title: Intestinal protein loss and hypoalbuminemia in children with pneumonia.
abstract: 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.
authors.affiliation: Gastroenterology, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel. aklar@inter.net.il
authors.forename: Aharon
authors.initials: A
authors.lastname: Klar
authors.forename: David
authors.initials: D
authors.lastname: Shoseyov
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Berkun
authors.forename: Abraham
authors.initials: A
authors.lastname: Brand
authors.forename: Jacques
authors.initials: J
authors.lastname: Braun
authors.forename: Gila
authors.initials: G
authors.lastname: Shazberg
authors.forename: Moise
authors.initials: M
authors.lastname: Jonathan
authors.forename: Eva
authors.initials: E
authors.lastname: Gross-Kieselstein
authors.forename: Shoshana
authors.initials: S
authors.lastname: Revel-Vilk
authors.forename: Haggit
authors.initials: H
authors.lastname: Hurvitz
mesh_terms: 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
chemical_list: D011506:Proteins; D012709:Serum Albumin; D000515:alpha 1-Antitrypsin; D002097:C-Reactive Protein