Department of Forensic Medicine, University Hospital of Montpellier, Montpellier, France.
Department of Biochemistry, University Hospital of Montpellier, Montpellier, France.
Int J Legal Med. 2021 Jan;135(1):293-299. doi: 10.1007/s00414-020-02343-8. Epub 2020 Jun 18.
Diabetic ketoacidosis (DKA) is a frequent and life-threatening complication, whose diagnosis remains challenging in forensic practice. We aimed at assessing the performance of a commercially available blood glucose and ketone monitoring device (BGMD) in measuring glucose and ketone levels in post-mortem vitreous (VH) and blood samples, in order to determine if such a device can be used for screening lethal cases of DKA at autopsy. VH and blood samples were collected in cases of unexplained causes of death at autopsy. Glucose and β-hydroxybutyrate (BHB) were measured in VH and BHB in blood using the BGMD. The values were compared to those obtained with validated enzymatic methods. Values ≥ 10 mmol/L were considered to be elevated for glucose, and BHB values ≥ 2.5 mmol/L were considered to indicate ketoacidosis. There was a strong and significant correlation between VH glucose and blood BHB concentrations measured with the BGMD and the validated method (r = 0.78 and r = 0.80, p < 0.0001, respectively), whereas no correlation was found for VH BHB values (r = 0.19, p = 0.19). The sensitivity and specificity of the BGMD were both excellent (1.0) to detect elevated VH glucose levels with a threshold of 14.4 mmol/L, and to detect elevated blood BHB levels with a threshold of 2.85 mmol/L. In contrast, the specificity of the BGMD to detect high BHB levels in VH was poor (0.50) with an optimal threshold of 2.5 mmol/L. We showed that a commercially available BGMD is suitable for identifying cases of lethal DKA and other metabolic disorders at autopsy, through the investigation of vitreous glucose and blood BHB. We therefore recommend the systematic use of a BGMD for screening these conditions in cases of unexplained deaths.
糖尿病酮症酸中毒（DKA）是一种常见且危及生命的并发症，其在法医学实践中的诊断仍然具有挑战性。我们旨在评估一种市售血糖和酮体监测设备（BGMD）在测量死后玻璃体（VH）和血液样本中的葡萄糖和酮体水平的性能，以确定该设备是否可用于在尸检时筛查致死性 DKA 病例。VH 和血液样本是在尸检中不明原因死亡的情况下收集的。使用 BGMD 测量 VH 和血液中的葡萄糖和β-羟丁酸（BHB）。将这些值与通过验证的酶法获得的值进行比较。VH 葡萄糖值≥10mmol/L 和 BHB 值≥2.5mmol/L 分别被认为是升高的，表明有酮症酸中毒。BGMD 测量的 VH 葡萄糖和血液 BHB 浓度与经验证的方法之间存在很强且显著的相关性（r 值分别为 0.78 和 0.80，p 值均<0.0001），而 VH BHB 值之间无相关性（r 值为 0.19，p=0.19）。BGMD 检测 14.4mmol/L 阈值的升高的 VH 葡萄糖水平和 2.85mmol/L 阈值的升高的血液 BHB 水平的灵敏度和特异性均为 1.0。相比之下，BGMD 检测 VH 中高 BHB 水平的特异性较差（0.50），最佳阈值为 2.5mmol/L。我们表明，一种市售的 BGMD 通过对玻璃体葡萄糖和血液 BHB 的研究，适用于在尸检中识别致命性 DKA 和其他代谢紊乱病例。因此，我们建议在不明原因死亡的情况下系统使用 BGMD 来筛查这些情况。
