Journal List > Korean J Leg Med > v.44(1) > 1143453

Korean J Leg Med. 2020 Feb;44(1):17-23. Korean.
Published online Feb 29, 2020.
© Copyright 2020 by the Korean Society for Legal Medicine
Usefulness of Mast Cell Tryptase Analysis for Postmortem Diagnosis of Anaphylactic Shock
Jong-Pil Park,1 Bon Young Koo,2 and Nak-Won Lee3
1Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Korea.
2Division of Forensic Medicine, National Forensic Service Daegu Institute, Chilgok, Korea.
3Division of Forensic Medicine, National Forensic Service Daejeon Institute, Daejeon, Korea.

Correspondence to Jong-Pil Park. Department of Forensic Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-2482, Fax: +82-2-362-0860, Email:
Received Jan 30, 2020; Revised Feb 12, 2020; Accepted Feb 21, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Anaphylactic shock (AS) is a systemic and life-threatening type I hypersensitivity reaction and is often encountered at an autopsy. However, postmortem diagnosis of AS can be difficult due to non-specific autopsy findings. Clinically, the analysis of serum mast cell tryptase (MCT) is well known as a useful ancillary test for the diagnosis of AS. However, in order to apply this test to forensic autopsy, it is necessary to confirm its usefulness due to postmortem changes. We carried out serum MCT analysis in 299 autopsy cases including nine AS cases at National Forensic Service from January 2013 to May 2015 and analyzed the difference according to the cause of death and degree of postmortem change. As a result, the MCT level in AS was significantly increased compared to others, and the appropriate cutoff value for postmortem diagnosis of AS was 63.0 µg/L (sensitivity 88.9%, specificity 98.6%). Conclusively, serum MCT analysis is a useful test for postmortem diagnosis of AS and seems to be more appropriate for screening rather than confirmation.

Keywords: Anaphylaxis; Tryptases; Autopsy


Fig. 1
Comparison of mast cell tryptase level among groups according to cause of death. AS, anaphylactic shock; IHD, ischemic heart disease; SIDS, sudden infant death syndrome; AFE, amniotic fluid embolism.
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Fig. 2
Receiver operating characteristic (ROC) curve for mast cell tryptase levels to diagnose anaphylactic shock.
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Table 1
Anaphylactic shock cases
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Table 2
Comparison between peripheral blood and heart blood on the mast cell tryptase concentration
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Table 3
Comparison of mast cell tryptase level among groups according to COD
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Table 4
Analysis of variables affecting on postmortem mast cell tryptase concentration
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Table 5
Sensitivity and specificity of postmortem mast cell tryptase anlysis for anaphylactic shock diagnosis
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Table 6
False-positive cases
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Conflicts of Interest:No potential conflict of interest relevant to this article was reported.


This research was supported by a grant for Development of Scientific Investigation funded by the National Forensic Service (2013-Forensic Medicine-32).

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