Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period

• Published in: Forensic science international Vol. 119; no. 1; pp. 47 - 56
• Main Authors: Tsokos, Michael, Reichelt, Uta, Jung, Roman, Nierhaus, Axel, Püschel, Klaus
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ireland Ltd 01.06.2001; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autopsies; Autopsy - methods; Autopsy - standards; Bacterial infections; Biological and medical sciences; Biomarkers - blood; Blood; Burn injury; C-reactive protein; C-Reactive Protein - immunology; C-Reactive Protein - metabolism; C-reactive protein, CRP; Case-Control Studies; Cause of Death; Cytokines; Death; Discriminant Analysis; Emergency and intensive care: infection, septic shock; Fatalities; Female; Forensic sciences; Humans; Infections; Inflammation; Inflammatory response; Intensive care; Intensive care medicine; Interleukin 6; Interleukin-6 - blood; Interleukin-6 - immunology; Interleukin-6, IL-6; Interleukins; Linear Models; Male; Medical sciences; Middle Aged; Mortality; Patients; Postmortem biochemistry; Postmortem Changes; Postmortem markers of sepsis; Postmortem sepsis diagnostics; Prospective Studies; Proteins; Regression analysis; Regression models; Sepsis; Sepsis - blood; Sepsis - immunology; Sepsis - mortality; Serum levels; Systemic inflammatory response syndrome; Systemic inflammatory response syndrome, SIRS; Time Factors; Los Angeles California; United States > US; Germany; Postmortem sepsis diagnostics; Systemic inflammatory response syndrome, SIRS; Postmortem markers of sepsis; Interleukin-6, IL-6; C-reactive protein, CRP; Sepsis; Postmortem biochemistry; Burn injury; Human; Concentration factor; Legal medicine; Cytokine; Postmortem; Forensic aspect; Infection; Interleukin 6; Sepsis syndrome; Bacteriosis; Early; Serum; Diagnosis; C reactive protein
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/S0379-0738(00)00391-1

Postmortem interleukin-6 (IL-6) and C-reactive protein (CRP) serum levels were investigated prospectively in sepsis-related fatalities and non-septic fatalities by using a linear regression model. At least three blood samples were collected between 0.3 and 139 h postmortem from sepsis-related fatalities ( n=8) and non-septic fatalities ( n=16). In addition, one antemortem blood sample was collected shortly before death from the septic patients. Antemortem and postmortem IL-6 and CRP levels were highly elevated in all individuals included in the sepsis group. An excessive postmortem increase of IL-6 serum levels associated with progressive time after death was observed in five out of the eight septic patients. Both, IL-6 and CRP serum concentrations seem to be suitable biochemical postmortem markers of sepsis. The determination of IL-6 serum levels above 1500 pg/ml in peripheral venous blood obtained in the early postmortem interval can be considered as a diagnostic hint towards an underlying septic condition. A more precise postmortem discrimination between sepsis and non-septic underlying causes of death is provided by the postmortem measurement of serum CRP in peripheral venous blood: on condition that at least two postmortem CRP values have been determined at different time points postmortem, the CRP level of a deceased at the time of death can be calculated by using linear regression analysis. When assessing postmortem IL-6 and CRP concentrations as biochemical postmortem markers of sepsis, various clinical conditions, such as a preceding trauma or burn injury going along with elevated IL-6 and/or CRP levels prior to death as a result of the systemic inflammatory response syndrome (SIRS) should be taken into consideration, thus adding relevant information for the practical interpretation of the results.