Estudio de la determinación postmortem de la adrenomedulina y otros parámetros bioquímicos en líquido pericárdico y suerosu aplicación al diagnóstico de la causa de la muerte

Abstract

OBJECTIVES 1) The general objective of the research has been the postmortem evaluation, in pericardial fluid and in peripheral blood, of the inflammatory markers that are generated in the process of agony along with other analytical elements in order to establish the diagnostic capacity of both among the groups cause of death. 2) Determine if there are statistically significant differences in the elements analyzed between the different causes of death and, if there are any, what type of death obtains higher values and why. 3) To evaluate the diagnostic capacity in the etiology of death by combining complement proteins (C3 and C4) together with specific markers of myocardial damage such as Troponin I. 4) Study of adrenomedullin as a marker of respiratory distress, having to do in this case with the severity and duration of respiratory failure. METHODOLOGY We have carried out the study of samples in pericardial fluid and peripheral blood (specifically from the femoral vein) from a total of 92 cadavers. After obtaining, the samples have been centrifuged at 3000 rpm for 10 minutes and frozen at -80 degrees until the moment of analysis. The causes of death have been grouped according to their etiology in: - Polytrauma. - Acute Myocardial Infarction. - Choking-violent. - Miscellaneous. Of these samples, the study of different laboratory parameters has been carried out. All the samples have been verified to be in good condition to carry out their processing and the quality controls of the technique have been reviewed, as well as in case of variation, calibrations have been carried out. Most of the tests performed have been by immunoassay and chemiluminescence reactions, except for the measurement of adrenomedullin that was performed using the ELISA technique. RESULTS With all these results, we carried out a discriminant analysis between groups by etiology of death, where by applying the levels in peripheral blood and pericardial fluid together with complement C3, complement C4 and troponin I. We can correctly classify the etiology of death in 88% of cases. This sensitivity is greater in deaths caused by acute myocardial infarction (90%) and is 100% in deaths caused by asphyxiation or violent death. With respect to adrenomedullin, we have carried out a statistical study of its levels associated with the severity of acute lung edema (mild, moderate and severe), demonstrating higher levels of adrenomedullin with increased severity of acute lung edema. CONCLUSIONS 1)In relation to ions, urea and glucose, our results are consistent with previous studies in both serum and pericardial fluid. 2)There is a significant statistical association between cortisol and serum postmortem adrenomedullin, but this association hasn't been found in pericardial fluid. This reflects that both adrenomedullin and cortisol have a distribution and production by common nonspecific stimulation at the adrenal level. 3)Adrenomedullin reflects a statistically significant positive association, both in peripheral blood and in pericardial fluid, with respect to the different degrees of intensity of acute lung edema. 4)We have found statistically significant differences in the different parameters between the four types of death that we had, with the highest levels in deaths from acute myocardial infarction. 5)The ability to classify the etiology of death by discriminant analysis using the combination of inflammatory markers (complement C3 and C4) together with myocardial damage (troponin I) reached a sensitivity of 88%, highlighting the highest sensitivity (100%) in the violent-suffocation group.