Hernández-Romero Diana, Valverde-Vázquez María Del Rocío, Hernández Del Rincón Juan Pedro, Noguera-Velasco José A, Pérez-Cárceles María D, Osuna Eduardo
Department of Legal and Forensic Medicine, Faculty of Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", Biomedical Research Institute (IMIB), University of Murcia, 30100 Murcia, Spain.
Institute of Legal Medicine, 30003 Murcia, Spain.
Diagnostics (Basel). 2021 Mar 30;11(4):614. doi: 10.3390/diagnostics11040614.
In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.
在大约5%的意外死亡案例中，仅依据经典尸检的解剖病理学发现来确立确切诊断是困难的。死后生物标志物作为辅助指标已得到积极研究，以帮助就死亡情况得出有效结论。多项研究提出将心包液或外周静脉作为肌钙蛋白测定的部位，但最佳采样部位仍存在争议。我们的目的是评估心包液与血清中肌钙蛋白值的比率（死后测定）与心源性猝死背景下急性心肌梗死（AMI）诊断之间的关联。我们纳入了175例法医案例。设立了两组：AMI死亡组（48例；27.4%）和对照组（127例；72.6%）。发现心包液中心脏肌钙蛋白I（cTnI）值和肌钙蛋白比率与死亡原因相关。单变量回归分析表明，年龄和cTnI比率均与AMI死亡诊断显著相关。在多变量分析中，校正混杂因素后，年龄和cTnI比率是心肌梗死死亡的独立预测因素。我们针对AMI死亡的cTnI比率绘制了受试者工作特征（ROC）曲线并选择了一个切点。我们的生物标志物被发现是法医领域中一种有价值且高效的工具，可作为一种辅助方法，便于在无法得出结论的尸检中进行诊断。
