Postmortem Diagnosis of Sepsis and Inflammatory Responses

Sepsis, a life-threatening syndrome arising from a dysregulated host response to infection, remains a leading cause of mortality worldwide. In the postmortem setting, definitive diagnosis is hindered by nonspecific macroscopic findings, potential contamination of blood cultures, bacterial translocation and the absence of ante-mortem clinical data. Contemporary approaches integrate anatomical, histological and laboratory investigations to establish both the presence of pathogens and the character of the inflammatory response. Macroscopic examination of organs identifies gross changes such as consolidation of lung tissue or splenomegaly, while histology reveals microvascular injury, neutrophil infiltration and evidence of disseminated intravascular coagulation. Immunohistochemical markers and biochemical assays—particularly of blood or serous fluids—provide objective measures of systemic inflammation. Microbiological cultures and molecular techniques, including polymerase chain reaction, are employed to confirm or exclude bacteremia. The combined interpretation of these methods, often through quantitative scoring systems or multiplex biomarker panels, enhances specificity and sensitivity, permitting reliable attribution of death to sepsis even when conventional cultures yield equivocal results.

Research from Nature Portfolio

Recent studies have focused on developing integrated scoring systems to distinguish true sepsis at autopsy from postmortem artefacts. One prospective investigation established a triad of assessments—culture scoring, serum procalcitonin measurement and bone-marrow polyhemophagocytosis quantification—that together achieved high sensitivity and specificity for diagnosing agonal phase sepsis. Each component is graded according to standardised criteria: the culture score reflects pathogen dominance, the procalcitonin score gauges systemic bacterial stimulus and the polyhemophagocytosis score captures excessive phagocytic activity in marrow samples. Receiver operating characteristic analysis demonstrated that combining all three metrics yields the most reliable indicator of sepsis-related death, even in cases with discordant or negative postmortem cultures.

Postmortem Diagnosis of Sepsis and Inflammatory Responses publication trend

The graph below shows the total number of articles in postmortem diagnosis of sepsis and inflammatory responses across all publications each year (not limited to Nature Index journals).

Technical terms

Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Procalcitonin: A peptide precursor of calcitonin that rises significantly during bacterial infection, used as a biomarker of sepsis.

C-reactive protein (CRP): An acute-phase protein synthesised by the liver in response to inflammatory cytokines.

Polyhemophagocytosis: The excessive phagocytosis of blood cells by marrow macrophages, indicative of systemic inflammatory activation.

Immunohistochemistry: A laboratory technique employing labelled antibodies to detect specific antigens in tissue sections.

References

1. Exploration of sepsis assisting parameters in hospital autopsied-patients: a prospective study. Scientific Reports (2023).
2. Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature. Diagnostics (2020).
3. A Pathophysiological Insight into Sepsis and Its Correlation with Postmortem Diagnosis. Mediators of Inflammation (2016).
4. Markers for sepsis diagnosis in the forensic setting: state of the art. Croatian Medical Journal (2014).