Original Article
D-dimer and histamine in early stage bacteremia: A prospective controlled cohort study

https://doi.org/10.1016/j.ejim.2015.10.024Get rights and content
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Highlights

  • 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.

Abbreviations

CVC
central venous catheter
DIC
disseminated intravascular coagulation
ISTH
International Society on Thrombosis and Haemostasis
ICU
Intensive Care Unit
LMWH
low molecular weight heparin
NOAC
new oral anticoagulants
SSTI
skin and soft tissue infection
VKA
vitamin K antagonists

Keywords

Bacteremia
Inpatients
D-Dimer
Histamine
Mortality

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