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 4(1/2) years. Serum albumin, C-reactive protein (CRP), and fecal alpha-1 antitrypsin (alpha-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 alpha-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 alpha-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 alpha-1-AT. In most cases the development of hypoalbuminemia correlates with the development of intestinal protein loss.
Klar
Aharon
A
Gastroenterology, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel. aklar@inter.net.il
Shoseyov
David
D
Berkun
Yaakov
Y
Brand
Abraham
A
Braun
Jacques
J
Shazberg
Gila
G
Jonathan
Moise
M
Gross-Kieselstein
Eva
E
Revel-Vilk
Shoshana
S
Hurvitz
Haggit
H
D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000209:etiology* / Q000378:metabolism; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D010996:Pleural Effusion / Q000097:blood / Q000150:complications / Q000378:metabolism; D011014:Pneumonia / Q000097:blood / Q000150:complications* / Q000378:metabolism; D011446:Prospective Studies; D011504:Protein-Losing Enteropathies / Q000097:blood / Q000209:etiology* / Q000378:metabolism; D011506:Proteins / Q000032:analysis / Q000378:metabolism*; D012709:Serum Albumin / Q000378:metabolism; D000515:alpha 1-Antitrypsin / Q000032:analysis / Q000378:metabolism
D011506:Proteins; D012709:Serum Albumin; D000515:alpha 1-Antitrypsin; D002097:C-Reactive Protein