Sutton Ethan D, Parsons Sarah, Pricone Maria, de Boer Hans H
Bachelor of Biomedical Science Honours, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Dept. of Pathology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
Int J Legal Med. 2025 May 23. doi: 10.1007/s00414-025-03526-x.
Cardiac-specific troponin (cTn) is widely used in clinical medicine to support a diagnosis of acute myocardial infarction. Several studies have explored the value of cTn testing in deceased individuals. These studies suggest that -although there are important limitations associated with its use- post-mortem cTn can be useful in selected cases. A decision for post-mortem cTn testing should however be influenced by factors that have not been explored in much detail. This includes the success rate of post-mortem cTn testing, and whether cTn levels are stable after death.Therefore, this study addresses the post-mortem availability and stability of cardiac-specific Troponin I (cTnI). Post-mortem availability was determined by analysing the success rate in 250 high-sensitivity (hs-)cTnI tests on post-mortem blood samples, and its relationship with variables such as sample location, sample type, post-mortem interval, and decomposition. Post-mortem stability was explored by comparing post-mortem cTnI levels between two samples from the same individual, taken at different times.Post-mortem hs-cTnI tests were successful in 86.4% of cases (216/250), with little effect of sex, age, or cardiopulmonary resuscitation. Visible decomposition precluded a successful test. Other variables associated with decomposition (such as increased post-mortem interval) also affected test success negatively. Our results furthermore suggest that cTnI is very unstable post-mortem, with marked differences in hs-cTnI test results between samples from the same individual. The differences were large (on average 18734 ng/L) and not unidirectional. Instability appeared to increase with larger time intervals, but the results were overall erratic and difficult to interpret.We conclude that hs-cTnI testing results are generally available in a post-mortem setting, but that testing should be performed on the earliest available blood sample. Samples from decomposed individuals should not be tested. Furthermore, the severe instability of cTnI indicates that any post-mortem hs-cTnI result must be interpreted with caution.
心脏特异性肌钙蛋白（cTn）在临床医学中被广泛用于辅助急性心肌梗死的诊断。多项研究探讨了cTn检测在死亡个体中的价值。这些研究表明，尽管其使用存在重要局限性，但死后cTn在某些特定情况下可能有用。然而，决定进行死后cTn检测应受尚未详细探讨的因素影响。这包括死后cTn检测的成功率，以及死后cTn水平是否稳定。因此，本研究探讨了心脏特异性肌钙蛋白I（cTnI）的死后可获得性和稳定性。通过分析250例死后血样的高敏（hs-）cTnI检测成功率及其与样本位置、样本类型、死后间隔和尸体腐败等变量的关系来确定死后可获得性。通过比较同一个体在不同时间采集的两个样本之间的死后cTnI水平来探讨死后稳定性。死后hs-cTnI检测在86.4%的病例（216/250）中成功，性别、年龄或心肺复苏影响较小。明显的尸体腐败会导致检测失败。与尸体腐败相关的其他变量（如死后间隔增加）也对检测成功率有负面影响。我们的结果还表明，cTnI在死后非常不稳定，同一个体样本的hs-cTnI检测结果存在显著差异。差异很大（平均18734 ng/L）且并非单向。不稳定性似乎随着时间间隔的延长而增加，但结果总体不稳定且难以解释。我们得出结论，hs-cTnI检测结果在死后通常可以获得，但检测应在最早获得的血样上进行。不应检测尸体腐败个体的样本。此外，cTnI的严重不稳定性表明，任何死后hs-cTnI结果都必须谨慎解释。
