Background/Objectives: The function of adipokines, which play an important role in the etiopathogenesis of critical illness, has not been fully elucidated. We aim to investigate the sequential changes in serum adipokines and their association with clinical outcomes and nutritional parameters in ICU patients with SARS-CoV-2. Methods: This observational study was conducted prospectively in a Medical ICU. Blood samples were collected on admission and on the 7th day for analysis of adiponectin, GLP-1, resistin, visfatin, acyl ghrelin (AG), IGF-1, and leptin levels using ELISA kits. Results: This study included 30 critically ill patients and 10 healthy controls. Baseline and day 7 serum adiponectin, GLP-1, resistin, visfatin, baseline AG and day 7 IGF-1 levels are significantly lower in critically ill patients compared to the control group (p<0.05). A negative correlation was observed between time to initiate nutrition and serum adipokine levels (p<0.05). Patients with high mNUTRIC scores had elevated serum adiponectin and IGF-1 levels on day 7 (p<0.05). Positive correlations were found between MV duration and day 7 AG levels (p<0.05). Conclusions: This pilot study provides insights into serum adipokine dynamics in critically ill COVID-19 patients. Lower adiponectin, GLP-1, resistin, visfatin, AG, and IGF-1 levels suggest dysregulation in these pathways.