OBJECTIVE: This study aimed to assess the predictive value of the systemic inflammatory response index (SIRI) and APACHE II score for acute respiratory distress syndrome (ARDS) resulting from wasp stings. METHODS: A retrospective study was conducted, including patients who suffered wasp stings and developed ARDS between January 2018 and November 2024 in the Shiyan area of Hubei province. Based on the 28-day prognosis, patients were categorized into two groups: survivors (n = 21) and non-survivors (n = 25). Clinical data, including demographic characteristics, sting site, clinical symptoms, laboratory findings, and treatment measures, were collected. Univariate and multivariate logistic regression analyses were performed to evaluate the predictive roles of SIRI and APACHE II scores in ARDS prognosis, and their clinical predictive value was assessed using ROC curves. RESULTS: Significant differences were observed between the survivor and non-survivor groups in APACHE II scores, number of stings, and length of hospitalization (P <
0.05). However, factors such as gender, time of first visit, and site of stings showed no statistically significant differences (P >
0.05). Leukocyte counts, SIRI, and APACHE II scores were significantly lower in the survivor group compared to the non-survivor group (P <
0.05). Multivariate logistic regression analysis revealed that the APACHE II score (OR = 1.42, 95% CI: 1.12-1.79, P = 0.004) and SIRI (OR = 1.27, 95% CI: 1.07-1.49, P = 0.005) were significant independent predictors of 28-day mortality in ARDS patients. ROC curve analysis showed that the AUC for early SIRI was 0.821 (95% CI: 0.693-0.949, P <
0.001), while the AUC for the APACHE II score was 0.809 (95% CI: 0.681-0.936, P <
0.001), indicating that both measures have high clinical predictive value. CONCLUSION: This study demonstrated that the APACHE II score and SIRI are valuable tools for predicting the prognosis of ARDS patients caused by wasp stings. Early elevation of these markers is closely associated with an increased risk of mortality and can serve as an effective means of assessing disease severity and mortality risk.