Nationwide trends in incidence and in-hospital mortality of ARDS in Germany, 2008-2022.

Acute respiratory distress syndrome (ARDS) remains a major contributor to morbidity and mortality among critically ill patients. Recent events such as the COVID-19 pandemic and demographic changes have likely influenced its epidemiology. This study aimed to investigate nationwide trends in ARDS incidence and in-hospital mortality among adult intensive care patients in Germany over a 15-year period and to describe demographic and clinical differences between survivors and non-survivors. We conducted a retrospective nationwide cohort study using hospital discharge data from the German Federal Statistical Office. All adult patients diagnosed with ARDS (ICD-10 code J80) and treated in intensive care units between 2008 and 2022 were included. Among 87,488 patients, 52.2% died during hospitalization. The incidence increased significantly before the pandemic, peaking at 21.0 per 100,000 inhabitants in 2021. In-hospital mortality declined from 54.2% in 2008 to 50.8% in 2018, followed by an increase up to 53.8% in 2021 and a slight decline thereafter. Non-survivors were older (68 vs 60 yr), had a greater comorbidity burden (Elixhauser index 17 vs 12), and more severe ARDS (54.2% vs 41.1%). Mortality was highest among patients aged 90 to 94 years (82%). COVID-19-related cases had a higher observed in-hospital mortality (53.5% vs 51.8%) and a higher proportion of severe ARDS (77.2% vs 38.6%). ARDS incidence and in-hospital mortality remain high. The low detection of mild to moderate ARDS highlights the need for better diagnostic tools and standardized criteria. Elderly patients are especially vulnerable, underscoring the need for age-specific therapies and improved early detection.