi SM. Role of SARS-CoV-2-induced cytokine storm in multi-organ failure: Molecular pathways and potential therapeutic options. Int Immunopharmacol. 2022;113:109428. https://doi.org/10.1016/j.intimp.2022.109428

Silva MJA, Ribeiro LR, Gouveia MIM, Marcelino BDR, Santos CSD, Lima KVB, Lima LNGC. Hyperinflammatory Response in COVID-19: A Systematic Review. Viruses. 2023;15(2):553. https://doi.org/10.3390/v15020553

Murvanidze I, Nakashidze I, Gogitidze T, Jahja E, Shaikh AP, Tebidze N, Shaikh NP, Kakabadze B, Resulidze M, Khurana R. Correlation of ferritin, D-dimer, and CRP with disease severity and outcome in COVID-19 patients. Eur Chem Biotechnol J. 2025;4:24-39. https://doi.org/10.62063/ecb-59

Sukrisman L, Sinto R. Coagulation profile and correlation between D-dimer, inflammatory markers, and COVID-19 severity in an Indonesian national referral hospital. J Int Med Res 2021;49(11):03000605211059939. https://doi.org/10.1177/03000605211059939

Hiti L, Markovič T, Lainscak M, Farkaš Lainščak J, Pal E, Mlinarič-Raščan I. The immunopathogenesis of a cytokine storm: The key mechanisms underlying severe COVID-19. Cytokine Growth Factor Rev. 2025;82:1-17. https://doi.org/10.1016/j.cytogfr.2024.12.003

Ruscitti P, Berardicurti O, Barile A, Cipriani P, Shoenfeld Y, Iagnocco A, Giacomelli R. Severe COVID-19 and Related Hyperferritinaemia: More Than An Innocent Bystander? Ann Rheum Dis. 2020;79(11):1515–6. https://doi.org/10.1136/annrheumdis-2020-217618

Lam MT, Jiang CL, Lee PY. T-ing Up The Storm: Pathogenic Cycling Lymphocytes In The Biology of Macrophage Activation Syndrome. Pediatr Rheumatol. 2025;23(1):29. https://doi.org/10.1186/s12969-025-01081-8

Lee PY, Cron RQ. The Multifaceted Immunology of Cytokine Storm Syndrome. J Immunol. 2023;210(8):1015-1024. https://doi.org/10.4049/jimmunol.2200808

Weaver LK, Behrens EM. Hyperinflammation, rather than hemophagocytosis, is the common link between Macrophage Activation Syndrome and Hemophagocytic Lymphohistiocytosis. Curr Opin Rheumatol. 2014;26(5):562-569. https://doi.org/10.1097/BOR.0000000000000093

Dhondge RH, Agrawal S, Kumar S, Acharya S, Karwa V. A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease. Cureus. 2024;16(3):e57365. https://doi.org/10.7759/cureus.57365

Fang YP, Zhang HJ, Guo Z, Ren CH, Zhang YF, Liu Q, Wang Z, Zhang X. Effect of Serum Ferritin on the Prognosis of Patients with Sepsis: Data from the MIMIC-IV Database. Emerg Med Int. 2022;2022:2104755. https://doi.org/10.1155/2022/2104755

Liao Y, Zeng T, Guo X, Li X. Ferritin's role in infectious diseases: Exploring pathogenic mechanisms and clinical implications. New Microbes New Infect. 2025;65:101582. https://doi.org/10.1016/j.nmni.2025.101582

Abdullateef Abdullah Z, Fouad Ali L. Role of Serum Ferritin, D-Dimer, and C-Reactive Protein Parameters in COVID 19 Severity. Arch Razi Inst. 2023;78(2):737-742. https://doi.org/10.22092/ARI.2022.359731.2466

