Biochemical markers of fatal hypothermia

Palmière, Cristian; Bardy, Daniel; Letovanec, Igor; Mangin, Patrice; Augsburger, Marc; Ventura, Francesco; Iglesias, Katia; Werner, Dominique

doi:10.1016/j.forsciint.2012.12.007

Cited by 61 publications

(55 citation statements)

References 66 publications

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“…Many different biochemical substances and sample types have been studied in order to find an indicator of ante-mortem hypothermia or cold exposure [20]. After analysing several proposed markers in hypothermia deaths, Palmiere et al [21] concluded that the best indicators of hypothermia are increased levels of ketones and isopropyl alcohol in blood, adrenaline in urine, and cortisol in serum and urine. The sensitivity of urinary TM was comparable to those of urinary Fig.…”

Section: Discussionmentioning

confidence: 99%

Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

et al. 2014

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Severe cold stress has been shown to cause changes in the expression and secretion of thrombomodulin (TM), an endothelial protein regulating haemostasis and inflammation. To further evaluate TM as a cold stress indicator, relative TM mRNA and TM protein levels in the myocardium and the concentrations of TM in serum and urine were analysed in different causes of death (hypothermia main cause, n = 80; hypothermia contributory cause, n = 26; cardiovascular disease (CVD) main cause, n = 94; trauma main cause, n = 45; other main cause, n = 25). Urinary catecholamine concentrations and myocardial heat shock factor 1 (HSF1) transcript levels were also studied. The TM mRNA and the TM protein levels in myocardium and urine were significantly lower in hypothermia deaths than those in the controls. Post-mortem interval did not correlate with urinary TM concentration. The sensitivity and specificity of urinary TM assay to detect hypothermia deaths were 70.8 and 70.3 %, respectively. Catecholamine concentrations in urine correlated significantly with TM concentration in urine and TM mRNA levels in all groups excluding CVD deaths. There were no differences in the HSF1 transcript levels and no correlation to TM levels. These findings provide further evidence that cold stress and hypothermia affect TM expression and secretion and that they are possibly linked to catecholamine action. Thus, measuring post-mortem TM levels may provide additional support to diagnosing hypothermia in medico-legal examination. The results may also provide additional knowledge for the treatment of hypothermic patients and the use of hypothermia for medical purposes.

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Section: Discussionmentioning

confidence: 99%

Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

et al. 2014

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“…Exposure to cold is characterized by significant stress reactions that enhance catecholamine and counter-regulatory hormone release. Enhanced fat catabolism and increased acetoacetate/β-hydroxybutyrate production are the metabolic consequences of hypothermia-induced secretion of insulin antagonist hormones [34][35][36][37][38].…”

Section: Postmortem Biochemistrymentioning

confidence: 99%

“…There is a general consensus in the literature that increased levels of blood β-hydroxybutyrate, acetone, isopropyl alcohol, and glucocorticosteroids as well as increased urine adrenaline and cortisol concentrations should be considered potential biochemical hallmarks of fatal hypothermia [24,[34][35][36][37].…”

Section: Postmortem Biochemistrymentioning

confidence: 99%

Postmortem diagnosis of hypothermia

2014

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The identification of hypothermia as the cause of death has always been somewhat problematic in forensic pathology because of unspecific, inconstant, or even negative macroscopic and microscopic findings. Though the simultaneous presence of frost erythema, Wischnewski spots, hemorrhages into the synovial membrane, bloody discoloration of synovial fluid of the knee, and basal vacuolization of the renal tubular epithelial cells has been indicated as strongly supportive of fatal hypothermia, their absence does not allow the diagnosis of hypothermia to be ruled out. Postmortem biochemical investigations are valuable in detecting adaptation responses to cold stress and metabolic changes that occur following cold exposure. However, ethanol intoxication prevents appearance of adaptation responses to cold, rendering the diagnosis less obvious. Immunohistochemistry, postmortem imaging, and molecular pathology have shown promising results, although at present, they do not provide pathognomonic signs of fatal hypothermia. The aim of this article is to present a review of the literature covering the significance of different postmortem investigations that are associated with hypothermia fatalities.

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“…Previous studies that applied these markers in blood to the postmortem investigation of death mainly focused on determining fatal hypothermia (cold exposure) and evaluating the agony period, but failed to present consistent results, although their postmortem stabilities were established [1][2][3][4][5]. In addition, there were significant differences in catecholamine levels in blood, pericardial and cerebrospinal fluid, depending on the cause of death, with substantial interindividual variations in each cause of death [6,7], suggesting that multiple site analyses of catecholamine in blood and other body fluids are useful to investigate stress responses or toxic/hyperthermic neuronal dysfunction during the death process in individual cases, when they are used in combination with other biochemical and immunohistochemical markers [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Meanwhile, previous studies of urinary catecholamine levels mainly focused on the diagnosis of hypothermia (cold exposure), using selected control cases [3][4][5]; thus, there were limited data on urinary levels with regard to the cause of death that might be involved in differentiation from hypothermia (cold exposure) in routine forensic casework, and insufficient published data about hyperthermia (heatstroke) as another end of thermal disorder.…”

Section: Introductionmentioning

confidence: 99%