The relationship between smoking and the risk of acute respiratory distress syndrome (ARDS) has been recognized, but the conclusions have been inconsistent. This systematic review and meta-analysis investigated the association between smoking and ARDS risk in adults. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for eligible studies published from January 1, 2000, to December 31, 2023. We enrolled adult patients exhibiting clinical risk factors for ARDS and smoking condition. Outcomes were quantified using odds ratios (ORs) for binary variables and mean differences (MDs) for continuous variables, with a standard 95% confidence interval (CI). A total of 26 observational studies involving 36,995 patients were included. The meta-analysis revealed a significant association between smoking and an increased risk of ARDS (OR 1.67; 95% CI 1.33–2.08; P < 0.001). Further analysis revealed that the associations between patient-reported smoking history and ARDS occurrence were generally similar to the results of all the studies (OR 1.78; 95% CI 1.38–2.28; P < 0.001). In contrast, patients identified through the detection of tobacco metabolites (cotinine, a metabolite of nicotine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of tobacco products) showed no significant difference in ARDS risk (OR 1.19; 95% CI 0.69–2.05; P = 0.53). The smoking group was younger than the control group (MD − 7.15; 95% CI − 11.58 to − 2.72; P = 0.002). Subgroup analysis revealed that smoking notably elevated the incidence of ARDS with extrapulmonary etiologies (OR 1.85; 95% CI 1.43–2.38; P < 0.001). Publication bias did not affect the integrity of our conclusions. Sensitivity analysis further reinforced the reliability of our aggregated outcomes. There is a strong association between smoking and elevated ARDS risk. This emphasizes the need for thorough assessment of patients' smoking status, urging healthcare providers to vigilantly monitor individuals with a history of smoking, especially those with additional extrapulmonary risk factors for ARDS.

中文翻译：

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吸烟对急性呼吸窘迫综合征风险的影响：系统评价和荟萃分析

吸烟与急性呼吸窘迫综合征（ARDS）风险之间的关系已得到认可，但结论却不一致。这项系统评价和荟萃分析调查了成人吸烟与 ARDS 风险之间的关联。在 PubMed、EMBASE、Cochrane Library 和 Web of Science 数据库中检索了 2000 年 1 月 1 日至 2023 年 12 月 31 日发表的符合条件的研究。我们招募了表现出 ARDS 和吸烟状况临床危险因素的成年患者。结果使用二元变量的比值比 (OR) 和连续变量的平均差 (MD) 进行量化，并采用标准 95% 置信区间 (CI)。总共纳入了 26 项观察性研究，涉及 36,995 名患者。荟萃分析显示吸烟与 ARDS 风险增加之间存在显着关联（OR 1.67；95% CI 1.33–2.08；P < 0.001）。进一步分析显示，患者报告的吸烟史与 ARDS 发生之间的关联与所有研究的结果大体相似（OR 1.78；95% CI 1.38–2.28；P < 0.001）。相比之下，通过检测烟草代谢物（可替宁，尼古丁的代谢物和 4-(甲基亚硝基氨基)-1-(3-吡啶基)-1-丁醇 (NNAL)，烟草制品的代谢物）发现的患者没有表现出明显的ARDS 风险存在差异（OR 1.19；95% CI 0.69–2.05；P = 0.53）。吸烟组比对照组年轻（MD − 7.15；95% CI − 11.58 至 − 2.72；P = 0.002）。亚组分析显示，吸烟显着增加肺外病因的 ARDS 发生率（OR 1.85；95% CI 1.43–2.38；P < 0.001）。发表偏见并没有影响我们结论的完整性。敏感性分析进一步增强了我们汇总结果的可靠性。吸烟与 ARDS 风险升高之间存在密切关联。这强调了对患者吸烟状况进行彻底评估的必要性，敦促医疗保健提供者警惕地监测有吸烟史的个人，特别是那些有其他ARDS肺外危险因素的人。