This prospective study investigated histamine and D-dimer levels in 72 patients with early stage bacteremia.
•
Histamine does not predict mortality in normal-ward inpatients with newly diagnosed bacteremia.
•
Early elevated d-dimer levels identify bacteremia patients at risk for in-hospital mortality.
Abstract
Introduction
Plasma histamine levels and D-dimer predict disease severity and mortality in advanced septic shock. We hypothesized that increased plasma histamine levels parallel coagulation activation and yield prognostic significance already at a very early stage of bacteremia.
Patients and methods
This prospective controlled cohort study enrolled 72 consecutive non-surgical non-ICU-ward inpatients with newly culture-diagnosed bacteremia and a Pitt Bacteremia score ≤ 2 to determine the extent of histamine and D-dimer release and their predictive role on outcome at the earliest stage of blood stream infection. Age-matched healthy adults served as internal controls (n = 36). A binominal logistic regression and a Cox proportional hazards regression analysis were performed to ascertain the effects of D-dimer and histamine on in-hospital mortality.
Results
In contrast to plasma histamine, D-dimer levels were significantly higher within hours of culture-proven bacteremia. In-hospital mortality occurred in 17%. Histamine levels were neither associated with D-dimer level (r = 0.04; p > 0.05) nor with ICU admissions (r = 0.06; p > 0.05) and outcome (crude OR 0.8, 95% CI 0.3–1.9; p = 0.6). In contrast, early-elevated D-dimer levels predicted mortality: the odds to die increased with the D-dimer level, and was 12.6 (crude OR, 95% CI 3–52; p = 0.001) in patients with a D-dimer ≥ 4 μg/mL (n = 13).
Conclusion
Histamine levels are elevated in only few patients (4%) with newly diagnosed bacteremia. Our findings suggest that D-dimer, but not plasma histamine, could be a promising marker of lethality already at a very early stage of blood stream infection.
Graphical abstract
Abbreviations
CVC
central venous catheter
DIC
disseminated intravascular coagulation
ISTH
International Society on Thrombosis and Haemostasis