Usefulness of Dipstick Test for Vitreous Glucose in Autopsy Practice

Kyunghong Lee; Hyung Nam Koo; Tae Gong Kim; Jeong Yeol Park; Kang-Hyun Baek; Seung-Gyu Choi; Cheol Ho Choi; Nahyun Aum; Nak-won Lee; Byung Ha Choi

doi:10.7580/kjlm.2016.40.4.99

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Lee, Koo, Kim, Park, Baek, Choi, Choi, Aum, Lee, and Choi: Usefulness of Dipstick Test for Vitreous Glucose in Autopsy Practice

Original Article

Korean J Leg Med 2016;40(4):99-103.

Published online: 19 December 2016

DOI: https://doi.org/10.7580/kjlm.2016.40.4.99

Usefulness of Dipstick Test for Vitreous Glucose in Autopsy Practice

Kyunghong Lee, Hyung Nam Koo, Tae Gong Kim, Jeong Yeol Park, Kang-Hyun Baek, Seung-Gyu Choi, Cheol Ho Choi, Nahyun Aum, Nak-won Lee, Byung Ha Choi

The study was presented as poster at the 40th Autumn Congress of the Korean Society for Legal Medicine; November 25, 2016; Daegu, Korea

Correspondence to Byung Ha Choi Division of Forensic Medicine Investigation, National Forensic Service Seoul Institute, 139 Jiyang-ro, Yangcheon-gu, Seoul 08036, Korea Tel: +82-2-2600-4611 Fax: +82-2-2600-4828 E-mail: pathosky@korea.kr

Received 8 November 201621 November 2016 Accepted 26 November 2016

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

The concentration of glucose in the vitreous humor serves as an important diagnostic marker for diabetic mellitus in post-mortem examinations, as the vitreous humor can be easily collected and the glucose test using vitreous humor is not significantly affected by cell autolysis and hemolysis. For a quick and effective glucose test, we suggest a dipstick test of the vitreous humor during autopsy. The results were evaluated and compared with other methods for significance testing. In this study, vitreous humor was analyzed from 257 autopsy cases. Qualitative concordance rate of the dipstick test for glucose and the hexokinase test was 98.7%, positive prediction rate was 89.6%, and negative prediction rate was 100%. However, there was no significant correlation between the dipstick glucose test and the hexokinase test. We conclude that the dipstick glucose test is effective and useful for post-mortem glucose screening testing and for additional post-mortem diabetes testing. Recently, the importance of post-mortem glucose testing has increased with the increase in deaths from diabetes complications. The use of the dipstick glucose test in autopsy practice can improve forensic medicine in Korea.

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Keywords: Vitreous humor, Glucose, Diabetic mellitus, Autopsy

REFERENCES

1.Boulagnon C., Garnotel R., Fornes P, et al. Post-mortem biochemistry of vitreous humor and glucose metabolism: an update. Clin Chem Lab Med. 2011. 49:1265–70.

2.Belsey SL., Flanagan RJ. Postmortem biochemistry: current applications. J Forensic Leg Med. 2016. 41:49–57.

3.Keltanen T., Sajantila A., Valonen T, et al. HbA1c method evaluation for postmortem samples. Forensic Sci Med Pathol. 2015. 11:35–9.

4.Park JP., Kang HM., Won YJ, et al. Postmortem diagnosis of diabetic ketoacidosis: an autopsy case. Korean J Leg Med. 2016. 40:19–22.

5.Luna A. Is postmortem biochemistry really useful? Why is it not widely used in forensic pathology? Leg Med (Tokyo). 2009. 11(Suppl 1):S27–30.

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Fig. 1.

(A) Principle of glucose detection of the dipstick glucose test. (B) Principle of glucose detection of the hexokinase test.

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Fig. 2.

(A) Figure shows quantitative change in the dipstick glucose test result to determine vitreous glucose concentration. As the concentration of glucose increases, the strip color changes to darker brown. Classifications are negative, 1+, 2+, 3+ and 4+, dependent on dose. (B) Graph shows linear correlation of the dipstick glucose test and the hexokinase test (HEX) results of the vitreous humor. X-axis is the HEX results (mg/dL). Y-axis is the dipstick test results (n+).

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Fig. 3.

Schematic model showing the efficiency of the dipstick glucose test for determining vitreous glucose concentration during autopsy.

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Table 1.

Qualitative concordance rate of the dipstick glucose test and the HEX of vitreous humor

Dipstick glucose test	Glucose, HEX ≥100 mg/dL	Glucose, HEX <100 mg/dL	Total (n=257)	Concordance rate^a) (%)
Positive	26	3	29	98.7^b)
Negative	0	215	215
Trace (+/-)	2	11	13

HEX, hexokinase test.

^a )Percentage of total number excluding trace;

^b) Positive prediction rate: 89.6%, negative prediction rate: 100%.

Table 2.

Autopsy cases with positive results for the dipstick glucose test of vitreous humor

Case No.	Natural/Unnatural	Cause of death	Dipstick test	Glucose (mg/dL)
01^a)	Natural	Pneumonia and diabetic complications	4+	659
02	Unnatural	Traumatic subdural hemorrhage	4+	242
03	Natural	Sudden cardiac death	4+	209
04	Unnatural	Hanging	4+	226
05	Natural	Pneumonia and ischemic heart diseases	4+	204
06	Natural	Ischemic heart diseases	3+	264
07	Natural	Sudden cardiac death	3+	260
08	Natural	Ischemic heart diseases	2+	139
09^a)	Natural	Acute diabetic complications (ketoacidosis)	2+	175
10^a)	Natural	Acute diabetic complications and chronic alcoholism	2+	187
11	Natural	Sudden cardiac death	2+	141
12	Natural	Ischemic heart diseases	2+	185
13	Natural	Pulmonary embolism	2+	155
14^a)	Natural	Sudden cardiac death and diabetic complications	2+	143
15	Natural	Intracerebral hemorrhage	2+	131
16^a)	Natural	Diabetic complications (ketoacidosis)	1+	158
17	Natural	Pneumonia	1+	248
18^a)	Natural	Sudden cardiac death and acute diabetic complications	1+	112
19	Natural	Chronic alcoholism	1+	129
20	Natural	Sudden cardiac death	1+	105

^a) Related to diabetic mellitus.

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