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Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy

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Abstract

Circulating erythropoietin (EPO) is mainly produced in the kidneys, depending on blood oxygen level. The present study investigated the postmortem serum EPO levels with regard to the cause of death and survival time. Serial medicolegal autopsy cases of postmortem time within 48 h (n = 536) were examined. Serum EPO levels were within the clinical reference range in most cases. Uremic patients with medical administration of an EPO agent (n = 11) showed a markedly high level (140–4,850 mU/ml; median, 1,798 mU/ml). Otherwise, an elevation in serum EPO level (>30 mU/ml) was mainly seen in protracted deaths due to blunt injury and fire fatality, depending on the survival time (r = 0.69, p < 0.0001, and r = 0.45, p < 0.0001, respectively), and in subacute deaths from gastrointestinal bleeding and infectious diseases. However, mildly to moderately elevated serum EPO levels were sporadically found in acute deaths due to mechanical asphyxiation, fire fatality, and acute ischemic heart disease, and in fatal hypothermia cases, especially for elderly subjects. Protracted deaths due to mechanical asphyxiation and ischemic heart disease did not show any survival time-dependent increase in serum EPO level (p > 0.05). EPO was immunohistochemically detected in the tubular epithelia and interstitial cells, showing no evident difference among the causes of death, independent of survival time or serum level. These findings suggest that serum EPO can be used as a marker for investigating anemia and/or hypoxia as a consequence of fatal insult in subacute or prolonged deaths, or a predisposition to traumatic deaths or fatal heart attacks in acute deaths.

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Acknowledgment

This study was supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS; grant no. 19890189).

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Authors and Affiliations

  1. Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585, Osaka, Japan

    L. Quan, T. Ishikawa, T. Michiue, D. Zhao & H. Maeda

  2. Department of Forensic Pathology, China Medical University School of Forensic Medicine, No. 92, Beier Road, Heping District, Shenyang City, 110001, Liaoning, China

    B.-L. Zhu

  3. Department of Forensic Pathology, Sichuan University West China School of Preclinical Medical Sciences and Forensic Medicine, Chengdu City, 610041, Sichuan, China

    D.-R. Li

  4. Department of Clinical Pharmaceuticals, Osaka Ohtani University School of Pharmaceutical Sciences, Nisikiorikita 3-11-1, Tondabayashi City, 584-8540, Osaka, Japan

    M. Ogawa

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  1. L. Quan
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  2. B.-L. Zhu
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  3. T. Ishikawa
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  4. T. Michiue
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  5. D. Zhao
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  6. D.-R. Li
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  7. M. Ogawa
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  8. H. Maeda
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Correspondence to L. Quan.

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Quan, L., Zhu, BL., Ishikawa, T. et al. Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy. Int J Legal Med 122, 481–487 (2008). https://doi.org/10.1007/s00414-008-0276-9

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  • DOI: https://doi.org/10.1007/s00414-008-0276-9

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