Huyut MT, Huyut Z. Effect of Ferritin, INR, and D-Dimer Immunological Parameters Levels As Predictors of COVID-19 Mortality: A Strong Prediction with The Decision Trees. Heliyon 2023;9:e14015. https://doi.org/10.1016/j.heliyon.2023.e14015

Ahirwar B, Ahmad M, Ahmad M. A Study on the Correlation Between Serum Ferritin Levels and Disease Severity in Patients with COVID-19. Eur J Cardiovasc Med. 2025;15:420-424. https://doi.org/10.5083/ejcm/25-06-76

Abulseoud OA, Yehia A, Egol CJ, Nettey VN, Aly M, Qu Y, Skolnik AB, Grill MF, Sen A, Schneekloth TD. Attenuated initial serum ferritin concentration in critically ill coronavirus disease 2019 geriatric patients with comorbid psychiatric conditions. Front Psychiatry. 2022;13:1035986. https://doi.org/10.3389/fpsyt.2022.1035986

Bozkurt FT, Tercan M, Patmano G, Bingol Tanrıverdi T, Demir HA, Yurekli UF. Can Ferritin Levels Predict the Severity of Illness in Patients With COVID-19? Cureus.13(1):e12832. https://doi.org/10.7759/cureus.12832

Kurian SJ, Mathews SP, Paul A, Viswam SK, Kaniyoor Nagri S, Miraj SS, Karanth S. Association of serum ferritin with severity and clinical outcome in COVID-19 patients: An observational study in a tertiary healthcare facility. Clin Epidemiol Glob Health. 2023;21:101295. https://doi.org/10.1016/j.cegh.2023.101295

Zhang X, Shang N, Zhang D, Wu J, Guo S. The independent predictive value of admission serum ferritin concentration for prognosis in elderly patients with community-acquired pneumonia in the emergency department. Front Cell Infect Microbiol.2025;14:1505207. https://doi.org/10.3389/fcimb.2024.1505207

Bobbio-Pallavicini F, Verde G, Spriano P, Losi R, Bosatra MG, Braschi A, Iotti G, Chiaranda M, Villa S. Body iron status in critically ill patients: significance of serum ferritin. Intensive Care Med. 1989;15(3):171-178. https://doi.org/10.1007/BF01058569

Shakaroun DA, Lazar MH, Horowitz JC, Jennings JH. Serum Ferritin as a Predictor of Outcomes in Hospitalized Patients with Covid-19 Pneumonia. J Intensive Care Med. 2023;38:21-26. https://doi.org/10.1177/08850666221113252

Sharkey RA, Donnelly SC, Connelly KG, Robertson CE, Haslett C, Repine JE. Initial serum ferritin levels in patients with multiple trauma and the subsequent development of acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1506-1509. https://doi.org/10.1164/ajrccm.159.5.9809027

Fauter M, Mainbourg S, El Jammal T, Guerber A, Zaepfel S, Henry T, Gerfaud-Valentin M, Sève P, Jamilloux Y. Extreme Hyperferritinemia: Causes and Prognosis. J Clin Med. 2022; 11(18):5438. https://doi.org/10.3390/jcm11185438

Bellmann-Weiler R, Lanser L, Barket R, Rangger L, Schapfl A, Schaber M, Fritsche G, Wöll E, Weiss G. Prevalence and Predictive Value of Anemia and Dysregulated Iron Homeostasis in Patients with COVID-19 Infection. J Clin Med. 2020;9(8):2429. https://doi.org/10.3390/jcm9082429

Patil S, Dhumal U, Acharya A. Correlation of Ferritin with The Duration of Illness, Disease Severity, Oxygenation Status, Ventilatory Requirement, and Lung Fibrosis in COVID-19 Pneumonia: A Single-Center Experience of 1000 Cases in Tertiary Care Setting in India. Adesh Univ J Med Sci Res 2022;4:86-93. https://doi.org/10.25259/AUJMSR_35_2022

Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324-1329. https://doi.org/10.1111/jth.14859

