Adiponectin, Leptin, and Lipid Profiles Characterise a Metabolic High-Risk Phenotype in ICU Patients

Critical illness triggers profound metabolic and inflammatory changes, yet interactions between adipokines and lipid metabolism remain poorly understood. This study examined the prognostic value of adiponectin, leptin, their ratio, and standard lipid parameters at ICU admission and explored their combined association with 30-day mortality.

In this prospective, single-centre study, 224 consecutive ICU patients were enrolled. Adiponectin and leptin were quantified by ELISA, and standard lipid parameters, including total cholesterol and triglycerides, were measured at admission in the central laboratory.

Adiponectin levels were markedly elevated in non-survivors, whereas total cholesterol was significantly reduced (both p < 0.001). Both markers independently predicted 30-day mortality (p < 0.001). Their combination defined a distinct high-risk phenotype (HALC: high adiponectin, low cholesterol) with a cumulative survival rate below 20%. Compared with patients exhibiting a low-risk phenotype, those in the HALC group had a hazard ratio of 12.888 (p < 0.001). This finding was independent of age, sex, creatinine, and BMI. While leptin and triglycerides showed no prognostic association in the overall cohort, both were significantly lower within the HALC group. Integrating adiponectin and cholesterol with the SAPS II score further improved its predictive accuracy (AUC 0.85 vs. 0.81, p = 0.039).

Adiponectin and total cholesterol are strong predictors of survival and appear to capture complementary aspects of critical illness. Their combination defines a high-risk phenotype with markedly reduced 30-day survival. The HALC profile may improve ICU outcome prediction by capturing metabolic dysregulation not captured by conventional scoring systems.