Department of Forensic Medicine, Gandaki Medical College Teaching Hospital and Research Center, Gandaki, Pokhara, Nepal.
DECODE MAUN Research Project, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal.
Eur J Med Res. 2023 Oct 7;28(1):407. doi: 10.1186/s40001-023-01392-0.
Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death.
A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death.
Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p < 0.001).
MITS was useful in establishing the cause of death in the majority of adult deaths and the most common cause was infectious disease. Our findings suggest that MITS can be a valuable and alternative tool for mortality surveillance in low-resource settings, where complete diagnostic autopsies are less accepted or less prioritized.
微创组织采样 (MITS) 已成功用于确定中低收入国家（主要是死产儿和新生儿）的死亡原因。本研究的目的是确定尼泊尔甘达基省使用 MITS 的成年人的死亡原因，并了解 MITS 在确定死亡原因方面的作用。
进行了一项多中心基于医院的试点研究，纳入 100 例成人死亡病例。利用 MITS 采集脑脊液、血液、大脑、肺和肝组织标本。这些标本进行了标准的组织病理学、血清学和微生物学分析。编译 MITS 的发现，如果有临床记录和法医尸检发现，则由死因鉴定小组确定死因。根据世界卫生组织国际死亡医学证明，为每个病例分配最终死因。
在研究期间共纳入 100 例病例，77 例（77%）感染性病因是直接死亡原因，10 例（10%）心血管病因，8 例（8%）神经病因，2 例（2%）恶性肿瘤病因，1 例（1%）胃肠道和肝胆病因。病例的平均年龄为 50.8±15.9 岁，76 例（76%）为男性。MITS 在 81 例（81%）病例的死因链中确定了死因，并确定感染性病因比非感染性病因更能确定死因（p<0.001）。
MITS 可用于确定大多数成人死亡的死因，最常见的死因是传染病。我们的研究结果表明，MITS 可以成为资源匮乏地区死亡率监测的一种有价值的替代工具，在这些地区，完整的诊断性尸检不太被接受或不太受重视。
