Abstract
The aims of this study were to investigate the usefulness of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, interleukin-6, and interleukin-8 as postmortem markers of sepsis and to compare C-reactive protein and procalcitonin values in serum, vitreous humor, and cerebrospinal fluid in a series of sepsis cases and control subjects, in order to determine whether these measurements may be employed for the postmortem diagnosis of sepsis. Two study groups were formed, a sepsis group (eight subjects coming from the intensive care unit of two university hospitals, with a clinical diagnosis of sepsis in vivo) and control group (ten autopsy cases admitted to two university medicolegal centers, deceased from natural and unnatural causes, without elements to presume an underlying sepsis as the cause of death). Serum C-reactive protein and procalcitonin concentrations were significantly different between sepsis cases and control cases, whereas serum tumor necrosis factor alpha, interleukin-6, and interleukin-8 values were not significantly different between the two groups, suggesting that measurement of interleukin-6, interleukin-8, and tumor necrosis factor alpha is non-optimal for postmortem discrimination of cases with sepsis. In the sepsis group, vitreous procalcitonin was detectable in seven out of eight cases. In the control group, vitreous procalcitonin was clearly detectable only in one case, which also showed an increase of all markers in serum and for which the cause of death was myocardial infarction associated with multi-organic failure. According to the results of this study, the determination of vitreous procalcitonin may be an alternative to the serum procalcitonin for the postmortem diagnosis of sepsis.
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References
Balci C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoglu B (2003) Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 7(1):85–90
Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J, Network GS (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164(3):396–402
Torgersen C, Moser P, Luckner G, Mayr V, Jochberger S, Hasibeder WR, Dünser MW (2009) Macroscopic postmortem findings in 235 surgical intensive care patients with sepsis. Anesth Analg 108(6):1841–1847
Tsokos M, Reichelt U, Nierhaus A, Püschel K (2001) Serum procalcitonin (PCT): a valuable biochemical parameter for the postmortem diagnosis of sepsis. Int J Legal Med 114(4–5):237–243
Tsokos M, Reichelt U, Jung R, Nierhaus A, Püschel K (2001) Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period. Forensic Sci Int 119(1):47–56
Tsokos M, Fehlauer F, Püschel K (2000) Immunohistochemical expression of E-selectin in sepsis-induced lung injury. Int J Legal Med 113(6):338–342
Tsokos M, Fehlauer F (2001) Postmortem markers of sepsis: an immunohistochemical study using VLA-4 (CD49d/CD29) and ICAM-1 (CD54) for the detection of sepsis-induced lung injury. Int J Legal Med 114:291–294
An JL, Ishida Y, Kimura A, Tsokos M, Kondo T (2009) Immunohistochemical detection of CCR2 and CX3CR1 in sepsis-induced lung injury. Forensic Sci Int 192(1–3):21–25
Heper Y, Akalin EH, Mistik R, Akgöz S, Töre O, Göral G, Oral B, Budak F, Helvaci S (2006) Evaluation of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, and interleukin-10 levels as diagnostic and prognostic parameters in patients with community-acquired sepsis, severe sepsis, and septic shock. Eur J Clin Microbiol Infect Dis 25(8):481–491
American College of Chest Physicians, Society of Critical Care Medicine Consensus Conference Committee (1992) Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874
Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36(6):691–709
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844):515–518
Uhlin-Hansen L (2001) C-reactive protein (CRP), a comparison of pre- and postmortem blood levels. Forensic Sci Int 124(1):32–35
Fujita MQ, Zhu BL, Ishida K, Quan L, Oritani S, Maeda H (2002) Serum C-reactive protein levels in postmortem blood—an analysis with special reference to the cause of death and survival time. Forensic Sci Int 130(2–3):160–166
Maeda H, Zhu BL, Bessho Y, Ishikawa T, Quan L, Michiue T, Zhao D, Li DR, Komatsu A (2008) Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. Forensic Sci Med Pathol 4(3):175–180
Ishikawa T, Hamel M, Zhu BL, Li DR, Zhao D, Michiue T, Maeda H (2008) Comparative evaluation of postmortem serum concentrations of neopterin and C-reactive protein. Forensic Sci Int 179(2–3):135–143
Astrup BS, Thomsen JL (2007) The routine use of C-reactive protein in forensic investigations. Forensic Sci Int 172(1):49–55
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Bettina Schrag and Cristian Palmiere equally contributed as first authors to this work.
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Schrag, B., Roux-Lombard, P., Schneiter, D. et al. Evaluation of C-reactive protein, procalcitonin, tumor necrosis factor alpha, interleukin-6, and interleukin-8 as diagnostic parameters in sepsis-related fatalities. Int J Legal Med 126, 505–512 (2012). https://doi.org/10.1007/s00414-011-0596-z
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DOI: https://doi.org/10.1007/s00414-011-0596-z