Hydrocortisone Bests Other Corticosteroids for Community-Acquired Pneumonia in New Analysis

New research shows that treatment with hydrocortisone, but not with other corticosteroids, is associated with a decrease in morality among patients hospitalized with community-acquired pneumonia (CAP).

Findings were presented at the CHEST 2023 Annual Meeting, held October 8-11 in Honolulu, Hawaii.

“Corticosteroids have been reported to have no effects on survival outcomes of hospitalized patients with CAP,” wrote authors in the study abstract published in the journal CHEST. However, a recent randomized controlled trial (RCT) did show that one corticosteroid, hydrocortisone, was associated with lower mortality of CAP, added researchers.

Investigators conducted the systematic review and meta-analysis using PubMed, Cochrane Library, and Embase databases to examine whether treatment with hydrocortisone, compared to other corticosteroids, has “differential effects on clinical outcomes of patients with CAP.”

The primary endpoint was all-cause mortality and secondary endpoints included the need for mechanical intervention and adverse events (eg, secondary infections, gastrointestinal bleeding), according to the abstract.

FINDINGS

Researchers identified 17 RCTs that evaluated the efficacy of systematic corticosteroids for management of CAP.

Of the 17 trials, 6 reported on the use of hydrocortisone, 6 on prednisolone, 3 on methylprednisolone, and 2 on dexamethasone.

Investigators found that hydrocortisone was associated with a lower risk of all-cause mortality (risk ratio [RR] 0.48, 95% CI 0.33-0.71; P<.001), whereas other corticosteroids—prednisolone, methylprednisolone, and dexamethasone—were not associated with a reduced risk of all-cause mortality (RR 1.01, 95% CI 0.83-1.22; P=0.94).

Hydrocortisone was also associated with a lower need for mechanical ventilation (RR 0.65, 95% CI 0.50-0.84; P=.001), however, researchers did not observe any association with the other corticosteroids (RR 0.67, 95% CI 0.34-1.35; P=0.27).

In terms of adverse events, investigators noted that both hydrocortisone and other corticosteroids were not associated with an increased risk of secondary infections (hydrocortisone: RR 0.93, 95% CI 0.27-3.22; P=.90; other corticosteroids: RR 1.01, 95% CI, 0.78-1.31; P=.93) or gastrointestinal bleeding (hydrocortisone: RR 0.77, 95% CI, 0.39-1.53; P=.46; other corticosteroids: RR 1.65, 95% CI, 0.84-3.24; P=.146).

“We found that hydrocortisone, a low-cost and generally well-tolerated medication, had a significant mortality benefit compared to other types of corticosteroids in CAP.”

Source: See XY, Chiang CH, Chiang CH, Chiang, CH. The effects of hydrocortisone vs other corticosteroids on patient outcomes in community-acquired pneumonia: a systematic review and meta-analysis. CHEST. 2023;164:A844.