Hydrocortisone for the Treatment of Acute Respiratory Distress Syndrom: A Systematic Review and Meta-Analysis

Acute respiratory distress syndrome (ARDS) remains associated with substantial morbidity and mortality, while the efficacy and safety of hydrocortisone in its treatment remain uncertain. This study aimed to evaluate the efficacy and safety of hydrocortisone in patients with ARDS through a systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) database were searched for eligible studies published during the 20-year period preceding June 1, 2024. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Statistical analyses were performed using Review Manager (RevMan) version 5.3, with treatment effects expressed as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Four RCTs involving 566 participants were included in the meta-analysis. Hydrocortisone treatment was associated with significantly lower overall mortality (OR = 0.60; 95% CI: 0.42–0.87). However, the reduction in 28-day mortality was not statistically significant (OR = 0.70; 95% CI: 0.45–1.08). No statistically significant differences were observed between treatment groups in the incidence of nosocomial infections or gastrointestinal bleeding. These findings suggested a potential survival benefit associated with hydrocortisone treatment in patients with ARDS. Nevertheless, variations in follow-up duration, clinical heterogeneity, and the limited number of included trials and participants restricted the strength and generalizability of the evidence. Hydrocortisone may have a beneficial role as an adjunctive treatment for ARDS; however, the available findings did not demonstrate a consistent improvement in short-term survival or establish definitive safety. Larger, adequately powered multicenter RCTs using standardized treatment regimens, consistent outcome definitions, and comprehensive adverse-event monitoring are warranted to clarify the efficacy and safety of hydrocortisone in ARDS management.