Raychaudhuri S, Pujani M, Menia R, Verma N, Singh M, Chauhan V, Jain M, Chandoke RK, Kaur H, Agrawal S, Singh A. COVID-19 Associated Coagulopathy in an Indian Scenario: A Correlation with Disease Severity and Survival Status. Indian J Hematol Blood Transfus. 2022;38(2):341-351. https://doi.org/10.1007/s12288-021-01465-2

Li Y, Deng Y, Ye L, Sun H, Du S, Huang H, Zeng F, Chen X, Deng G. Clinical Significance of Plasma D-Dimer in COVID-19 Mortality. Front. Med. 2021;8:638097. https://doi.org/10.3389/fmed.2021.638097

Artifoni M, Danic G, Gautier G, Gicquel P, Boutoille D, Raffi F, Néel A, Lecomte R. Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors. J Thromb Thrombolysis. 2020;50(1):211-216. https://doi.org/10.1007/s11239-020-02146-z

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and Clinical Characteristics of 99 Cases Of 2019 Novel Coronavirus Pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. https://doi.org/10.1016/S0140-6736(20)30211-7

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-847. https://doi.org/10.1111/jth.14768

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, Clark C, Iba T. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-1026. https://doi.org/10.1111/jth.14810

Naymagon L, Zubizarreta N, Feld J, van Gerwen M, Alsen M, Thibaud S, Kessler A, Venugopal S, Makki I, Qin Q, Dharmapuri S, Jun T, Bhalla S, Berwick S, Christian K, Mascarenhas J, Dembitzer F, Moshier E, Tremblay D. Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19. Thromb Res. 2020;196:99-105. https://doi.org/10.1016/j.thromres.2020.08.032

Ali N. Elevated level of C‐reactive protein may be an early marker to predict risk for severity of COVID‐19. J Med Virol. 2020;92:2409-2411. https://doi.org/10.1002/jmv.26097

Luan Y, Yin C, Yao Y. Update Advances on C-Reactive Protein in COVID-19 and Other Viral Infections. Front Immunol. 2021;12:720363. https://doi.org/10.3389/fimmu.2021.720363

Stringer D, Braude P, Myint PK, Evans L, Collins JT, Verduri A, et al. The role of C-reactive protein as a prognostic marker in COVID-19. Int J Epidemiol. 2021;50:420–9. https://doi.org/10.1093/ije/dyab012

Conte G, Cei M, Evangelista I, Colombo A, Vitale J, Mazzone A, et al. The Meaning of D-Dimer value in Covid-19. Clin Appl Thromb. 2021;27:10760296211017668. https://doi.org/10.1177/10760296211017668

Schutgens RE. D-dimer in COVID-19: A Guide With Pitfalls. HemaSphere. 2020;4:e422. https://doi.org/10.1097/HS9.0000000000000422

Hulkoti VS, Acharya S, Kumar S, Talwar D, Khanna S, Annadatha A, et al. Association of serum ferritin with COVID-19 in a cross-sectional study of 200 intensive care unit patients in a rural hospital: Is ferritin the forgotten biomarker of mortality in severe COVID-19? J Fam Med Prim Care. 2022;11:2045-2050. https://doi.org/10.4103/jfmpc.jfmpc_1921_21

Yousaf MN, Sarwar S, Tarique S, Ahmed M, Tahir H. Mortality in Patients of COVID-19 Infection: Biochemical Markers and its Cut-off Values for Predicting Outcome. J Coll Physicians Surg--Pak JCPSP. 2022;32:37-41. https://doi.org/10.29271/jcpsp.2022.01.37

Kaushal K, Kaur H, Sarma P, Bhattacharyya A, Sharma DJ, Prajapat M, Pathak M, Kothari A, Kumar S, Rana S, Kaur M, Prakash A, Mirza AA, Panda PK, Vivekanandan S, Omar BJ, Medhi B, Naithani M. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. J Crit Care. 2022;67:172-181. https://doi.org/10.1016/j.jcrc.2021.09.023

