Hydrocortisone vs. Methylprednisolone in Community-Acquired Pneumonia: A Propensity Score Matching Study

Community-acquired pneumonia is one of the main causes of morbidity and mortality due to infections worldwide. This has led to the study of the use of corticosteroids as adjunctive therapy, which has shown an inclination to provide clinical benefits. However, controversy persists regarding the use of one corticosteroid over another Objectives: Evaluate the outcomes associated with the use of hydrocortisone versus methylprednisolone in patients with community-acquired pneumonia. Methods: We conducted a multicenter retrospective cohort study that included hospitalized adults diagnosed with CAP at two high-complexity clinics in Colombia between 2010 and 2020. Propensity score matching was used in a 1:1 ratio to balance the baseline characteristics between the hydrocortisone and methylprednisolone groups. The primary outcome was 30-day mortality. Secondary outcomes included septic shock, vasopressor use, admission to the intensive care unit, mechanical ventilation, and other hospital outcomes. Survival analyses were performed using Kaplan-Meier curves and estimates of the average treatment effect, as well as subgroup analyses according to the dose and duration of treatment. Results: The study initially included 366 patients, with significant baseline differences between groups. After matching, an adjusted cohort of 168 patients (84 per group) was obtained, with an adequate balance of clinical, paraclinical, and severity-related variables. No statistically significant differences were found in 30-day mortality between patients who received hydrocortisone and those who received methylprednisolone before or after matching. Additionally, no differences were detected in the secondary clinical outcomes. Survival analyses revealed no differences according to corticosteroid type, treatment duration, or administered dose. Conclusions: In this retrospective propensity-score-matched cohort study, no differences were observed in 30-day mortality or other clinical outcomes between hydrocortisone and methylprednisolone in patients with community-acquired pneumonia.