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Post-mortem in situ stability of serum markers of cerebral damage and acute phase response

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Abstract

The aim of the given study was to test the in situ stability of biochemical markers of cerebral damage and acute phase response in the early post-mortem interval to assess their usability for forensic pathology. A monocentric, prospective study investigated post-mortem femoral venous blood samples at four time points obtained within 48 h post-mortem starting at the death of 20 deceased, using commercial immunoassays for the ten parameters: S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), ferritin, soluble tumor necrosis factor receptor type 1 (sTNFR1), and lactate dehydrogenase (LDH). Significant changes in serum levels were observed only later than 2 h after death for all markers. Inter-laboratory comparability was high, and intra-assay precision was sufficient for most markers. Most of the biomarker levels depended on the severity of hemolysis and lipemia but were robust against freeze-thaw cycles. Serum levels increased with longer post-mortem intervals for S100B, NSE, ferritin, sTNFR1, and LDH (for all p < 0.001) but decreased over this period for CRP (p = 0.089) and PCT (p < 0.001). Largely unchanged median values were found for GFAP (p = 0.139), BDNF (p = 0.106), and IL-6 (p = 0.094). Serum levels of CRP (p = 0.059) and LDH (p = 0.109) did not differ significantly between the final ante-mortem (resuscitation) and the first post-mortem sample (moment of death). Collecting the post-mortem blood sample as soon as possible will reduce the influence of post-mortem blood changes. Serum GFAP for detection of cerebral damage as well as serum IL-6 and CRP as proof of acute phase response seemed to be preferable due to their in situ stability in the first 2 days after death.

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Acknowledgments

The authors would like to thank Ms. Aqeeda Singh (Department of Anatomy, University of Otago, New Zealand) for proofreading the paper as a native speaker and Prof. Ralph Burkhardt (Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany) for his kind support in aliquot checking of serum interference indices.

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Author notes

  1. Benjamin Ondruschka and Lina Woydt contributed equally to this work.

Authors and Affiliations

  1. Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany

    Benjamin Ondruschka, Lina Woydt & Jan Dreßler

  2. Emergency Department, Heinrich Heine University Duesseldorf, Duesseldorf, Germany

    Michael Bernhard

  3. Rudolf Boehm Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, Germany

    Heike Franke

  4. Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany

    Holger Kirsten

  5. LIFE Center (Leipzig Interdisciplinary Research Cluster of Genetic Factors, Phenotypes and Environment), University of Leipzig, Leipzig, Germany

    Holger Kirsten

  6. Institute of Anatomy, University of Leipzig, Leipzig, Germany

    Sabine Löffler

  7. Center of Diagnostics GmbH, Klinikum Chemnitz, Chemnitz, Germany

    Dirk Pohlers

  8. Department of Anatomy, University of Otago, Dunedin, New Zealand

    Niels Hammer

  9. Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany

    Niels Hammer

  10. Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany

    Niels Hammer

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  1. Benjamin Ondruschka
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Corresponding author

Correspondence to Benjamin Ondruschka.

Ethics declarations

All experiments were conducted in accordance with the human and ethical principles of the University of Leipzig (no. 388/15-ek).

Conflict of interest

BO has received reimbursement of travel costs from Randox Laboratories. The authors declare no competing interests.

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Ondruschka, B., Woydt, L., Bernhard, M. et al. Post-mortem in situ stability of serum markers of cerebral damage and acute phase response. Int J Legal Med 133, 871–881 (2019). https://doi.org/10.1007/s00414-018-1925-2

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  • DOI: https://doi.org/10.1007/s00414-018-1925-2

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