Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis
Abstract Background 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. Methods...
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2025-07-01
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| Series: | Journal of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s40560-025-00810-1 |
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| author | Takuya Sato Yusuke Sasabuchi Ryota Inokuchi Shotaro Aso Hideo Yasunaga Kent Doi |
| author_facet | Takuya Sato Yusuke Sasabuchi Ryota Inokuchi Shotaro Aso Hideo Yasunaga Kent Doi |
| author_sort | Takuya Sato |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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). Conclusion 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. |
| format | Article |
| id | doaj-art-3533f9e4af7f4032a5cc03b704d232b2 |
| institution | DOAJ |
| issn | 2052-0492 |
| language | English |
| publishDate | 2025-07-01 |
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| series | Journal of Intensive Care |
| spelling | doaj-art-3533f9e4af7f4032a5cc03b704d232b22025-08-20T03:04:17ZengBMCJournal of Intensive Care2052-04922025-07-011311910.1186/s40560-025-00810-1Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysisTakuya Sato0Yusuke Sasabuchi1Ryota Inokuchi2Shotaro Aso3Hideo Yasunaga4Kent Doi5Department of Emergency and Critical Care Medicine, The University of Tokyo HospitalDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of TokyoDepartment of Emergency and Critical Care Medicine, The University of Tokyo HospitalDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of TokyoDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of TokyoDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of TokyoAbstract Background 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. Methods 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. Results 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). Conclusion 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.https://doi.org/10.1186/s40560-025-00810-1Severe pneumoniaCorticosteroidPropensity score matchingIn-hospital mortalitySeptic shock |
| spellingShingle | Takuya Sato Yusuke Sasabuchi Ryota Inokuchi Shotaro Aso Hideo Yasunaga Kent Doi Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis Journal of Intensive Care Severe pneumonia Corticosteroid Propensity score matching In-hospital mortality Septic shock |
| title | Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis |
| title_full | Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis |
| title_fullStr | Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis |
| title_full_unstemmed | Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis |
| title_short | Mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone: a propensity-matched analysis |
| title_sort | mortality of severe pneumonia treated with methylprednisolone versus hydrocortisone a propensity matched analysis |
| topic | Severe pneumonia Corticosteroid Propensity score matching In-hospital mortality Septic shock |
| url | https://doi.org/10.1186/s40560-025-00810-1 |
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