Hanafi FD, Esa T, Nurulita A, Mumang AA. D-Dimer, ferritin, and lactate dehydrogenase (LDH) as predictors of mortality in hospitalized COVID-19 patients. J Infect Dev Ctries. 2024;18:S27-32. https://doi.org/10.3855/jidc.18833

Hakami A, Altubayqi T, Qadah EA, Zogel B, Alfaifi SM, Refaei E, Sayed A, Alhazmi L, Sayegh M, Alamer A, Areeshi AS, Hakami D. Biochemical Analysis of Ferritin and D-dimer in COVID-19 Survivors and Non-survivors. Cureus. 2023;15(9):e45389. https://doi.org/10.7759/cureus.45389

Para O, Caruso L, Pestelli G, Tangianu F, Carrara D, Maddaluni L, Tamburello A, Castelnovo L, Fedi G, Guidi S, Pestelli C, Pennella B, Ciarambino T, Nozzoli C, Dentali F. Ferritin as prognostic marker in COVID-19: the FerVid study. Postgrad Med. 2022;134:58–63. https://doi.org/10.1080/00325481.2021.1990091

Franco-Martínez L, Cerón JJ, Vicente-Romero MR, Bernal E, Torres Cantero A, Tecles F, Sánchez Resalt C, Martínez M, Tvarijonaviciute A, Martínez-Subiela S. Salivary Ferritin Changes in Patients with COVID-19. Int J Environ Res Public Health. 2021;19(1):41. https://doi.org/10.3390/ijerph19010041

Dahan S, Segal G, Katz I, Hellou T, Tietel M, Bryk G, Amital H, Shoenfeld Y, Dagan A. Ferritin as a Marker of Severity in COVID-19 Patients: A Fatal Correlation. Isr Med Assoc J IMAJ. 2020;22:494-500.

Feld J, Tremblay D, Thibaud S, Kessler A, Naymagon L. Ferritin levels in patients with COVID-19: A poor predictor of mortality and hemophagocytic lymphohistiocytosis. Int J Lab Hematol. 2020;42:773-779. https://doi.org/10.1111/ijlh.13309

Lino K, Guimarães GMC, Alves LS, Oliveira AC, Faustino R, Fernandes CS, Tupinambá G, Medeiros T, Silva AAD, Almeida JR. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2021;25:101569. https://doi.org/10.1016/j.bjid.2021.101569

Ramonfaur D, Aguirre-García GM, Diaz-Garza CA, Torre-Amione G, Sanchez-Nava VM, Lara-Medrano R, Ramírez-Elizondo MT, Esparza-Sandoval AC, Ortega-Hernández FJ, Martínez-Reséndez MF. Early increase of serum ferritin among COVID-19 patients is associated with need of invasive mechanical ventilation and with in-hospital death. Infect Dis Lond Engl. 2022;54:810-818. https://doi.org/10.1080/23744235.2022.2101691

Volfovitch Y, Tsur AM, Gurevitch M, Novick D, Rabinowitz R, Mandel M, et al. The intercorrelations between blood levels of ferritin, sCD163, and IL-18 in COVID-19 patients and their association to prognosis. Immunol Res. 2022;70(6):817-828. https://doi.org/10.1007/s12026-022-09312-w

Alroomi M, Rajan R, Omar AA, Alsaber A, Pan J, Fatemi M, Zhanna KD, Aboelhassan W, Almutairi F, Alotaibi N, Saleh MA, AlNasrallah N, Al-Bader B, Malhas H, Ramadhan M, Abdullah M, Abdelnaby H. Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients. Immun Inflamm Dis. 2021;9:1648-1655. https://doi.org/10.1002/iid3.517

