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Intestinal Protein Loss and Hypoalbuminemia in Children with Pneumonia

Klar, Aharon*,§; Shoseyov, David; Berkun, Yaakov§; Brand, Abraham; Braun, Jacques§; Shazberg, Gila§; Jonathan, Moise§; Gross-Kieselstein, Eva§; Revel-Vilk, Shoshana§; Hurvitz, Haggit§

Journal of Pediatric Gastroenterology and Nutrition: August 2003 - Volume 37 - Issue 2 - p 120-123
Original Articles—Gastroenterology

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 4½ 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.

*Gastroenterology, †Cardiology, and ‡Pulmonology Units of the §Department of Pediatrics, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel

Received April 19, 2002; accepted February 28, 2003.

Address correspondence and reprint requests to Dr. Aharon Klar, Gastroenterology Unit, Department of Pediatrics, Bikur Cholim General Hospital, POB 492, Jerusalem, 91004, Israel (e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.