The prognostic value of resistin in patients with sepsis: a systematic review and meta-analysis

Sepsis remains a leading cause of mortality worldwide. Resistin, a pro-inflammatory cytokine secreted by monocytes and macrophages, has emerged as a potential biomarker of sepsis severity and prognosis. We systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to January 2025. Prospective studies reporting resistin levels and mortality or disease severity in sepsis were included. Standardized mean differences (SMDs) and areas under the receiver operating characteristic curve (AUCs) were calculated using random-effects models. Subgroup and meta-regression analyses were conducted to explore heterogeneity and potential effect modifiers. Eighteen studies including 2,197 sepsis patients were analyzed. Resistin levels were significantly higher in non-survivors than in survivors (SMD: 0.83, 95% CI: 0.31 to 1.36), and in patients with septic shock compared to those without shock (SMD: 1.34, 95% CI: 0.62 to 2.05). Compared with controls, sepsis patients also showed elevated resistin levels (SMD: 1.99, 95% CI: 1.63 to 2.35). Substantial heterogeneity was observed in the main pooled analyses, reaching I² = 89%, and the 95% prediction intervals for sepsis-related mortality, 28-day mortality, and septic shock all included zero. The pooled AUC for predicting mortality was 0.68 (95% CI: 0.64 to 0.73). In adult patients, the pooled AUC was 0.70 (95% CI: 0.65 to 0.75). A stepwise increase in resistin was observed with sepsis severity, from healthy controls to non-shock sepsis, septic shock, and ultimately non-survivors. Admission resistin levels may be associated with disease severity and adverse outcomes, but their clinical utility remains uncertain and requires confirmation in large, multicenter prospective studies. Clinical trial number: Not applicable. Systematic review registration: PROSPERO CRD42025639277.