Paixão JTR, Santos CJSE, França APFM, Lima SS, Laurentino RV, Fonseca RRS, Vallinoto ACR, Oliveira-Filho AB, Machado LFA. Association of D-Dimer, C-Reactive Protein, and Ferritin with COVID-19 Severity in Pregnant Women: Important Findings of a Cross-Sectional Study in Northern Brazil. Int J Environ Res Public Health. 2023;20:6415. https://doi.org/10.3390/ijerph20146415

Patel SV, Pathak JM, Parikh RJ, Pandya KJ, Kothari PB, Patel A. Association of Inflammatory Markers With Disease Progression and the Severity of COVID-19. Cureus. 2024;16(2):e54840. https://doi.org/10.7759/cureus.54840

Shaikh AA, Mubasher TA, Makkawi MH, Alasmari SZ. Predictive value of ferritin, glucose, urea, and creatinine for COVID-19 severity and mortality in patients from Asir, Saudi Arabia. Saudi Med J. 2023;44:773-781. https://doi.org/10.15537/smj.2023.44.8.20230162

AbdelFattah EB, Madkour AM, Amer SMI, Ahmed NO. Correlation between the serum level of ferritin and D-dimer and the severity of COVID-19 infection. Egypt J Bronchol. 2023;17:45. https://doi.org/10.1186/s43168-023-00218-1

Jaskolowska J, Balcerzyk-Barzdo E, Jozwik A, Gaszynski T, Ratajczyk P. Selected Predictors of COVID-19 Mortality in the Hospitalised Patient Population in a Single-Centre Study in Poland. Healthc Basel Switz. 2023;11(5):719. https://doi.org/10.3390/healthcare11050719

Budin CE, Nemeș AF, Râjnoveanu RM, Nemeș RM, Rajnoveanu AG, Sabău AH, Cocuz IG, Mareș RG, Oniga VI, Pătrîntașu DE, Cotoi OS. The Inflammatory Profile Correlates with COVID-19 Severity and Mortality in Cancer Patients. J Pers Med. 2023;13(8):1235. https://doi.org/10.3390/jpm13081235

Jahan H, Yeasmin T, Roy M. Elevated D-dimer is associated with severity of COVID-19: A systematic review and meta-analysis. Med Res Arch. 2022;10(7). https://doi.org/10.18103/mra.v10i7.2870

Wendel Garcia PD, Fumeaux T, Guerci P, Heuberger DM, Montomoli J, Roche-Campo F, Schuepbach RA, Hilty MP; RISC-19-ICU Investigators. Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort. EClinicalMedicine. 2020;25:100449. https://doi.org/10.1016/j.eclinm.2020.100449

Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, Tobin KA, Cerfolio RJ, Francois F, Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. https://doi.org/10.1136/bmj.m1966

Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1753466620937175. https://doi.org/10.1177/1753466620937175

Werfel S, Jakob CEM, Borgmann S, Schneider J, Spinner C, Schons M, Hower M, Wille K, Haselberger M, Heuzeroth H, Rüthrich MM, Dolff S, Kessel J, Heemann U, Vehreschild JJ, Rieg S, Schmaderer C; LEOSS study group. Development and validation of a simplified risk score for the prediction of critical COVID-19 illness in newly diagnosed patients. J Med Virol. 2021: 93(12), 6703-6713. https://doi.org/10.1002/jmv.27252

Kandil E, Ibraheem K, Attia A, Youssef M, Abdelgawad M, Al-Qurayshi Z, Hussein MH, Duchesne J. Predictive Factors of Intubation in COVID-19 Patients: A Better Answer to the Ventilator Shortage Crisis? 2020. https://dx.doi.org/10.2139/ssrn.3578762

Chowdhury MEH, Rahman T, Khandakar A, Al-Madeed S, Zughaier SM, Doi SAR, Hassen H, Islam MT. An Early Warning Tool for Predicting Mortality Risk of COVID-19 Patients Using Machine Learning. Cogn Comput. 2021:1-16. https://doi.org/10.48550/arXiv.2007.15559

