Inflammation-linked adipokine profiles associate with acute organ dysfunction after severe trauma

Abstract Introduction Polytrauma initiates an abrupt shift in immunometabolic signalling, but the role of circulating adipokines in acute post-traumatic organ dysfunction is not fully understood. Resistin and adiponectin are circulating immune-metabolic markers at the interface of inflammation, metabolic stress, and renal dysfunction, but their dynamic response to trauma and their clinical relevance remain uncertain. We therefore characterised serial changes in circulating adipokines during the first 10 days after severe multiple trauma and evaluated their associations with systemic inflammation, organ-specific dysfunction and clinical outcomes. We additionally explored associations between CT-derived waist-to-hip ratio (WHR), as a marker of body-fat distribution, and adipokine profiles. Methods This study represents a secondary retrospective analysis of prospectively collected plasma samples and clinical data from a longitudinal observational cohort, including 67 patients with Injury Severity Score ≥ 16 and 31 healthy volunteers. Plasma resistin, adiponectin, leptin and retinol-binding protein 4 (RBP4) were measured at admission (D0) and on D1, D5 and D10. Longitudinal changes were analysed using linear mixed-effects models adjusted for age, sex, BMI and WHR. Associations with inflammatory markers and organ dysfunction were assessed using partial Spearman correlations. Exploratory receiver-operating characteristic (ROC) analyses evaluated adipokine-based classification of hospital length of stay (LOS), ICU LOS, shock severity and 30-day mortality. Results Compared with healthy volunteers, trauma patients showed an altered adipokine profile at admission, characterised by elevated resistin ( p < 0.01) and reduced adiponectin ( p < 0.05). At admission, resistin correlated strongly with IL-6 ( r ≈ 0.75), which remained significant after FDR correction. The resistin-to-adiponectin (R/A) ratio demonstrated the most consistent associations across inflammatory and renal parameters. Most WHR-stratified comparisons showed no clear separation across groups. In exploratory ROC analyses, several adipokine measures showed moderate classification of selected clinical outcomes; however, mortality analyses were limited by few available events at later timepoints. Conclusions Severe trauma was associated with rapid changes in circulating adipokine profiles, characterised by early resistin elevation, lower circulating adiponectin, and an increased R/A ratio. Resistin and the R/A ratio showed the most consistent associations with systemic inflammation and renal dysfunction. WHR-stratified differences for most adipokines were limited. Clinical outcome associations were exploratory and require prospective multicentre validation to establish added value beyond conventional clinical parameters.