title: Endocan measurement for the postmortem diagnosis of sepsis.
abstract: The vascular endothelium has been shown to play a pivotal role in the pathophysiology of sepsis through the expression of surface proteins and secretion of soluble mediators. Endocan (endothelial cell-specific molecule-1), a 50-kDa dermatan sulfate proteoglycan, is expressed by endothelial cells in lung and kidney and can be detected at low levels in the serum of healthy subjects. Increased concentrations were described in patients with sepsis, severe sepsis and septic shock compared to healthy individuals, with serum concentrations related to the severity of illness. In the present study, we investigated endocan, procalcitonin and C-reactive protein in postmortem serum from femoral blood in a series of sepsis-related fatalities and control individuals who underwent medicolegal investigations. Endocan was also measured in pericardial fluid. Two study groups were prospectively formed, a sepsis-related fatalities group and a control group. The sepsis-related fatalities group consisted of sixteen forensic autopsy cases with documented clinical diagnosis of sepsis in vivo. The control group consisted of sixteen forensic autopsy cases with various noninfectious causes of death. Postmortem serum endocan concentrations were significantly higher in the sepsis group, with values ranging from 0.519 ng/ml to 6.756 ng/ml. In the control group, endocan levels were undetectable in eleven out of sixteen cases. The results of the data analysis revealed similar endocan concentrations in the pericardial fluid of both studied groups. Endocan can be considered a suitable biological parameter for the detection of sepsis-related deaths in forensic pathology routine.
authors.affiliation: University Centre of Legal Medicine, Rue du Bugnon 21, 1011 Lausanne, Switzerland. Electronic address: cristian.palmiere@chuv.ch.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
authors.affiliation: University Centre of Legal Medicine, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Augsburger
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000032:analysis / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D003933:Diagnosis; D006801:Humans; D009363:Neoplasm Proteins / Q000032:analysis / Q000097:blood*; D010490:Pericardial Effusion / Q000737:chemistry; D011446:Prospective Studies; D011498:Protein Precursors / Q000032:analysis / Q000097:blood; D011509:Proteoglycans / Q000032:analysis / Q000097:blood*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; C101134:ESM1 protein, human; D009363:Neoplasm Proteins; D011498:Protein Precursors; D011509:Proteoglycans; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: C-reactive protein; CRP; EC; Endocan; Forensic pathology; PCT; Postmortem biochemistry; Procalcitonin; SIRS; Sepsis; endothelial cells; procalcitonin; systemic inflammatory response syndrome