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Forensic application of three interstitial pneumonia markers: search for new pneumonia markers in dead bodies

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Abstract

In forensic cases, detailed identification of pneumonia is important. Our objective was to statistically determine the applicability of three interstitial lung disease (ILD) markers for forensic diagnosis using serum collected from dead bodies with various postmortem intervals (PMIs). We retrospectively analyzed the levels of postmortem serum Krebs von den Lungen-6 (KL-6) and pulmonary surfactant–associated proteins A and D (SP-A and SP-D) using 221 samples obtained during forensic autopsy at our facility from 2019 to 2023. We evaluated the diagnostic efficacy of ILD markers for various pneumonias against the pathological diagnosis, and examined the assessment of the severity of ILD. When comparing the ILD group with bacterial pneumonia (BP) versus the control group, there was a significant increase in KL-6 in the ILD group. When comparing the severe ILD (SILD) group with the mild ILD (MILD) group, there was a significant increase in KL-6 and SP-D in the SILD group. The optimal cutoff values for differentiating SILD were 607.0 U/mL for KL-6, 55.5 ng/mL for SP-A, and 160.0 ng/mL for SP-D, and the sensitivity/specificity (%) of KL-6, SP-A, and SP-D for SILD were 84.1/95.2, 55.6/85.7, and 66.7/74.6, respectively. This is the first study to examine KL-6 in postmortem serum in forensic medicine. By analyzing dead bodies with various PMIs, our results confirmed statistically that postmortem serum KL-6 specifically detects ILD, postmortem serum SP-A has high sensitivity to lung injury, and postmortem serum SP-D is potentially useful in assessing the severity of ILD.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ILD:

Interstitial lung disease

KL-6:

Krebs von den Lungen-6

SP-A:

Pulmonary surfactant–associated protein A

SP-D:

Pulmonary surfactant–associated protein D

IIP:

Idiopathic interstitial pneumonia

ARDS:

Acute respiratory distress syndrome

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

COVID-19P:

Coronavirus disease 2019 pneumonia

BP:

Bacterial pneumonia

CRP:

C-reactive protein

PMI:

Postmortem interval

SILD:

Severe interstitial lung disease

MILD:

Mild interstitial lung disease

AP:

Alveolar pneumonia

BrP:

Broncho pneumonia

AsP:

Aspiration pneumonia

PF:

Pulmonary fibrosis

FP:

Fungal pneumonia

OP:

Organized pneumonia

IIP:

Idiopathic interstitial pneumonia

AIDS:

Acquired immune deficiency syndrome

COPD:

Chronic obstructive pulmonary disease

HCC:

Hepatocellular carcinoma

SOP:

Secondary organized pneumonia

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

COP:

Cryptogenic organized pneumonia

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Acknowledgements

We thank Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan

    Keisuke Okaba, Kie Horioka, Hiroyuki Inoue, Ayumi Motomura, Namiko Ishii, Chihiro Moue & Daisuke Yajima

  2. Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan

    Keisuke Okaba, Go Inokuchi, Hirotaro Iwase, Ayumi Motomura, Namiko Ishii & Daisuke Yajima

  3. Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center, University of Oulu, Oulu, Finland

    Kie Horioka

  4. Department of Pathology, School of Medicine, International University of Health and Welfare, Narita, Japan

    Takayuki Shiomi

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Contributions

KO, KH, and CM performed the measurements. GI, H Iwase, H Inoue, AM, NI, TS, and DY reviewed this manuscript. GI supervised the study.

Corresponding author

Correspondence to Keisuke Okaba.

Ethics declarations

Ethical approval

This study was conducted with the approval of the Human Research Ethics Committee of the University of the International University of Health and Welfare, School of Medicine (ethics approval number: 19-Im-019).

Consent to participate

Because all the subjects of this study are the dead bodies, it is impossible for us to obtain the informed consent from them. However, we are making an effort to obtain the informed consent of the families and/or other interested parties of the dead bodies through an opt-out method via leaflets and our website.

Research involving human participants and/or animals

This study was performed with human dead bodies. This manuscript does not contain any studies with (living) human participants or animals performed by any of the authors.

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The authors declare no competing interests.

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Okaba, K., Inokuchi, G., Horioka, K. et al. Forensic application of three interstitial pneumonia markers: search for new pneumonia markers in dead bodies. Int J Legal Med (2024). https://doi.org/10.1007/s00414-024-03187-2

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