Intestinal protein loss and hypoalbuminemia in children with pneumonia

Background: Intestinal protein loss has been reported mainly in diseases affecting the gastrointestinal tract. Intestinal protein loss during pneumonia with effusion has not been reported to date. The authors attempted to assess the associations between pneumonia with effusion and intestinal protein loss and hypoalbuminemia in children. Methods: This was a prospective consecutive case series study of in children hospitalized with pneumonia and effusion during a period of 41/2 years. Serum albumin, C-reactive protein (CRP), and fecal α-1 antitrypsin (α-1-AT) were measured in the first 72 hours of hospitalization. Two control groups were studied: one consisted of 50 febrile children hospitalized because of viral or mild bacterial infections, and the other consisted of 20 afebrile children hospitalized because of convulsive disorders. Results: Sixty-seven children ages 4 months to 14 years hospitalized with pneumonia and effusion were enrolled in the study. Fifty-nine percent (40 children) were found to have elevated fecal α-1-AT excretion (range, 2-10 mg/g) compared with none in the two control groups (P < 0.000). Fifty-two percent (35 children) of the children with pneumonia and effusion had mild to moderate hypoalbuminemia (range, 22-34 g/L). Only one child (2%) in the febrile control group had a low albumin of 34 g/L; none were found in the afebrile control group. The level of fecal α-1-AT was inversely correlated with serum albumin level. Conclusions: Pneumonia with effusion in children is often associated with an intestinal protein loss that can be monitored by measuring gastrointestinal loss of protein, namely fecal α-1-AT. In most cases the development of hypoalbuminemia correlates with the development of intestinal protein loss.