The effects of hydrocortisone vs other corticosteroids on patient outcomes in community-acquired pneumonia: a systematic review and meta-analysis

SESSION TITLE: Chest Infections Posters 5 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Large randomized trials and meta-analysis to date have shown that corticosteroids do not lower the mortality of community-acquired pneumonia (CAP). However, one recent randomized controlled trial showed that hydrocortisone is associated with lower mortality of CAP. In this systematic review and meta-analysis, we aimed to evaluate whether the use of hydrocortisone versus other corticosteroids have differential effects on clinical outcomes of patients with CAP. METHODS: We performed a comprehensive search of PubMed, Cochrane Library, and Embase databases to identify randomized controlled trials that evaluated the efficacy of systemic corticosteroids for managing CAP. The primary endpoint was all-cause mortality, while the secondary endpoints included need for mechanical ventilation, and adverse events such as secondary infections and gastrointestinal bleeding. RESULTS: We identified seventeen trials eligible for inclusion, of which 6 trials reported on the use of hydrocortisone, 2 on dexamethasone, 6 on prednisolone, and 3 on methylprednisolone. Hydrocortisone was associated with a lower risk of all-cause mortality (risk ratio, 0.48 [95% CI: 0.33, 0.71], p < 0.001), while other corticosteroids were not associated with a lower risk of all-cause mortality (risk ratio, 1.01 [95% CI: 0.83, 1.22], p = 0.94). Similarly, hydrocortisone was associated with a lower need for mechanical ventilation (risk ratio, 0.65 [95% CI: 0.50, 0.84], p = 0.001), while other corticosteroids were not associated with a lower need for mechanical ventilation (risk ratio, 0.67 [95% CI: 0.34, 1.35], p = 0.27). Both hydrocortisone and other corticosteroids were not associated with increased risk of secondary infections (hydrocortisone: risk ratio, 0.93 [95% CI: 0.27, 3.22], p = 0.90; other corticosteroids: risk ratio, 1.01 [95% CI: 0.78, 1.31], p = 0.93) or gastrointestinal bleeding (hydrocortisone: risk ratio, 0.77 [95% CI: 0.39, 1.53], p = 0.46; other corticosteroids: risk ratio, 1.65 [95% CI: 0.84, 3.24], p = 0.146). CONCLUSIONS: Among patients hospitalized with CAP, treatment with hydrocortisone, but not other corticosteroids, was associated with a decrease in mortality. CLINICAL IMPLICATIONS: Corticosteroids have been reported to have no effects on survival outcomes of hospitalized patients with CAP. 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. DISCLOSURES: No disclosure on file for Cho-Hsien Chiang No relevant relationships by Cho Hung Chiang No relevant relationships by Cho Han Chiang No relevant relationships by Xin Ya See