Independent predictors of long-term pulmonary function recovery in patients with acute respiratory distress syndrome: a meta-analysis

BACKGROUND: The factors influencing the long-term pulmonary function recovery in survivors of acute respiratory distress syndrome (ARDS) remain unclear. METHODS: We systematically searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases for cohort studies published from inception to August 31, 2025. Two researchers independently performed literature screening and data extraction, and the Newcastle-Ottawa Scale was used to assess study quality. RESULTS: A total of 23 cohort studies involving 5876 patients were included. The meta-analysis revealed that factors associated with poor long-term pulmonary function recovery included: age ≥ 65 years (OR=2.35, 95% CI: 1.98-2.79, P < 0.001), severe ARDS (OR=3.16, 95% CI: 2.64-3.78, P < 0.001), prolonged mechanical ventilation time (OR=1.08 per additional day, 95% CI: 1.05-1.11, P < 0.001), coexisting chronic obstructive pulmonary disease (OR=3.27, 95% CI: 2.45-4.37, P < 0.001), and elevated interleukin-6 levels during the acute phase (SMD=1.24, 95% CI: 0.87-1.61, P < 0.001). The meta-analysis results showed that factors associated with favorable long-term pulmonary function recovery included: early lung-protective ventilation (OR=0.42, 95% CI: 0.33-0.54, P < 0.001), glucocorticoid intervention (OR=0.56, 95% CI: 0.43-0.73, P < 0.001), and initiation of rehabilitation treatment within ≤ 7 days of onset (OR=0.38, 95% CI: 0.29-0.49, P < 0.001). Subgroup analysis of ARDS type indicated that both disease severity and duration of mechanical ventilation influenced prognosis. CONCLUSION: Older age, severity of ARDS, prolonged ventilation time, coexisting chronic obstructive pulmonary disease and elevated interleukin-6 levels during the acute phase are the main factors associated with poor long-term pulmonary function recovery in patients with ARDS. Early lung-protective ventilation, glucocorticoid use, and rehabilitation interventions are important protective measures.