Md Najib Asyraff, Yusof Khairunnisa' Md, Wan Shuaib Wan Muhammad Azfar, Shafee Mohamed Swarhib, Mohd Nor Faridah
Forensic Unit, Department of Pathology, Universiti Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.
Biochemistry Unit, International Medical School, Management and Science University (MSU), Off Persiaran Olahraga, 40100, Shah Alam, Selangor, Malaysia.
Int J Legal Med. 2025 Jan;139(1):253-265. doi: 10.1007/s00414-024-03328-7. Epub 2024 Sep 20.
Postmortem analysis of C-reactive protein (CRP) in autopsies has been extensively researched for its potential utility. This analysis could aid forensic pathologists in screening for and investigating the potential infectious or inflammatory causes of death, thereby guiding appropriate autopsy procedures. To assess the diagnostic accuracy of postmortem CRP analysis in autopsy settings, a thorough electronic literature search was conducted across databases such as PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers screened eligible studies, followed by a methodological quality assessment using the QUADAS-2 checklist. Utilising a random-effects model, hierarchical summary receiver operating characteristic (HSROC) curve analysis and bivariate model meta-analysis were performed to evaluate heterogeneity across studies. Of the 1286 studies initially identified, nine met the eligibility criteria for the final analysis. The pooled sensitivity of postmortem CRP analysis was 0.93 (95% CI, 0.76, 0.98), with a pooled specificity of 0.80 (95% CI, 0.71, 0.87). The prevalence across studies ranged from 0.23 to 0.68, with a median of 0.5. Moderate variability was observed in the heterogeneity assessment across the primary studies. In summary, the study findings indicate that postmortem serum CRP analysis demonstrates high diagnostic accuracy with moderate heterogeneity. Additionally, postmortem CRP testing may be useful as a screening tool in autopsy practice to rule out the likelihood of sepsis.
尸检中C反应蛋白（CRP）的死后分析因其潜在用途已得到广泛研究。这种分析可以帮助法医病理学家筛查和调查潜在的感染性或炎症性死亡原因，从而指导适当的尸检程序。为了评估尸检环境中死后CRP分析的诊断准确性，我们在PubMed、Scopus、Web of Science和Cochrane图书馆等数据库中进行了全面的电子文献检索。两名独立的评审员筛选了符合条件的研究，随后使用QUADAS - 2清单进行方法学质量评估。采用随机效应模型，进行分层汇总接受者操作特征（HSROC）曲线分析和双变量模型荟萃分析，以评估不同研究之间的异质性。在最初确定的1286项研究中，有9项符合最终分析的纳入标准。死后CRP分析的合并敏感性为0.93（95%CI，0.76，0.98），合并特异性为0.80（95%CI，0.71，0.87）。各研究中的患病率范围为0.23至0.68，中位数为0.5。在对主要研究的异质性评估中观察到中等程度的变异性。总之，研究结果表明，死后血清CRP分析显示出较高的诊断准确性，异质性中等。此外，死后CRP检测在尸检实践中作为一种筛查工具可能有助于排除败血症的可能性。
