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

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.

Diagnostic Roles of Postmortem cTn I and cTn T in Cardiac Death with Special Regard to Myocardial Infarction: A Systematic Literature Review and Meta-Analysis

“…The quality assessment of the included studies was conducted with the Newcastle–Ottawa Quality Assessment Scale (NOS), and the studies with NOS scores ≥ 7 were considered to be high-quality studies [63]. The evaluation contents include: (1) Selection of the included studies: ① case definition adequate (the cause of death was diagnosed by at least two independent pathologists according to autopsy findings, histological investigations, and other lab investigations), ② representativeness of the cases, ③ selection of controls, ④ definition of controls (1 point for each item, 4 points in total).…”

Biomarkers in Human Anaphylaxis: A Critical Appraisal of Current Evidence and Perspectives

“…It is worth noting that older publications (37) (prior to late 1990s) used β MCT as opposed to total (α and β) MCT in the last decade. Sun et al recently published a systematic review and meta-analysis to address this question and concluded that at concentrations >30.4 μg/L, sensitivity and specificity for anaphylaxis were 68.5 and 83.9%, respectively (50).…”

Postmortem diagnostics of assumed suicidal food anaphylaxis in prison: a unique case of anaphylactic death due to peach ingestion

“…The severe and potentially lethal multi-organ hypersensitivity reaction [17] defined as anaphylactic shock is due to the exposure to a specific allergen [9,18], towards which an immune system sensitization has already developed. The reexposure to the same allergen-type I hypersensitivity IgE antibodies mediated-ultimately causes the degranulation of the mast cells and of the tissue basophils with the release of histamine and other mediators that may cause a precipitous death due to cardio-respiratory arrest [7].…”