Adiponectin, leptin, and lipid profiles characterise a meta-bolic high-risk phenotype in ICU patients

Background Critical illness triggers profound metabolic and inflammatory changes, yet the interaction between adipokines and lipid metabolism remains insufficiently defined. This study evaluated the prognostic value of adiponectin, leptin, and lipid profiles at intensive care unit (ICU) admission and explored their combined association with short-term mortality. Purpose To identify a metabolic high-risk phenotype integrating adipokine and lipid markers that enhances prediction of 30-day mortality in unselected ICU patients. Methods In this prospective single-centre study, 224 consecutive ICU patients were enrolled. Adiponectin and leptin were measured by ELISA, while total cholesterol and triglycerides were assessed using standard laboratory methods. Associations with 30-day mortality were analysed using Cox regression adjusted for age, sex, creatinine, and BMI. Predictive performance was compared by receiver operating characteristic (ROC) analyses. Results Adiponectin was markedly elevated in non-survivors, whereas total cholesterol was significantly reduced (both p < 0.001). Each independently predicted 30-day mortality. Combining both defined a High Adiponectin–Low Cholesterol (HALC) phenotype associated with a survival rate < 20% and a hazard ratio of 12.888 (p < 0.001), independent of confounders. Leptin and triglycerides were not prognostic overall but were significantly lower within the HALC group. Integrating adiponectin and cholesterol with the SAPS II score increased predictive accuracy (AUC 0.85 vs 0.81; p = 0.039). (Figure 1: adipokine/lipid profiles; Figure 2: ROC curves). Conclusions Adiponectin and total cholesterol are strong, complementary predictors of short-term survival in critical illness. Their combination defines a distinct metabolic high-risk phenotype that identifies patients with markedly increased mortality and augments established ICU risk assessment by capturing metabolic dysregulation not represented in conventional scores.