Huyut MT, Velichko A, Belyaev M. Detection of Risk Predictors of COVID-19 Mortality with Classifier Machine Learning Models Operated with Routine Laboratory Biomarkers. Appl Sci. 2022;12(23):12180. https://doi.org/10.3390/app122312180

Yamamoto A, Wada H, Ichikawa Y, Mizuno H, Tomida M, Masuda J, Makino K, Kodama S, Yoshida M, Fukui S, Moritani I, Inoue H, Shiraki K, Shimpo H. Evaluation of Biomarkers of Severity in Patients with COVID-19 Infection. J Clin Med. 2021;10(17):3775. https://doi.org/10.3390/jcm10173775

Paliogiannis P, Mangoni AA, Dettori P, Nasrallah GK, Pintus G, Zinellu A. D-Dimer Concentrations and COVID-19 Severity: A Systematic Review and Meta-Analysis. Front Public Health. 2020;8:432. https://doi.org/10.3389/fpubh.2020.00432

Pawlowski C, Wagner T, Puranik A, Murugadoss K, Loscalzo L, Venkatakrishnan AJ, Pruthi RK, Houghton DE, O'Horo JC, Morice WG 2nd, Williams AW, Gores GJ, Halamka J, Badley AD, Barnathan ES, Makimura H, Khan N, Soundararajan V. Inference from longitudinal laboratory tests characterizes temporal evolution of COVID-19-associated coagulopathy (CAC). Elife. 2020;9:e59209. https://doi.org/10.7554/eLife.59209

Mourji D, Abouelfath Z, Abassor T, Biaz A, Elmachtani S, Doghmi N, Dami A, Bouhsain S. Association between Ferritin and COVID-19 Mortality in 1310 Moroccan Patients. Cross Curr Int J Med Biosci. 2022;4(3):50-54. https://doi.org/10.36344/ccijmb.2022.v04i03.001

Bolondi G, Russo E, Gamberini E, Circelli A, Meca MCC, Brogi E, Viola L, Bissoni L, Poletti V, Agnoletti V. Iron metabolism and lymphocyte characterisation during Covid-19 infection in ICU patients: an observational cohort study. World J Emerg Surg. 2020;15(1):41. https://doi.org/10.1186/s13017-020-00323-2

Kaftan AN, Hussain MK, Algenabi AA, Naser FH, Enaya MA. Predictive Value of C-reactive Protein, Lactate Dehydrogenase, Ferritin and D-dimer Levels in Diagnosing COVID-19 Patients: a Retrospective Study. Acta Inform Med. 2021;29(1):45-50. https://doi.org/10.5455/aim.2021.29.45-50

Chicamy YA, Safitri A, Nindrea RD. Serum Ferritin Levels for the Prediction of Mortality among COVID-19 Patients in an Indonesia’s National Referral Hospital. Open Access Maced J Med Sci 2022;10:1056–1061. https://doi.org/10.3889/oamjms.2022.8777

Savrun ŞT, Savrun A. Investigation of the Relationship between Serum Ferritin Levels, Lung Involvement and Treatment Methods in COVID 19 Patients: A Retrospective Study. Med Rec. 2022;4:418-421. https://doi.org/10.37990/medr.1115815

Galland J, Thoreau B, Delrue M, Neuwirth M, Stepanian A, Chauvin A, Dellal A, Nallet O, Roriz M, Devaux M, London J, Martin-Lecamp G, Froissart A, Arab N, Ferron B, Groff MH, Queyrel V, Lorut C, Regard L, Berthoux E, Bayer G, Comarmond C, Lioger B, Mekinian A, Szwebel TA, Sené T, Amador-Boreiro B, Mangin O, Sellier PO, Mouly S, Kevorkian JP, Siguret V; Lariboisière COVID Group; Vodovar D, Sene D. White blood count, D-dimers, and ferritin levels as predictive factors of pulmonary embolism suspected upon admission in noncritically ill COVID-19 patients: The French multicenter CLOTVID retrospective study. Eur J Haematol 2021;107:190-201. https://doi.org/10.1111/ejh.13638

