title: Postmortem serum levels of amylase and gamma glutamyl transferase (GGT) as markers of systemic tissue damage in forensic autopsy.
abstract: Serum amylase (AMY) and gamma glutamyl transferase (GGT) are routine clinical markers for investigating pancreatic and hepatobiliary disorders, respectively, but are also increased in systemic deterioration following critical trauma and diseases. The present study investigated the postmortem levels in bilateral cardiac blood of medicolegal autopsy cases without decomposition (n=163), excluding those with pancreatic or hepatic injury, or preexisting pathologies, as well as prolonged death cases, to evaluate the changes due to systemic deterioration in the death process after fatal insults with special regard to intoxication, hyperthermia (heatstroke) and hypothermia (cold exposure). Serum AMY and GGT levels were virtually independent of postmortem interval. Serum AMY level was mostly higher than the clinical reference range, predominantly including salivary fractions, but was usually below 1000U/L except for fatal intoxication, which showed significant increases of total AMY as well as salivary and pancreatic fractions in bilateral cardiac blood. Serum levels of salivary and pancreatic AMY fractions showed tendencies to be related to pancreatic subcapsular and interstitial bleeding, respectively, which were relatively frequent and evident in mechanical asphyxiation, intoxication and hyperthermia (heatstroke). Serum GGT was often elevated (mostly below 300U/L) in cases other than hypothermia (cold exposure). These findings suggest postmortem serum AMY and GGT as indicators of the severity of systemic organ damage in death processes, especially in intoxication; however, elevated serum AMY and GGT levels over 1000 and 300U/L might indicate significant pancreatic and hepatobiliary pathologies, respectively, except for an elevated serum AMY level in intoxication.
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan. michi.leg@med.osaka-cu.ac.jp
authors.forename: Tomomi
authors.initials: T
authors.lastname: Michiue
authors.forename: Takaki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Kawamoto
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Chen
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Bao-Li
authors.initials: BL
authors.lastname: Zhu
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maeda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood*; D001237:Asphyxia / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood; D002543:Cerebral Hemorrhage / Q000097:blood; D004332:Drowning / Q000097:blood; D005260:Female; D005390:Fires; D049429:Forensic Pathology; D018883:Heat Stroke / Q000097:blood; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007035:Hypothermia / Q000097:blood; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood; D010182:Pancreatic Diseases / Q000473:pathology; D011041:Poisoning / Q000097:blood; D011180:Postmortem Changes; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D005723:gamma-Glutamyltransferase; D000681:Amylases