Liver Cirrhosis in Forensic Autopsies in Moscow

Abstract

Introduction: There has been an increase in the number of liver cirrhosis worldwide. Liver cirrhosis in forensic practice is common enough. Medical experts diagnose liver cirrhosis according to morphological data. At the same time this problem in medicolegal analytical reports and publications are still small. The purpose of our research consisted in characteristic of liver cirrhoses by forensic medical examinations for the 12-year period from 2007 to 2018 in the city of Moscow. Materials and methods. We studied 3.371 case of death from liver cirrhosis in proportion to the number of non-violent deaths. We analyzed the acts of forensic autopsies and histological studies performed at the Bureau of Forensic Medicine of the Department of Health of Moscow during 2007-2018. We calculated the frequency of occurrence, gender and age, annual changes and the overall trend of mortality from liver cirrhosis. we determined the liver cirrhosis form and liver failure stage.We determined the liver cirrhosis form and liver failure stage by the results of the section and histologic morphological signs. Results. We found that forensic examination of corpses diagnosed a significant number of liver cirrhosis. Their annual number averaged 1.15% of total non-violent deaths. During the studied period, the annual incidence of liver cirrhosis changed significantly: it increased in 2009, 2015, 2017, 2018 and decreased in 2013 and 2016. Change difference reached 20.5%. We determined that the highest number of liver cirrhosis were diagnosed between 2009 and 2012, the lowest in 2016. In the last 2 years, the number of liver cirrhosis cases tends to increase. Over a 12-year liver cirrhosis study period we were a steady trend in the decline established. We found that liver cirrhosis during forensic examination of corpses in Moscow were more likely in young and middle-aged men detected. The morphological structure was dominated by small and mixed morphological forms. We found that in histological forensic examination the terminal (48.9%) and decompensated (43.4%) stages of hepatic failure was most often diagnosed. Conclusion: According to traditional perceptions liver cirrhosis can rarely be the cause of sudden death and is therefore more likely to be the subject of an autopsy by anatomists rather than forensic experts. On the one hand we established that high (1/100) incidence of liver cirrhosis correlates with the prevalence of this disease among the population of the city of Moscow and on the other indicates a significant number of cases of non-violent death in the total volume of forensic autopsies. We have calculated that the number of annually diagnosed deaths from liver cirrhosis were proportional to the total number of non-violent deaths. During the period 2007-2018 a marked dynamics of decline in the frequency of forensic detection of liver cirrhosis, which is consistent with the general trend of reduction of cirrhosis incidence in Moscow. However, in the last 2 years there was some increase in the number of the liver cirrhosis. The young and middle-aged men in mixed and small-node morphological form at the terminal and decompensated stage of the disease were diagnosed.