title: D-dimer and histamine in early stage bacteremia: A prospective controlled cohort study.
abstract: BACKGROUND
  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.
  
  
  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 ≥4μg/mL (n=13).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwameis
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Margarete Maria
authors.initials: MM
authors.lastname: Steiner
authors.affiliation: Department of Internal Medicine I, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Schoergenhofer
authors.affiliation: Department of Internal Medicine I, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Heimo
authors.initials: H
authors.lastname: Lagler
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Nina
authors.initials: N
authors.lastname: Buchtele
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Jilma-Stohlawetz
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, 1090 A Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boehm
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, 1090 A Vienna, Austria. Electronic address: bernd.jilma@meduniwien.ac.at.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jilma
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis; D001431:Bacteriological Techniques / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006632:Histamine / Q000032:analysis*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D006632:Histamine
keywords: Bacteremia; D-Dimer; Histamine; Inpatients; Mortality