HISTAMINE-RELEASE IN SEPSIS - A PROSPECTIVE, CONTROLLED, CLINICAL-STUDY

Objective: To determine if histamine release occurs in clinical sepsis . Design: Prospective, controlled, clinical study. Setting: Interdisci plinary intensive care unit and trauma ward. Patients: Sepsis was conf irmed in 20 patients (test group) by the criteria of the Veterans Admi nistration Systemic Sepsis Cooperative Study Group (1987) and was veri fied by positive blood culture, In addition, patients were scored by t he Elebute and Stoner Sepsis Score (1983), as modified by Dionigi et a l (1985), A concomitant control group consisted of 20 postoperative pa tients with non-life-threatening trauma to the extremities and without signs of local or systemic infection. Interventions: Observational st udy, Blood samples were collected for determination of plasma histamin e concentrations in both groups at the time of study entry and on five succeeding days. Measurements and Main Results: The patients were wel l matched, and the groups were not significantly different for all cri teria known to influence histamine release, Comparison of the median v alues of each group on days 1 through 5 demonstrated significantly hig her plasma histamine values in the test group on days 1 through 4, but these values were no longer significantly higher on day 5, While none of the nonseptic control patients achieved a plasma histamine concent ration of >1 ng/mL (the concentration of which was considered to be th e pathologic cutoff point representing histamine release), these value s (i.e., >1 ng/mL) were found in nine of 20 test group patients, In th e test group, nonsurvivors (n = 9) had significantly higher plasma his tamine concentrations than survivors (n = 11) throughout the whole stu dy and eight of nine nonsurvivors showed a plasma histamine concentrat ion of >1 ng/mL. Correlation of plasma histamine concentrations on day 1 to sepsis severity (initial Sepsis Score) showed that all but one p atient with a combined low Sepsis Score (<20 points) and histamine con centration of <1 ng/mL survived, while all patients with a Sepsis Scor e of >20 points and histamine release (plasma histamine concentration of >1 ng/mL) died. Conclusion: Increased histamine concentrations were shown to be causally associated (contributory determinant) with sepsi s.