Plasma fibronectin, transferrin and prealbumin in children with bacterial pneumonia with and without protein supplementation

ABSTRACT

The study included 100 patients with bacterial pneumonia, as well as 20 apparently healthy controls. Their ages ranged from 2-36 months. Any disease that could affect the plasma proteins, e.g. hepatic, renal and/or nutritional were excluded from the patients and controls. Patients were classified according to Downe's score for respiratory distress into mild [score <2], moderate [score 2-5] and severe [score >5]. The patients were subjected to full clinical examination, chest x-ray, tuberculin test, full blood picture and early morning fasting stomach aspirate for bacteriological studies. All patients and controls had fibronectin [Fn], transferrin [Tn] and Prealbumin [PA] measured initially and on follow up after 10 days for the patients. On systematic random basis, to every other case a high protein supplementation was given. Cases with bacterial pneumonia showed significantly lower values of mean +/- S.D. plasma Fn, Tn and PA than controls. Severe and moderate pneumonia, cases showed significantly lower values of plasma. Fn, Tn and PA than mild ones. Patients with non pneumococcal pneumonia showed significantly lower values of plasma Fn, Tn and PA than those with pneumococcal pneumonia. There was a strong positive significant correlation, between the 3 protein markers studied, i.e. Fn, Tn and PA, and estimation of one of them could save estimation of the others. Cases with mild pneumonia initially [as measured by Downe's score] that became either moderate or severe during the course of the disease, showed significantly lower values of Fn, Tn and PA than cases with wild pneumonia that became neither moderate nor severe. With recovery [with or without protein supplementation] follow up levels of Fn, Tn and PA were significantly higher than initially. These data, suggest that early estimation of protein markers may have a predictive value in forecasting the outcome of bacterial pneumonia. They are more accurate than using Downe's score only. The old myth of avoiding excessive intake of proteins during pneumonia is now obsolete. It is recommended, that high intake of proteins during the course of bacterial pneumonia speeds recovery