Federspiel Jan Michael, Kettner Mattias, Potente Stefan, Heinbuch Sara, Lux Constantin, Verhoff Marcel A, Ramsthaler Frank
Institute for Legal Medicine, Faculty of Medicine, Saarland University, Campus Homburg, Building 49.1, Kirrberger Straße 100, 66421, Homburg, Saarland, Germany.
Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, 60596, Frankfurt (Main), Hessen, Germany.
Int J Legal Med. 2025 May 29. doi: 10.1007/s00414-025-03517-y.
In cardiac death, some entities, such as arrhythmia or nonocclusive myocardial ischemia, are not associated with clear and certain macroscopic surrogates of cardiac death. Cardiac biomarker point-of-care testing (POCT) seems suitable for further improving postmortem diagnostics in legal medicine casework. Considering the preanalytic phase, the present study aims to define criteria for blood samples suitable for POCT and assess the diagnostic performance of postmortem cardiac biomarker POCT. A fluorescent immunoassay device was used. The biomarkers assessed were myoglobin, brain-type natriuretic peptide (BNP), N-terminal proBNP, creatine kinase muscle-brain type, and cardiac troponin I. Blood was obtained from the intrapericardial inferior vena cava. In a prestudy, criteria for the selection of blood samples were established and the biomarker stability over time, test reliability and reproducibility of postmortem cardiac biomarker analyses were assessed. Afterward, blood samples from 150 autopsied individuals were evaluated for their diagnostic performance and compared with findings from autopsy as the postmortem diagnostic gold standard. In doing so, the assessed biomarkers provided valid and reproducible results. Cardiac troponin I yielded the highest sensitivity for detecting cardiac death, whereas BNP had the highest specificity and positive predictive value for detecting cardiac death. Markers of myocardial damage had better negative than positive predictive value. NT-proBNP and BNP POCT seem applicable to support diagnosis of death associated with congestive heart failure. Postmortem cardiac biomarker POCT results need to be interpreted in conjunction with all available information, i.e., autopsy findings, medical history, investigatory results, and other test results.
在心脏性死亡中，某些情况，如心律失常或非闭塞性心肌缺血，与明确且肯定的心脏性死亡宏观替代指标无关。心脏生物标志物即时检验（POCT）似乎适合进一步改善法医学尸检诊断。考虑到分析前阶段，本研究旨在确定适合POCT的血样标准，并评估死后心脏生物标志物POCT的诊断性能。使用了一种荧光免疫分析设备。评估的生物标志物包括肌红蛋白、脑钠肽（BNP）、N末端前脑钠肽（NT-proBNP）、肌酸激酶同工酶MB以及心肌肌钙蛋白I。血液取自心包内下腔静脉。在一项预研究中，确定了血样选择标准，并评估了生物标志物随时间的稳定性、死后心脏生物标志物分析的测试可靠性和可重复性。随后，对150例尸检个体的血样进行诊断性能评估，并与作为死后诊断金标准的尸检结果进行比较。在此过程中，评估的生物标志物提供了有效且可重复的结果。心肌肌钙蛋白I在检测心脏性死亡方面具有最高的敏感性，而BNP在检测心脏性死亡方面具有最高的特异性和阳性预测值。心肌损伤标志物的阴性预测值优于阳性预测值。NT-proBNP和BNP的POCT似乎适用于支持充血性心力衰竭相关死亡的诊断。死后心脏生物标志物POCT结果需要结合所有可用信息进行解读，即尸检结果（包括病史、调查结果和其他检测结果）。
