ABSTRACT
The postmortem diagnosis of heat-related deaths presents certain difficulties. Firstly, preterminal or terminal body temperatures are often not available. Additionally, macroscopic and microscopic findings are nonspecific or inconclusive and depend on survival duration after exposure. The diagnosis of hyperthermia is therefore essentially based on scene investigation, the circumstances of death, and the reasonable exclusion of other causes of death. Immunohistochemistry and postmortem biochemical investigations have been performed by several authors in order to better circumstantiate the physiopathology of hyperthermia and provide further information to confirm or exclude a heat-related cause of death. Biochemical markers, such as electrolytes, hormones, blood proteins, enzymes, and neurotransmitters, have been analyzed in blood and other biological fluids to improve the diagnostic potential of autopsy, histology, and immunohistochemistry. The aim of this article is to present a review of the medicolegal literature pertaining to the postmortem biochemical investigations that are associated with heat-related deaths.
Subject(s)
Fever/diagnosis , Adrenocorticotropic Hormone/blood , Adrenocorticotropic Hormone/cerebrospinal fluid , Atrial Natriuretic Factor/blood , Atrial Natriuretic Factor/cerebrospinal fluid , Biomarkers/analysis , Blood Urea Nitrogen , C-Reactive Protein/analysis , Calcitonin/blood , Calcium/analysis , Catecholamines/analysis , Chlorides/analysis , Chromogranin A/blood , Chromogranin A/cerebrospinal fluid , Creatine Kinase, MB Form/blood , Creatine Kinase, MB Form/cerebrospinal fluid , Creatinine/blood , Electrolytes/analysis , Fever/blood , Fever/cerebrospinal fluid , Fever/urine , Forensic Pathology , Growth Hormone/blood , Growth Hormone/cerebrospinal fluid , Heat Stroke/blood , Heat Stroke/cerebrospinal fluid , Heat Stroke/diagnosis , Heat Stroke/urine , Humans , Magnesium/analysis , Myocardium/pathology , Myoglobin/analysis , Myoglobinuria/diagnosis , Myoglobinuria/etiology , Natriuretic Peptide, Brain/blood , Natriuretic Peptide, Brain/cerebrospinal fluid , Neopterin/blood , Protein Precursors/blood , Sodium/analysis , Troponin/blood , Troponin/cerebrospinal fluid , Tryptases/blood , Uric Acid/analysis , Vitreous Body/chemistryABSTRACT
Previous studies suggested the usefulness of postmortem cardiac troponin (cTn) and creatine kinase MB (CKMB) levels in blood and pericardial fluid for investigating myocardial damage in the death process. The present study investigated the postmortem levels in cerebrospinal fluid (CSF), using serial medicolegal autopsy cases (n=257, within 48h postmortem). For CSF, the postmortem increase was slight for cTnT and cTnI, and was not significant for CKMB. A moderate correlation was seen between cTnT and cTnI levels (r=0.598, p<0.0001), whereas the correlations of cTnT and cTnI with CKMB were insignificant. The correlation between peripheral blood and CSF levels was significant for cTnT and cTnI, but insignificant for CKMB. Marked concomitant increases in CSF cTnT and cTnI levels were seen for protracted asphyxiation and hyperthermia (heat stroke). In addition, marked elevation of CSF cTnI was detected in some cases of acute cardiac death. Increased CKMB was apparently independent of the cause of death, and was frequently seen in acute or subacute deaths. These findings suggest that CSF levels of cTnT and cTnI are useful for investigating the progress and duration of myocardial damage in the death process. CKMB may be used as a marker of persistent hypoxic myocardial damage before death.
