Source: Annual Congress 2006 - Pneumonia and other invasive pulmonary infections in children
Disease area: Respiratory infections

Abstract

Background: Parapneumonic fluid is the most common cause of pleural effusion in children. Hypoalbuminemia is often associated with massive pleural effusion, but its incidence and pathogenesis are unclear.
Aim: To assess the presence and severity of hypoalbuminemia in children with parapneumonic pleural effusion and to propose a possible pathophysiological mechanism.
Methods: The clinical records of patients diagnosed with bacterial pneumonia complicated by pleural effusion during 1999-2002 were reviewed (n=50). Albumin levels were compared with age and sex-matched groups of children with bacterial pneumonia alone or with acute illnesses other than pneumonia (n=50 each). Caloric intake and protein loss in urine and stools were also evaluated.
Results: Albumin levels in the three groups are shown in the Table.

	Parapneumonic pleural effusion	Pneumonia	Control
Lowest albumin level (g/dl)
Mean±SD	3.1±0.58	3.5±0.34	4.2±0.42
Range	2.0-4.4	2.9-4.0	3.1-4.8
Severity of hypoalbuminemia n(%)
Normal (≥3.8 g/dl)	7 (14)	7 (14)	37 (74)
Mild (3-3.8 g/dl)	17 (34)	40 (80)	13 (26)
Moderate (2.6-3.0 g/dl)	16 (32)	3 (6)	0
Severe (<3 g/dl)	10 (20)	0	0

Mean serum albumin level in the study group was lower in patients with large effusions (n=19, 38%) than in those with small ones (n=15, 30%) (2.7±0.37 vs.3.7±0.47 g/dl, p<0.0001). Albumin loss was not found. Estimation of the amount of albumin in the drained pleural fluid suggested an albumin shift from blood to pleural fluid.
Conclusions: Significant hypoalbuminemia is common in children with parapneumonic pleural effusion. Low albumin levels correlate with large effusions, probably because of a shift from blood to pleural fluid.

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Citations should be made in the following way:
D. Prais, I. Kuzmenko, L. Harel, J. Amir (Petah Tikwa, Tel Aviv, Israel). Parapneumonic pleural effusion as a cause of hypoalbumunemia in pediatric patients. Eur Respir J 2006; 28: Suppl. 50, 1782

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