Sequential changes in serum adipokines and their clinical associations in critically ill COVID-19 patients: A prospective observational study.

Adipokines regulate metabolic and inflammatory pathways and may be altered during critical illness. We explored sequential serum adipokine concentrations and their associations with nutritional and clinical variables in critically ill COVID-19 patients. This prospective observational, exploratory study included 30 critically ill COVID-19 patients and 10 age- and sex-matched healthy controls. Serum adiponectin, resistin, GLP-1, visfatin, IGF-1, leptin, and acylated ghrelin were measured at intensive care unit admission and on day 7. Biomarker-clinical correlations were analyzed using Spearman correlation, and the Benjamini-Hochberg false discovery rate procedure was applied to account for multiple biomarker comparisons. After false discovery rate correction, longer time to nutrition initiation remained inversely associated with day-7 adiponectin (ρ = -0.464, q = 0.027), GLP-1 (ρ = -0.568, q = 0.015), IGF-1 (ρ = -0.488, q = 0.022), leptin (ρ = -0.539, q = 0.015), and acylated ghrelin (ρ = -0.503, q = 0.021). Several adipokines showed exploratory associations with nutrition-initiation time in this small cohort of critically ill COVID-19 patients. These observational findings do not establish that earlier nutritional support causes changes in adipokine concentrations and require validation in larger, adequately controlled studies.