Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis

Abstract

The aim of this study was to investigate the presence and concentrations of procalcitonin and C-reactive protein in pericardial fluid and compare these levels to those found in the postmortem serum obtained from the femoral blood. Two groups were formed, a sepsis-related fatalities group and a control group. Postmortem native CT scans, autopsies, histology, neuropathology and toxicology as well as other postmortem biochemistry investigations were performed in all cases. Pericardial fluid procalcitonin levels were significantly different between the cases of sepsis-related fatalities and those of the control group. Postmortem serum procalcitonin levels below the detection limit were also reflected in undetectable pericardial fluid levels. Similarly, a large increase in postmortem serum procalcitonin levels was reflected in a large increase of procalcitonin pericardial fluid levels. Based on these findings, pericardial fluid could be an alternative to postmortem serum for the determination of procalcitonin levels in cases where postmortem serum is not available and measurements of procalcitonin are required to circumstantiate the pathogenesis of death

Procalcitonin as a postmortem sepsis marker. A comparison of the validity of results obtained from blood serum, aqueous humour and cerebrospinal fluid

“…By contrast with publications stating contrary positions [15][16][17], the results of the study presented here are in harmony with the study by Tsokos et al [12] which asserts a postmortem decrease in procalcitonin levels. Assuming a secondary influence of this type, the recommendation of fixed tolerance limits for procalcitonin levels in postmortem sepsis diagnostics appears to make little sense.…”

“…Moreover, with a ROC AUC value of 1.000, it also yields ideal values of 100 % for both test sensitivity and specificity, unlike the cut-off value for unadjusted procalcitonin levels in blood serum. In contrast to the results reported in other publications [15][16][17], this confirms the need to factor in a postmortem process of elimination of the analyte procalcitonin. At present, such specific rates are not known for aqueous humour and cerebrospinal fluid.…”

“…In order to enhance the options for postmortem verification of death caused by sepsis in forensic contexts, alternative media with a lower risk of haemolysis are needed to determine procalcitonin levels. According to the results of recent publications, besides pericardial fluid [15], vitreous humour and cerebrospinal fluid appear particularly suited to this purpose [16]. In this context, it remains unclear whether, in fact, portions of the gelatinous vitreous humour were used for the relevant analyses, or samples of the aqueous humour, the watery fluid in the chambers of the eyeball.…”

“…Even if procalcitonin, in the view of different authors, may be considered a stable analyte in respect of its in vitro assay [15][16][17], relevant measurements with the available immunoassays are, in part, seriously disrupted due to interferences by high haemoglobin levels. Blood samples whose free haemoglobin content is above 500 mg/dl are unsuitable for sepsis diagnostics in general.…”

“…Only recently has the inherent suitability of a variety of other sample types for determining procalcitonin levels been investigated in the light of a complete lack of availability of cadaveric blood to harvest serum [15,16]. However, the fact that cut-off values used in clinical contexts for analysing blood serum cannot be uncritically transferred in this process poses a serious problem.…”