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Diagnostic role of serum tryptase in anaphylactic deaths in forensic medicine: a systematic review and meta-analysis

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Abstract

Postmortem diagnosis of sudden death due to anaphylaxis can be very difficult due to the non-specific pathological findings in forensic practice. Postmortem serum tryptase has been used as an indicator of possible ante-mortem anaphylaxis. Though many previous studies have been conducted to explore the diagnostic significance of serum tryptase for lethal anaphylaxis, inconsistent results were documented. In this study, we made a retrospective study and presented a systematic review and meta-analysis that aims to summarize the diagnostic significance of postmortem serum tryptase in the deceased with and without anaphylactic shock and to calculate a cutoff value for future reference in the identification of deaths due to anaphylactic shock. A complete literature search in the PubMed, Cochrane Library, CNKI and Embase databases (published prior to March 1st, 2017) was performed. The quality of the eligible literature was evaluated according to the Newcastle-Ottawa Quality Assessment Scale (NOS), and the relevant data was extracted. The procedure of meta-analysis was performed by RevMan 5.3 software. Subgroup analysis was performed according to different causes of death. A total of nine studies with 296 patients were identified. The NOS of each included study was equal to 7. The results indicated that high concentrations of tryptase were significantly associated with anaphylactic shock when compared to the other causes of death. The weighted mean difference (WMD) was 29.53 (95% CI = 7.58–51.47, p = 0.008). Similar results were detected in the subgroup analysis when compared to deaths due to cardiovascular disease (CVD). However, no obvious elevation of tryptase in decedents with CVD compared to the other cause of death was observed (WMD = 4.42, 95% CI = −0.94–9.79). We concluded that high serum tryptase is a promising diagnostic biomarker for deaths due to anaphylactic shock, especially when it is higher than 30.4 μg/L.

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Acknowledgments

This research was supported by the National Natural Science Foundation of China (Grant No. 81401556 and 81601641), the Natural Science Foundation of Guangdong Province (No. 2014A030310504 and 2014A030310293), the Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry(No.2015-311), and the Special Foundation of President of School of Public Health of Southern Medical University (Grant No.GW201619).

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Authors and Affiliations

  1. The First Clinical Medical College, Southern Medical University, Guangzhou, China

    Kai-Jian Sun

  2. Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China

    Jie-Tao He, Hong-Yan Huang, Ye Xue & Qi Wang

  3. Department of Toxicology, School of Public Health and Tropical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China

    Xiao-Li Xie

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  1. Kai-Jian Sun
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Correspondence to Xiao-Li Xie or Qi Wang.

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Sun, KJ., He, JT., Huang, HY. et al. Diagnostic role of serum tryptase in anaphylactic deaths in forensic medicine: a systematic review and meta-analysis. Forensic Sci Med Pathol 14, 209–215 (2018). https://doi.org/10.1007/s12024-018-9980-z

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