Postmortem computed tomography assessment of intracardiac and intravascular blood clots and gravitational sedimentation: clinical and laboratory associations in 114 in-hospital deaths.

Abstract

Purpose: Postmortem computed tomography (PMCT) typically reveals blood clots and sedimentation in cardiac and vascular structures. We examined the associations between these postmortem findings and antemortem clinical and laboratory parameters in in-hospital death.

Material and methods: This prospective study included 114 non-traumatic in-hospital deaths where PMCT was performed within 24 h postmortem. Two radiologists evaluated high-density areas in the right and left atria, pulmonary artery, and thoracic aorta, and classified them as blood clots or gravitational sedimentation. The clinical and laboratory data from the week before death were analyzed using univariate and multivariate logistic regression.

Results: Interobserver agreement was excellent for all anatomical sites (κ = 0.87-0.91). Blood clot or blood sedimentation were observed in 34-53% of cases across different locations. Per univariate analysis, non-pneumonic infections, positive blood cultures, and elevated coagulation parameters (prothrombin time-international normalized ratio, activated partial thromboplastin time) were associated with gravitational sedimentation. In contrast, solid malignancies and higher values of hematologic parameters (platelet count, red blood cells, hemoglobin, neutrophil percentage) were associated with blood clot formation (all p < .05). Per multivariate analysis, non-pneumonic infections maintained strong associations with gravitational sedimentation across all sites (p < .05), while higher platelet counts independently predicted blood clot formation in the right atrium, left atrium, and thoracic aorta (p < .05).

Conclusion: Postmortem gravitational sedimentation was associated with non-pneumonic infections, whereas clot formation correlated with higher platelet counts. These findings provide objective criteria for interpreting PMCT findings and may aid in evaluating patients' antemortem clinical status, particularly when clinical information is limited.