Serial monitoring of interleukin-1?, soluble interleukin-2 receptor and lipopolysaccharide binding protein levels after death

Abstract

We prospectively monitored the postmortem course of interleukin-1beta (IL-1beta), soluble interleukin-2 receptor (sIL-2R) and lipopolysaccharide binding protein (LBP) in septic and non-septic fatalities to evaluate their potential as biochemical postmortem markers of sepsis. Serum concentrations were determined by chemiluminescent immunometric assays. In both the sepsis group and the control group a postmortem increase of IL-1beta levels with the progression of time after death was observed, in both groups mainly starting from the reference concentration of healthy individuals (5 pg/ml) and with no significant differences at later time points postmortem. SIL-2R (reference limit 1,000 U/ml) was highly elevated in all individuals included in the sepsis group at all time points postmortem with statistically significant differences between the sepsis and control groups (p<0.01). An excessive postmortem decrease of sIL-2R serum levels associated with progression of time after death was observed in all cases included in the sepsis group in contrast to just 1 out of 16 control cases. LBP (reference limit <10 g/ml) was elevated in all sepsis cases whereas in the control group LBP levels were below 10 microg/ml in 88%. The postmortem time course of LBP serum concentrations showed a continuous increase in both the sepsis and control groups. We conclude that sIL-2R and LBP seem to represent appropriate diagnostic tools for the postmortem diagnosis of sepsis in forensic autopsy practice. sIL-2R serum levels above 1,000 U/ml and LBP serum levels above 10 microg/ml in peripheral venous blood obtained in the early postmortem interval can be regarded as diagnostic hints for an underlying septic condition in a deceased person.

Postmortem chemistry update part II

“…The acutephase protein LBP is a 60-kDa serum glycosylated protein, forming high-affinity complexes with bacterial endotoxins (lipopolysaccharide), functioning as an opsonin, that is produced and secreted by hepatocytes. The reference limit of LBP in healthy individuals is less than 10 μg/ml [83][84][85]. The results of this study showed increased sIL-2R and LBP postmortem serum levels over the clinical reference limits in sepsis-related fatalities, suggesting that these markers could be an appropriate diagnostic tool, in combination with other biochemical markers, in the postmortem diagnosis of sepsis in forensic autopsy practice.…”

“…Reichelt et al [83] investigated interleukin-1β (IL-1β), soluble interleukin-2 receptor (sIL-2R) and lipopolisaccharide binding protein (LBP) in postmortem serum from femoral blood in two series of autopsy cases (eight septic cases and 16 control cases). IL-1β is predominantly produced by monocytes/macrophages as an inactive 31 kDa precursor protein (pIL-1β) and is processed to its active 17.5 kDa form by the specific interleukin-1β converting enzyme.…”

Post-mortem diagnostics in cases of sepsis. Part 2. Biochemical and morphological examinations

“…There are also studies indicating that assays of soluble IL-2 receptor (sIL-2R) -a marker Archiwum Medycyny Sądowej i Kryminologii Archives of Forensic Medicine and Criminology tora interleukiny 2 (sIL-2R) -markera aktywacji limfocytów, endokanu (ESM1) -markera dysfunkcji śródbłonka naczyniowego [9,10]. W diagnostyce pośmiertnej inwazyjnych zakażeń grzybiczych, któ-re dotyczą głównie osób z nabytymi lub wrodzonymi niedoborami odporności, wykazano efektywność oceny stężenia β-glukanu w surowicy lub innych płynach ustrojowych [11].…”

“…Należy ich szukać zarówno na skórze, jak i błonach śluzowych. Z kolei w zespole toksycznej nekrolizy naskórka (TEN) i gronkowcowego złuszczającego zapalenia skóry (SSSS) domiof lymphocyte activation, and endocan (ESM1) -a marker of vascular endothelial dysfunction could also be used for that purpose [9,10]. An assessment of β-glucan concentration in the blood serum or other bodily fluids has also been demonstrated to be an effective test in the post-mortem diagnostics of invasive fungal infections occurring mainly in patients with congenital or acquired immunodeficiencies [11].…”

Postmortem cytokine levels and severity of traumatic injuries

“…Furthermore, postmortem cytokine levels in systemic inflammation have been studied extensively by other researchers [13,14]. However, these studies discussed the association between postmortem cytokine levels and sepsis.…”