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

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• Picked for Pediatrics and Child Health (paper of the day, 13 September 2026): Secondary hypoalbuminemia predicts mortality in E. coli BSI

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.

Abstract as published, via PubMed.