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Oh, Ham, Park, Kim, Park, and Na: Study of the Test for Postmortem C-Reactive Protein in Routine Autopsy Practice
Original Article

Korean J Leg Med 2016;40(1):8-13.

Published online: 19 December 2016

DOI: https://doi.org/10.7580/kjlm.2016.40.1.8

Study of the Test for Postmortem C-Reactive Protein in Routine Autopsy Practice

Yeon-Ho Oh1, Suk-Hoon Ham1, Jeong-Woo Park2, Hyung-Seok Kim3, Jong-Tae Park3, Joo-Young Na1

1Forensic Medicine Division, National Forensic Service Gwangju Instititue, Jangseong, Korea

2Division of Forensic Medicine, National Forensic Service Busan Instititue, Yangsan, Korea

3Department of Forensic Medicine, Chonnam National University Medical School, Gwangju, Korea

Correspondence to Joo-Young Na Forensic Medicine Division, National Forensic Service Gwangju Institute, 687, Chungnyeong-ro, Seosam-myeon, Jangseong 57231, Korea Tel: +82-61-393-8442 Fax: +82-61-393-8440 E-mail: pdrdream@gmail.com

Received 16 October 201521 October 2015       Accepted 11 February 2016

Copyright © 2016 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

C-Reactive protein (CRP) is an acute phase response protein synthesized in the liver as a response to various inflammation. CRP is extensively used as a general marker for inflammation in clinical medicine. A forensic applications of the CRP using postmortem samples have been studied in oversea. We have compared CRP in the between antemortem and postmortem samples and studied stability of postmortem blood samples for CRP test. In 69 consecutive autopsy cases, we have analysed heart blood samples (69 cases), peripheral blood samples (33 cases), and vitreous humor samples (60 cases). Postmortem CRP was elevated in 25 cases (36.2%) and possible causes of CRP elevation were inflammatory disease except one case (unknown). Postmortem CRP test shows sensitivity 86.7%, specificity 80%, positive predictive value 92.9%, and negative predictive value 66.7% for inflammation based on 20 cases with antemortem CRP results. The postmortem CRP levels were similar in the heart blood samples and peripheral blood samples. Vitreous humor samples are not useful in postmortem CRP testing. And both whole blood and serum samples are stable in room temperature until 31 days. We conclude that serum from heart blood is best suitable sample for postmortem CRP test and postmortem CRP test is useful in routine autopsy practice to detect inflammatory disease such as sepsis. From the view of postmortem point, we desire that this valuable test should be used in routine autopsy practice in Korea.

Keywords: Autopsy, C-Reactive protein, Forensic medicine

REFERENCES

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3.Tsokos M., Reichelt U., Jung R, et al. Interleukin-6 and C-reactive protein serum levels in sepsis-related fatalities during the early postmortem period. Forensic Sci Int. 2001. 119:47–56.
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5.Na JY., Cho WY., Park JW, et al. Infective endocarditis: an autopsy case report with literature review. Korean J Leg Med. 2014. 38:78–82.
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6.Na JY., Park JW., Oh YH, et al. Vibrio vulnificus sepsis: an autopsy case. Korean J Leg Med. 2015. 39:45–8.
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Fig. 1.
(A) This graph shows postmortem C-reactive protein (CRP) level is decreased according to time of storage in positive result case. (B) This graph shows that the change of postmortem CRP is irregular in negative result case. (A, B) X indicates results of whole blood which was stored at room temperature; ▲ indicates results of whole blood which was kept refrigerated; ■ indicates results of serum which was stored at room temperature; ◆ indicates results of serum which was kept refrigerated.
kjlm-40-8-f1.tif
Table 1.
Cases of positive postmortem C-Reactive protein (CRP)
Case No. Cause of death Possible cause of CRP elevation PMI (hr) Postmortem CRP (mg/dL)
Heart blood Peripheral blood
1 Vibrio sepsis Vibrio sepsis 162 28.60 No test
2 PTE PTE 31 1.53 No test
5 Infective endocarditis Infective endocarditis 72 9.70 No test
6 ARDS Upper respiratory infection 120 1.96 No test
7 Pneumonia Pneumonia 96 18.00 No test
11 Sudden cardiac death Urinary tract infection 28 5.39 4.64
24 Myocardial infarction Pneumonia 21 13.00 No test
30 Sepsis Peritonitis 29 7.71 9.41
34 PTE Pneumonia   17.00 16.7
35 Sepsis Peritonitis 38 14.90 No test
44 Liver cirrhosis Unknown 49 4.94 6.22
45 Pneumonia Pneumonia 39 15.90 14.2
47 Myocardial infarction Upper respiratory infection 51 6.75 6.86
49 Ludwig angina Ludwig angina 32 9.04 No test
51 PTE PTE 91 2.33 No test
53 Myocarditis Myocarditis 33 3.84 4.34
55 Sepsis Operation site infection 266 4.81 No test
56 PTE Operation site infection 29 8.97 No test
58 Acetic acid intoxication Pneumonia 92 11.50 No test
59 Hypovolemic shock after C-section Myometritis 79 8.76 No test
60 DCMP Pneumonia 56 7.61 No test
61 Myocardial infarction Pneumonia 98 10.60 No test
62 Sepsis Peritonitis 66 22.20 No test
63 MOF after TA Pneumonia 66 12.90 No test
67 Intoxication of agricultural chemical Pneumonia 54 30.10 No test

PMI, postmortem interval; PTE, pulmonary thromboembolism; ARDS, adult respiratory distress syndrome; DCMP, dilated cardiomyopathy; MOF, multiorgan failure; TA, traffic accident.

Table 2.
C-Reactive protein (CRP) concentration in antemortem and postmortem
Case No. Cause of death PMI (hr) tPMI (hr) Antemortem CRP (mg/dL) Postmortem CRP (mg/dL) P-valuea)
2 PTE 31 201 2.20 1.53  
11 Sudden cardiac death 28 118 8.70 5.39  
17 Aortic dissection 51 70 0.20 0.42  
29 PTE 49 123 3.93 0.73  
30 Sepsis 29 101 0.07 7.71  
35 Sepsis 38 61 17.94 14.90  
43 Myocardial infarction 24 100 0.05 0.01  
45 Pneumonia 39 82 8.53 15.90  
46 Multiorgan failure 64 181 2.40 0.77  
47 Myocardial infarction 51 76 7.37 6.75  
49 Ludwig's angina 32 96 17.8 9.04  
51 PTE 91 168 9.30 2.33  
52 Poisoning 38 43 0.11 0.12  
55 Sepsis 266 271 9.03 4.81  
56 PTE 29 76 10.29 8.97  
57 PTE 50 76 0.99 0.88  
58 Multiorgan failure 92 111 26.80 11.50  
60 DCMP 56 624 13.80 7.61  
61 Myocardial infarction 98 202 11.70 10.60  
63 Multiorgan failure 66 144 33.10 12.90  
  Total (mean±SD)     9.21±9.13 6.14±5.22 0.13

PMI, postmortem interval; tPMI, testing postmortem interval; PTE, pulmonary thromboembolism; DCMP, dilated cardiomyopathy; SD, standard deviation.

a) A difference of results between antemortem and postmortem CRP. The difference between the two is rejected.

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