Anemia predictor of treatment failure at high altitude

Children with anemia, living at high altitude, have an increased risk for poor outcomes when being treated for severe pneumonia compared with children living at low altitude, according to recent study findings published in Pediatrics.

Researchers evaluated data from the Severe Pneumonia Evaluation Antimicrobial Research (SPEAR) study, which included 958 children aged 2 to 59 months living at eight sites with different elevations. Elevations were either considered high (2,000 meters or higher) or low (less than 2,000 meters).

One hundred ninety-three patients were living at high altitude and 765 at low altitude. Eighty-six percent of the patients living at high altitude had an oxyhemoglobin saturation level of less than 80% compared with 11% at low altitude (RR=7.7; 95% CI, 6.3-9.5). At high altitude, anemia was a predictor of treatment failure (RR=4.07; 95% CI, 2.60-6.38), but not at low altitude (RR=1.12; 95% CI, 0.96-1.30). Patients at high altitude also took longer to reach normomexia (median time, 5.25 days) compared with low altitude (0.75 days; P<.0001 for difference).

“This study reveals that young children with severe pneumonia living at high altitude present with significantly more severe hypoxemia than do children at low altitude, that children at high altitude take longer to recover from hypoxemia, and that anemia at high altitude increases the risk of poor outcome,” the researchers wrote. “Prevention and treatment of anemia should be a high priority in young children living at high altitude, and addressing this risk factor could reduce morbidity and mortality from severe pneumonia."

Peter P. Moschovis, MD, MPH, can be reached at Massachusetts General Hospital, Department of Pediatrics, Division of Global Health, 100 Cambridge Street, 15th Floor, Boston, MA 02114; email:

Disclosure: See the study for a full list of relevant financial disclosures.