Abdel-Ghany MF, El-Karn AFM, Anis MI, Youssif SF. Study of CRP, ferritin, and D-dimer in COVID-19 RICU patients as per HRCT severity in assiut university hospitals. Egypt J Bronchol 2024;18:87. https://doi.org/10.1186/s43168-024-00340-8

Aslan ES, Aydın H, Tekin YK, Keleş S, White KN, Hekim N. Association between iron metabolism and SARS-COV-2 infection, determined by ferritin, hephaestin and hypoxia-induced factor-1 alpha levels in COVID-19 patients. Mol Biol Rep. 2023;50(3):2471-2478. https://doi.org/10.1007/s11033-022-08221-3

Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 202069(12):1181-1189. https://doi.org/10.1007/s00011-020-01401-6

Lim MS, Mcrae S. COVID-19 and immunothrombosis: Pathophysiology and therapeutic implications. Crit Rev Oncol Hematol. 2021;168:103529. https://doi.org/10.1016/j.critrevonc.2021.103529

Shama, Mahmood A, Mehmood S, Zhang W. Pathological Effects of SARS-CoV-2 Associated with Hematological Abnormalities. Curr Issues Mol Biol. 2023; 45(9):7161-7182. https://doi.org/10.3390/cimb45090453

Cavezzi A, Menicagli R, Troiani E, Corrao S. COVID-19, Cation Dysmetabolism, Sialic Acid, CD147, ACE2, Viroporins, Hepcidin and Ferroptosis: A Possible Unifying Hypothesis. F1000Res. 2022;11:102. https://doi.org/10.12688/f1000research.108667.2

Taneri PE, Gómez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Díaz ZM, Salvador D Jr, Groothof D, Minder B, Kopp-Heim D, Hautz WE, Eisenga MF, Franco OH, Glisic M, Muka T. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020;35(8):763-773. https://doi.org/10.1007/s10654-020-00678-5

Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295. https://doi.org/10.1101/cshperspect.a016295

Rahi MS, Jindal V, Reyes SP, Gunasekaran K, Gupta R, Jaiyesimi I. Hematologic disorders associated with COVID-19: a review. Ann Hematol. 2021;100(2):309-320. https://doi.org/10.1007/s00277-020-04366-y

Gómez-Pastora J, Weigand M, Kim J, Wu X, Strayer J, Palmer AF, Zborowski M, Yazer M, Chalmers JJ. Hyperferritinemia in critically ill COVID-19 patients - Is ferritin the product of inflammation or a pathogenic mediator? Clin Chim Acta. 2020;509:249-251. https://doi.org/10.1016/j.cca.2020.06.033

Jia FJ, Han J. Liver injury in COVID-19: Holds ferritinophagy-mediated ferroptosis accountable. World J Clin Cases. 2022;10(36):13148-13156. https://doi.org/10.12998/wjcc.v10.i36.13148

Mahroum N, Alghory A, Kiyak Z, Alwani A, Seida R, Alrais M, Shoenfeld Y. Ferritin - from iron, through inflammation and autoimmunity, to COVID-19. J Autoimmun. 2022;126:102778. https://doi.org/10.1016/j.jaut.2021.102778

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Published

2026-06-30

How to Cite

Jahja Hodo, E., Parveen Shaikh, A., Parveen Shaikh, N., Chauhan, N., Febrian Nishanthan, A., & Nakashidze, I. (2026). A Narrative Review on the Significance of Ferritin, D-Dimer, and C-Reactive Protein in the Severity and Mortality of COVID-19 Patients. Pharmedicine Journal, 3(2), 61–71. https://doi.org/10.62482/pmj.42

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Review