Serum resistin as a potential biomarker for stratifying the severity of coronary heart disease: a network meta-analysis.

OBJECTIVE

To systematically quantify the graded relationship between serum resistin levels and the severity of coronary heart disease (CHD) using a network meta-analysis, thereby evaluating its potential as a biological marker of disease progression.

METHODS

We conducted a comprehensive search of major international and Chinese databases up to December 2025. A random-effects network meta-analysis was performed to calculate standardized mean differences (SMD) and Surface Under the Cumulative Ranking (SUCRA) values. Subgroup, sensitivity, and Trim-and-Fill analyses were conducted to investigate heterogeneity and publication bias.

RESULTS

A total of 26 studies (n = 9,169 subjects) were included. The network meta-analysis (5,450 individuals) demonstrated a progressive, stepwise increase in serum resistin levels across the disease spectrum: from healthy controls (CHD-), to stable CHD (SMD = 0.77, 95% CI: 0.38-1.15), to acute coronary syndrome (ACS; SMD = 1.88, 95% CI: 1.22-2.54), and culminating in acute myocardial infarction (AMI; SMD = 4.68, 95% CI: 3.92-5.43), all compared to controls. SUCRA rankings confirmed this clear hierarchy (AMI > ACS > stable CHD > CHD-). However, substantial heterogeneity (I²=95.8%) and evidence of publication bias were detected.

CONCLUSION

Serum resistin levels show a clear, graded association with CHD severity, positioning resistin as a potent biological correlate of the underlying inflammatory burden. However, due to significant heterogeneity and publication bias that likely inflate the observed effect sizes, resistin is not suitable as a standalone diagnostic tool. Its potential clinical utility may lie as an adjunctive marker in multi-biomarker models for risk stratification, a role that requires validation in large-scale prospective studies using standardized assays.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, PROSPERO CRD420261397089.