Objective: This study aimed to systematically assess the incidence of acute respiratory distress syndrome (ARDS) among Chinese patients with severe acute pancreatitis (SAP) and to identify factors independently associated with ARDS in multivariable models, with a view to providing a scientific basis for the early prevention and management of ARDS in this population.
Methods: A comprehensive search of nine Chinese and English databases was conducted to identify studies reporting the incidence or factors associated with ARDS in SAP patients. Studies were selected based on stringent inclusion and exclusion criteria. Relevant data were extracted, and study quality was assessed. A meta-analysis was performed using R 4.4.2 and Stata 16.0 software.
Results: Seventeen studies involving 3,576 SAP patients were included. The pooled incidence of ARDS was 36.38% (95% CI: 30.66%-42.50%). However, substantial between-study heterogeneity was observed (I² = 92.4%), and the prediction interval was wide (15.73%-63.66%), indicating that this pooled estimate should be regarded as a statistical average across different clinical settings rather than a stable nationwide epidemiological parameter. Seventeen factors were identified as independently associated with ARDS in multivariable analyses, including two demographic variables (age > 50 years and female sex), three clinical scoring systems (Charlson Comorbidity Index ≥ 3, Acute Physiology and Chronic Health Evaluation II score > 11, Ranson score > 5), four comorbidities (sepsis, abdominal compartment syndrome, ≥ 2 extrapulmonary organ failures, and concurrent infections), and eight physiological and biochemical markers (albumin ≤ 30 g/L, triglycerides > 1.7 mmol/L, fasting blood glucose > 12 mmol/L, C-reactive protein > 150 mg/L, neutrophil count > 14 × 10⁹/L, procalcitonin > 0.5 ng/mL, platelet count < 125 × 10⁹/L, lactate dehydrogenase > 250 U/L). It should be noted that the evidence for nine of these factors was derived from a single study each, and the generalizability of these variables as independent correlates requires further validation. All included studies were of moderate to high quality but generally demonstrated poor control for confounding factors.
Conclusion: The reported incidence of ARDS among Chinese patients with SAP is high and is independently associated with multiple demographic characteristics, clinical scores, comorbidities, and physiological or biochemical markers. Recognition of these factors, which demonstrated independent associations in multivariable models, may inform ARDS risk assessment in patients with SAP; however, their clinical utility should be interpreted with caution in light of limitations in study design.
Keywords: Acute Respiratory Distress Syndrome; Incidence; Independent Correlates; Meta-analysis; Severe Acute Pancreatitis.
© 2026. The Author(s).