Peer-reviewed article

Secondary hypoalbuminemia is independently associated with in-hospital mortality in children with Escherichia coli bloodstream infection.

Jie Cheng, Ya Liu, Shaojun Li, Hongdong Li, Junming Huo et al. · 10 Sept 2026

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This is a clinical medical study examining the association between low blood albumin levels and death in children with E. coli bloodstream infections. The researchers reviewed hospital records of 211 children and found that secondary hypoalbuminemia (low albumin developing after infection) was independently associated with higher in-hospital mortality. The study identifies hypoalbuminemia as a potential prognostic marker for risk stratification.

Key points

In-hospital mortality was 12.32% among 211 children with E. coli bloodstream infection
Secondary hypoalbuminemia occurred in 10.90% of cases and was independently associated with mortality (OR 10.59)
Four factors were independently associated with mortality: invasive mechanical ventilation, secondary hypoalbuminemia, higher PRISM III score, and shorter time to positivity
Children with secondary hypoalbuminemia had significantly lower survival probability (log-rank p = 0.002)
The findings were confirmed through sensitivity analysis using Firth penalized regression

Limitations

This is a retrospective observational study without a comparison group testing an intervention, so it cannot establish causation or the effectiveness of any treatment. The study identifies an association between hypoalbuminemia and mortality but does not evaluate whether correcting albumin levels would improve outcomes.

Abstract

OBJECTIVE: Hypoalbuminemia is common in critically ill children, however, its prognostic role in pediatric Escherichia coli (E. coli) bloodstream infection (BSI) remains unclear. We aimed to evaluate the association between secondary hypoalbuminemia (hypoalbuminemia developing after BSI onset in patients with normal pre-infection albumin levels) and in-hospital mortality in children with E. coli BSI. METHODS: We retrospectively enrolled 211 children with E. coli BSI. Logistic regression and Kaplan-Meier analysis were used to identify risk factors independently associated with in-hospital mortality. A Firth penalized regression was performed as sensitivity analysis. RESULTS: In-hospital mortality was 12.32% (26/211). Secondary hypoalbuminemia after BSI occurred in 10.90% (23/211). Multivariable analysis identified four factors independently associated with in-hospital mortality: invasive mechanical ventilation (OR 46.40, 95% CI 3.90-552.62), secondary hypoalbuminemia (OR 10.59, 95% CI 1.39-80.91), higher PRISM III score (OR 1.18, 95% CI 1.03-1.36), and shorter time to positivity (TTP) (OR 0.71 per hour increase, 95% CI 0.56-0.89; i.e. shorter TTP was associated with higher mortality); all p < 0.05. Survival probability was significantly lower among children who developed secondary hypoalbuminemia (log-rank p = 0.002). Sensitivity analysis confirmed the robustness of these findings. CONCLUSIONS: Secondary hypoalbuminemia developing after E. coli BSI is independently associated with mortality in children. Secondary hypoalbuminemia may serve as a dynamic prognostic marker for increased in-hospital mortality in children with E. coli BSI. Prospective multicenter studies are warranted to determine its value for clinical risk stratification.