Procalcitonin interest to assess a septic state inducing the death

Nouredine Sadeg^1,2*, Frédéric Tarlier^3,4, Laurence Veneau³, Hafid Belhadj-Tahar¹

¹Association Française de la Promotion de la Recherche Médicale (AFPreMed), Toulouse, France.
²Laboratoire Claude Bernard, Centre Hospitalier René Dubos, Pontoise, France.
³Unité Médico-Judiciaire, Centre Hospitalier Emmanuel Rain, Gonesse, France.
⁴Service des Urgences-SMUR Centre Hospitalier Léon Binet, Provins, France.

DOI: 10.4236/fmar.2013.14014                

Abstract

In this prospective study, we evaluated the use of PCT when collecting the body which was carried out. The chosen cut-off was set at 10 ng/mL because at this level, the PCT was associated to a multiorgan failure attributable to a septic shock.For 90 cases, two groups were stratified by their final diagnosis: 33 of for non violent deaths and 57 of violent deaths. There was no significant elevation of procalcitonin rate (PCT) in the group of violent deaths. We noted 6 elevations of PCT rate above 10 ng/mL for non violent deaths (15.4%) and in 3 cases there wasan evidence for an infectious context (recent anti- infectious treatments, chemotherapy in progress).Control of CRP performed on blood samples found initial elevations above 10 mg/L in 3 of the 6 cases (including 2 of 3 cases associated with an infectious context). There is no evidence of PCT rate increase for intermediate PMI (post mortem interval), long PMI and undefined PMI. This study found a PPV (positive predictive value) and clinical specificity of 100% for a cut-off set at 10 ng/mL. By taking this threshold, no significant PCT increase was observed in presence of death cases related to a violent origin as well as a fatal multiorgan failure due to malignant hyperthermia syndrome induced by neuroleptic use. The PCT appears to remain stable over time and whatever the conservation conditions of the body.

Keywords

Procalcitonin; Sepsis; Biomarker; Neuroleptic Malignant Syndrome

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	INSERM. Database on causes of death in France. http://www.cepidc.vesinet.fr
[2]	Tsokos, M. Reichelt, U. Nierhaus, A. and Püschel, K. (2001) Serum Procalcitonin (PCT): A valuable parameter for the postmortem diagnosis of sepsis. International Journal of Legal Medicine, 114, 237-244. http://dx.doi.org/10.1007/s004140000177
[3]	Belhadj-Tahar, H. Veneau, L. and Sadeg, N. (2008) Interest in forensic troponin Ic to a suspicious death. Canadian Society Forensic Science Journal, 41, 1-12.
[4]	Sands, K.E., Bates, D.W., Lanken, P.N., Graman, P.S., Hibberd, P.L., Kahn, K.L., Parsonnet, J., Panzer, R., Orav, E.J., Snydman, D.R., Black, E., Schwartz, J.S., Moore, R., Johnson, B.L. and Platt, R. (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. Journal of the American Medical Association, 278, 234-240. http://dx.doi.org/10.1001/jama.1997.03550030074038
[5]	Belhadj-Tahar, H., Coulais, Y., Tafani, M. and Bouissou, F. (2008) Procalcitonin implication in renal cell apoptosis induced by acute pyelonephritis in children. Infection Drug Resistance, 1, 17-20. http://dx.doi.org/10.2147/IDR.S3435
[6]	Ramsthaler, F., Kettner, M., Mall, G. and Bratzke, H. (2008) The use of rapid diagnosis test of Procalcitonin serum for the postmortem diagnosis of sepsis. Forensic Science International, 178, 139-145. http://dx.doi.org/10.1016/j.forsciint.2008.03.010