Hydrocortisone outperforms other corticosteroids for community-acquired pneumonia

Key takeaways:

• Hydrocortisone use was linked to lower risk ratios for all-cause mortality in a systematic review and meta-analysis.
• Risk for mechanical ventilation and shock were also low with this treatment.

HONOLULU — The risk for all-cause mortality was reduced among patients with community-acquired pneumonia who used hydrocortisone vs. other corticosteroids, according to a poster presented at the CHEST Annual Meeting.

“The use of corticosteroids, but especially hydrocortisone, has a mortality benefit in patients with community-acquired pneumonia (CAP),” Xin Ya See, MD, resident at Rochester Regional Health Unity Hospital, told Healio.

Using five different databases, See and colleagues assessed 17 studies including patients hospitalized with CAP to see how hydrocortisone compares against other corticosteroids when evaluating all-cause mortality.

Researchers also looked at differences in risk for mechanical ventilation, acute respiratory distress syndrome, shock, hyperglycemia, secondary infections and gastrointestinal bleeding between the treatment groups.

Of the 17 studies, seven included hydrocortisone, four included prednisolone, three included methylprednisolone and two included dexamethasone.

When considering all corticosteroids compared with control, researchers observed a decreased risk for all-cause mortality (RR = 0.75; 95% CI, 0.57-0.99). However, when looking at the corticosteroids separately, hydrocortisone showed the greatest reduction (RR = 0.45; 95% CI, 0.31-0.65), whereas no significant reduction was seen with dexamethasone (RR = 0.73; 95% CI, 0.36-1.46), methylprednisolone (RR = 0.91; 95% CI, 0.64-1.3) or prednisolone (RR = 1.12; 95% CI, 0.85-1.47).

In terms of mechanical ventilation, the overall risk ratio was low across treatments (RR = 0.54; 95% CI, 0.42-0.69), but hydrocortisone demonstrated a significantly reduced risk (RR = 0.52; 95% CI, 0.39-0.69) for mechanical ventilation, whereas prednisolone and methylprednisolone did not.

All three studies reporting on acute respiratory distress syndrome for hydrocortisone showed a significant reduction (RR = 0.23; 95% CI, 0.07-0.8). Notably, the one study reporting on methylprednisolone use had a ratio greater than one (RR = 1.14; 95% CI, 0.46-2.83), with mixed results from the two studies on prednisolone.

Hydrocortisone also conferred a significant reduction in risk for shock (RR = 0.16; 95% CI, 0.07-0.35), whereas the three studies on methylprednisolone did not.

In terms of other outcomes, hydrocortisone showed a trend toward reduction in gastrointestinal bleeding, secondary infections and hyperglycemia, although the results did not reach statistical significance, with mixed results seen for the other corticosteroids.

“We found that most of the time, only hydrocortisone has a benefit ... but we are not sure about the reason,” See told Healio.

“We hope that there will be more clinical trials coming to evaluate this,” See added.