Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period.
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.
Tsokos
M
M
Institute of Legal Medicine, University of Hamburg, Butenfeld 34, D-22529, Hamburg, Germany. mtsokos@ngi.de
Reichelt
U
U
Jung
R
R
Nierhaus
A
A
Püschel
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000379:methods* / Q000592:standards; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000276:immunology / Q000378:metabolism*; D016022:Case-Control Studies; D002423:Cause of Death; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood* / Q000276:immunology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011180:Postmortem Changes; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000276:immunology / Q000401:mortality; D013997:Time Factors
D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein