Background: Pneumonia represents a significant public health problem in the whole world, and it is one of the leading causes of morbidity and mortality among children. Disease severity and clinical outcome prediction are required in pneumonia to manage health resources and give effective treatment options. Ischemia-modified albumin (IMA) is a marker of the recently used oxidant-antioxidant mechanism and has been found toin crease in many inflammatory conditions. Procalcitonin (PCT) is released as a part of the pro-inflammatory response of the innate immune system from parenchymal cells reaching detectable levels within 4 h after endotoxin stimulation. Objectives: This study examined IMA and PCT levels in patients with pneumonia, in comparison with healthy controls and their possible association with disease severity and outcome. Methods: A total of 90 cases of pneumonia and 90 controls were included in this cohort observational study, and severity grading was performed according to pediatric respiratory severity score (PRESS). Serum IMA and PCT were evaluated in all study subjects. Results: In pneumonia, IMA levels were significantly elevated as compared with controls, and it was elevated in died patients compared to those who were discharged.IMA showed a significant positive correlation with PRESS.