Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis

TL;DR

This study compares the effectiveness of two corticosteroids in treating severe pneumonia and finds potential benefits for one in cases involving septic shock.

Contribution

A propensity-matched analysis comparing mortality rates of methylprednisolone and hydrocortisone in severe pneumonia.

Findings

No significant difference in in-hospital mortality between methylprednisolone and hydrocortisone groups overall.

Patients with septic shock had significantly lower mortality with methylprednisolone compared to hydrocortisone.

Abstract

Corticosteroids improve the outcomes of severe pneumonia; however, the most effective type remains unknown. In this study, we compared the mortality rates of patients with severe pneumonia who were treated with methylprednisolone versus those treated with hydrocortisone.

In this retrospective observational study, we utilized a nationwide Japanese Diagnosis Procedure Combination inpatient database to include adult patients with severe pneumonia who were admitted to hospitals between April 2017 and March 2022 and received either methylprednisolone or hydrocortisone. Propensity score matching was used to adjust for measured confounders, with in-hospital mortality as the primary outcome.

Among the 5,084 eligible patients, 623 matched pairs were analyzed. In-hospital mortality rates were 23.9% in the hydrocortisone group and 19.4% in the methylprednisolone group (risk difference [RD], 4.5%; 95% confidence interval [CI] −0.082 to 9.1; p = 0.054). Subgroup analysis of patients with shock demonstrated significantly higher mortality in the hydrocortisone group than in the methylprednisolone group (44.7% versus 30.1%; RD, 14.6%; 95% CI 1.4–27.8; p = 0.031).

No significant difference in in-hospital mortality was observed between patients with severe pneumonia treated with methylprednisolone and those treated with hydrocortisone. Nevertheless, patients experiencing severe pneumonia-induced septic shock may derive benefits from methylprednisolone treatment.

The online version contains supplementary material available at 10.1186/s40560-025-00810-1.

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