Utility of biomarkers in the postmortem diagnosis of fatal Anaphylaxis: A scoping review

IF 1.3 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine Pub Date : 2025-04-01 DOI:10.1016/j.legalmed.2025.102610

Bharath Karthikeyan , Ranjit Immanuel James , Jefferson Daniel , Senthil Kumar R , Benjy Tom Varughese , Daniel Manoj , Antony L. Arakkal , Latif Rajesh Johnson

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引用次数: 0

Abstract

Background

Diagnosing anaphylactic deaths is a challenging task for forensic pathologists. Although serum tryptase is considered to be a reliable biomarker, there are limitations to it. Thus, there is an urgent need to explore various other potential biomarkers which could be of diagnostic value, along with Tryptase, to diagnose anaphylactic shock at autopsy.

Aim

We want to systematically review the accuracy of newer postmortem biomarkers for anaphylaxis, such as chymase or eosinophilic cationic protein. Before embarking on this project, we intend to assess the feasibility of conducting systematic reviews on this topic. and identify any deficiencies in the existing literature to guide research priorities.

Methodology

We followed PRISMA guidelines and conducted the search in four databases, namely Medline, Scopus, EBSCO-CINAHL, and TRIP. Rayyan AI software was used to screen the articles.

Results

A total of 6112 articles were retrieved from the search, and 5079 articles were screened after removing duplicates. Only 25 articles were finally available as per our inclusion criteria. Studies pertaining to post-mortem tryptase levels were found in large numbers, with two recently done systematic reviews on this topic. The number of studies available on other newer biomarkers was too few. More clinical studies are needed before a meta-analysis can be done. Hence, we could perform only a narrative review on the topic.

Discussion

There is a scarcity of literature with definite cutoff levels for markers other than Tryptase. Based on the available studies, it is not possible to do diagnostic accuracy reviews at the moment. Hence, we narrate the usefulness of biomarkers like Immunoglobulin E, Chymase, Carboxypeptidase A3, Diamine Oxidase, Histamine and Eosinophilic Cationic Protein.

Conclusion

Based on the available evidence, serum tryptase is recognized as the primary biomarker for the postmortem diagnosis of anaphylactic death, with elevated levels strongly indicating anaphylaxis. Additionally, serum IgE, particularly allergen-specific IgE, is a valuable complementary biomarker. Further research is needed to understand the performance of other biomarkers.

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生物标志物在致死性过敏反应死后诊断中的应用：范围综述

诊断过敏性死亡对法医病理学家来说是一项具有挑战性的任务。虽然血清胰蛋白酶被认为是一种可靠的生物标志物，但它也有局限性。因此，迫切需要探索各种其他可能具有诊断价值的生物标志物，与胰蛋白酶一起，在尸检中诊断过敏性休克。目的：我们希望系统地回顾新的死后过敏反应生物标志物的准确性，如酶或嗜酸性阳离子蛋白。在开始这个项目之前，我们打算评估对这个主题进行系统审查的可行性。并找出现有文献中的任何不足，以指导研究重点。方法按照PRISMA指南，在Medline、Scopus、EBSCO-CINAHL和TRIP四个数据库中进行检索。Rayyan人工智能软件被用来筛选文章。结果共检索到6112篇论文，剔除重复后筛选出5079篇。根据我们的纳入标准，最终只有25篇文章可用。大量关于死后胰蛋白酶水平的研究被发现，最近有两篇关于这一主题的系统综述。关于其他较新的生物标志物的研究数量太少。在进行荟萃分析之前，还需要进行更多的临床研究。因此，我们只能对这个题目进行叙述性的回顾。除胰蛋白酶外，文献中对其他标记物有明确的截止水平。基于现有的研究，目前还不可能进行诊断准确性评估。因此，我们叙述了免疫球蛋白E、切酶、羧肽酶A3、二胺氧化酶、组胺和嗜酸性阳离子蛋白等生物标志物的有用性。结论根据现有证据，血清胰蛋白酶被认为是死后诊断过敏性死亡的主要生物标志物，血清胰蛋白酶水平升高强烈提示过敏反应。此外，血清IgE，特别是过敏原特异性IgE，是一个有价值的补充生物标志物。需要进一步的研究来了解其他生物标志物的性能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Legal Medicine Nursing-Issues, Ethics and Legal Aspects

CiteScore

2.80

自引率

6.70%

发文量

119

审稿时长

7.9 weeks

期刊介绍： Legal Medicine provides an international forum for the publication of original articles, reviews and correspondence on subjects that cover practical and theoretical areas of interest relating to the wide range of legal medicine. Subjects covered include forensic pathology, toxicology, odontology, anthropology, criminalistics, immunochemistry, hemogenetics and forensic aspects of biological science with emphasis on DNA analysis and molecular biology. Submissions dealing with medicolegal problems such as malpractice, insurance, child abuse or ethics in medical practice are also acceptable.