Corticosteroids play an important role in the management of septic shock patients, especially in those with higher doses of vasopressor. However, the therapeutic benefits of corticosteroids are not limited to hydrocortisone alone.

Our results show that no significant difference in 30-day mortality between those administered methylprednisolone and hydrocortisone.

The different effect of methylprednisolone or hydrocortisone in septic shock need to be further verified in prospective, randomized controlled trials.

A total of 1,607 septic shock patents were enrolled in this study, with an overall 30-day mortality rate of 42.1%.

After 1:1 PSM, 376 pairs were successfully matched.

The primary outcome occurred in 141 patients (37.5%) and in 131 patients (34.8%) in the methylprednisolone and hydrocortisone groups, respectively (HR = 1.105, 95% CI: 0.871–1.402, P = 0.410).

In subgroup analyses based on age, sex, blood culture positivity, pneumonia, and invasive mechanical ventilation (IMV), along with sensitivity analyses for deletion of missing values, findings remained consistent.

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