Elevated plasma histamine levels in trauma patients: Results of a well-designed cross-sectional study with polytrauma and two control groups

Abstract

Several components of trauma (initial stressors, responses and burdens and therapeutic interventions) are able to induce histamine release, but our knowledge is very limited about the role of histamine in this fundamental scenario in human life. Previous studies suffer from unreliable histamine assays from biases in sample preparation and from confounding biases in the clinical setting. Hence a well-designed (6) crosssectional study was performed with polytrauma patients at the site of accident as a test group and two control groups in the hospital. The patients of the control groups suffered from single, peripheral trauma (more stress than injury) or being in the recovery period from single trauma and operation at day 5 (reconvalescence from traumatization).

Patients at the normal ward had plasma histamine levels comparable to those of healthy human volunteers (<0.5 ng/ml) whereas 40% of the single trauma patients and 80% of the polytrauma patients showed elevated plasma levels (>=0.5 ng/ml). This was the case both at the place of the accident and in a second blood sample in the hospital. Hence the initial stimulus of injury was not the only cause of histamine release. Furthermore, histamine was one of the very early mediators in trauma. Its function has to be assessed as a contributory determinant in a multi-mediator scenario. Elevated plasma histamine concentrations of more than 1 ng/ml had a very bad prognosis for survival in previous studies, but the mechanism for that is not investigated at all.