Comprehensive evaluation of pericardial biochemical markers in death investigation
Introduction
A serial study has shown the usefulness of systematic biochemical analyses as ancillary procedures for investigating death, in which blood and various body fluids have been used, including the vitreous humor, and cerebrospinal and pericardial fluids [1], [2], [3], [4], [5], [33]. Rapid changes can occur in circulating blood in the death process, whereas such changes may be milder in body fluids; however, postmortem interference is inevitable for each of these materials. Pericardial fluid (PCF) is a transudate from the epicardium [11], [12], [13], and a well-preserved and useful postmortem material in cases without structural damage due to injury or medical intervention, containing various biochemical substances derived from serum and heart tissue [6], [7], [8], [9], [10], [11], [12], [13]. Alterations of heart tissue can immediately affect PCF components [8], but previous studies have suggested an hours-long half-life period of pericardial albumin [14], [15] as well as the substantial stability of circulating serum-derived substances, including urea nitrogen (UN), creatinine (Cr) and uric acid (UA), in agony and postmortem periods [6], [7]; however, pericardial electrolyte/mineral concentrations depend on postmortem period [16]. From these observations, we hypothesized that PCF components derived from circulating blood represent the antemortem status, including the status before fatal insults in acute death and the changes during survival in prolonged death, while pericardial electrolytes/minerals depend on both antemortem status, involving myocardial damage, and postmortem changes; the combined analysis of these PCF components may be useful for investigating the cause and process of death as well as postmortem changes of the myocardium, which can depend on the status at the time of death and ambient temperature after death.
With consideration of the hypothesis described above, the present study investigated a spectrum of fundamental serum components of PCF, including total protein (TP), albumin (Alb), non-protein nitrogen compounds (NPN), glucose (Glu), and electrolytes/minerals with regard to the postmortem time, survival time and cause of death in serial medicolegal autopsy cases and compared individual characteristics to provide basic data for postmortem biochemistry of PCF in death investigations.
Section snippets
Materials
Medicolegal autopsy cases having intact pericardial and cardiac structures (n = 288) within 48 h postmortem (median, 20.6 h) at our institute were examined, comprising 211 males and 77 females between 0 and 80 (median, 32.9) years of age with survival times of <0.5 h–12 months (median, 2.7 h). The causes of death were: blunt injury (n = 84: head injury, n = 53; others, n = 31), sharp instrument injury (n = 3), mechanical asphyxiation (n = 32), intoxication (n = 24: methamphetamine, n = 5; psychotropic drugs, n = 7;
Relationship of the amount of pericardial fluid to concentrations of biochemical markers
The amount of PCF was 0–200 ml with a median of 10.0 ml and a mean of 15.0 ml (5–95 percentile, 4.4–33.3 ml), showing no survival or postmortem time dependence, or significant difference among the causes of death. Few cases had an extremely large amount of PCF over 50 ml in blunt injury (n = 2), intoxication (n = 1), hyperthermia (heatstroke) (n = 1), and cardiac death (n = 1). Concentrations of most biochemical markers, including TP, Alb and NPN (UN, Cr and UA), were independent of the amount of PCF;
Discussion
Several studies have suggested the usefulness of PCF in postmortem biochemistry [1], [16], [27], [28], [29] and toxicology [30]; however, no detailed published data of the fundamental parameters of postmortem PCF have been available. In the present study, most cases (90%) had about 5–25 ml PCF, independent of the postmortem interval or cause of death. The amount was smaller than the clinical value reported previously (about 15–50 ml) [12], [13]; however, concentrations of TP, Alb and NPN (UN, Cr
Acknowledgements
This study was supported in part by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science and the Ministry of Education, Culture, Sports, Science and Technology, Japan (Grant Nos. 19890189 and 22590642).
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2020, Journal of Forensic and Legal MedicineCitation Excerpt :Although there is an assay that can measure the CRP in whole blood, and the results could be used regardless of hemolysis, the measured value was somewhat lower than the postmortem serum analysis.6 Therefore, the utility of pericardial fluid as an alternative to the serum for biochemical analysis has been considered for many markers, including CRP, in forensic practice.11–22 Previous studies have shown a correlation between postmortem CRP in the serum and pericardial fluid,11,12 but as far as we know, no study has compared levels in antemortem serum and postmortem pericardial fluid.
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