Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia

Abstract

The present study analyzed serum levels of urea nitrogen (UN), creatinine (Cr), and C-reactive protein (CRP), which are very stable during the early postmortem period, for investigation of the cause of death with special regard to hyperthermia (heat stroke) in serial medico-legal autopsy cases (n = 429), excluding fatal injury, intoxication, and fire fatality. In this series, mechanical asphyxiation, drowning, and sudden cardiac death cases (n = 56, n = 43, and n = 212, respectively) usually showed low levels within postmortem reference ranges for these serum markers, although UN and CRP levels were mildly elevated in cases of sudden cardiac death and cerebrovascular stroke. There were concomitant significant elevations in serum levels of UN (>50 mg/dL), Cr (>2 mg/dL), and CRP (>2 mg/dL) for chronic renal failure, gastrointestinal bleeding, pneumonia, and hypothermia (cold exposure). UN and CRP were especially high for chronic renal failure and pneumonia, respectively. However, hyperthermia cases showed an isolated elevation in the serum Cr level, suggesting an influence of systemic skeletal muscle damage. These serum markers may be practically useful for postmortem investigation of death due to hyperthermia (heat stroke), for which specific pathological and toxicological evidence may not be available.

Evaluation of C-reactive protein, procalcitonin, tumor necrosis factor alpha, interleukin-6, and interleukin-8 as diagnostic parameters in sepsis-related fatalities

“…The authors concluded that elevated serum CRP levels in cases of chronic renal failure may be related to the characteristics of diseases and/or infectious complications. For pneumonia, a markedly high serum CRP level may indicate the severity of infection, whereas a low CRP value in some infantile and elderly cases of pneumonia may be ascribed to an agedependent low inflammatory response [15].…”

Postmortem biochemical investigations in hypothermia fatalities

“…Moderately elevated CRP levels CRP, urea nitrogen, and creatinine Maeda et al [76] Postmortem serum Increased urea nitrogen, creatinine, and CRP levels CRP and neopterin Ishikawa et al [77] Postmortem serum from different sampling sites…”

“…Cold exposure cases were classified as nonacute deaths and short survivors (survival time up to 6 h) and displayed moderately elevated CRP levels (between 1 and 10 mg/l) compared with the other groups. Maeda et al [76] analyzed urea nitrogen, creatinine, and CRP in postmortem serum from the peripheral external iliac vein (or right heart chamber when peripheral blood was not available) in 429 medicolegal autopsy cases. They observed that the hypothermia fatalities had concomitant, significant elevations in the postmortem serum levels of urea nitrogen (>50 mg/dl), creatinine (>2 mg/dl), and CRP (>2 mg/ dl).…”

Postmortem chemistry update part II

“…The results have showed that both markers, particularly CRP, can be used in forensic routine similar to clinical practice [78][79][80][81][82].…”

“…Maeda et al [81] analysed urea nitrogen, creatinine, and CRP postmortem serum levels in 429 medico-legal autopsy cases and found that the combined use of these three markers could be useful for postmortem investigations of death due to hyperthermia, especially in the absence of pathological and toxicological evidence.…”