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Hydrocortisone vs. Methylprednisolone in Community-Acquired Pneumonia: A Propensity Score Matching Study
Juan Sebastian Hernández Puentes1, Alirio Rodrigo Bastidas1,2,3, Eduardo Andres Tuta Quintero3
1School of Medicine, Universidad de La Sabana, Campus del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía 250001, Cundinamarca, Colombia.
Journal of Clinical Medicine
|July 28, 2026
Summary
This study found no significant difference in 30-day mortality or clinical outcomes between hydrocortisone and methylprednisolone for community-acquired pneumonia (CAP). Both corticosteroids appear equally effective as adjunctive therapy for CAP patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Community-acquired pneumonia (CAP) is a major global cause of infection-related morbidity and mortality.
- Corticosteroids are increasingly studied as adjunctive therapy for CAP, showing potential clinical benefits.
- However, evidence comparing specific corticosteroids like hydrocortisone and methylprednisolone in CAP remains controversial.
Purpose of the Study:
- To compare the clinical outcomes of hydrocortisone versus methylprednisolone in hospitalized patients with CAP.
- To evaluate the impact of these corticosteroids on 30-day mortality and other secondary outcomes in CAP patients.
Main Methods:
- A multicenter retrospective cohort study was conducted in Colombia (2010-2020) involving hospitalized adults with CAP.
- Propensity score matching (1:1 ratio) was employed to balance baseline characteristics between hydrocortisone and methylprednisolone groups.
- Primary outcome was 30-day mortality; secondary outcomes included septic shock, vasopressor use, ICU admission, and mechanical ventilation.
Main Results:
- After propensity score matching, 168 patients (84 per group) were analyzed, demonstrating balanced baseline characteristics.
- No statistically significant differences were observed in 30-day mortality between the hydrocortisone and methylprednisolone groups, pre- or post-matching.
- Secondary clinical outcomes, including septic shock and ICU admission, also showed no significant differences between the treatment groups.
Conclusions:
- In this propensity-score-matched cohort study, hydrocortisone and methylprednisolone demonstrated comparable efficacy in treating community-acquired pneumonia.
- Neither corticosteroid showed superiority regarding 30-day mortality or other assessed clinical outcomes in CAP patients.
- The findings suggest that current evidence does not support a preference for hydrocortisone over methylprednisolone, or vice versa, for adjunctive CAP therapy.
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