Abstract
The diagnosis of mechanical asphyxia remains one of the most difficult issues in forensic pathology. Asphyxia ultimately results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence. Histological examination is currently considered the gold standard for CA post-mortem diagnosis. Here we present the comparative results of histopathology versus those previously obtained by 1H nuclear magnetic resonance (NMR) metabolomics in a swine model, originally designed for clinical purposes, exposed to two different CA causes, namely ventricular fibrillation and asphyxia. While heart and brain microscopical analysis could identify the damage induced by CA without providing any additional information on the CA cause, metabolomics allowed the identification of clearly different profiles between the two groups and showed major differences between asphyxiated animals with good and poor outcomes. Minute-by-minute plasma sampling allowed to associate these modifications to the pre-arrest asphyxial phase showing a clear correlation to the cellular effect of mechanical asphyxia reproduced in the experiment. The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA.
Highlights
Emanuela Locci 1*, Alberto Chighine 1, Antonio Noto 1, Giulio Ferino 1, Alfonso Baldi 2, Dimitrios Varvarousis 3, Theodoros Xanthos 4, Fabio De‐Giorgio
Asphyxia results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence
The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA
Summary
Emanuela Locci 1*, Alberto Chighine 1, Antonio Noto 1, Giulio Ferino 1, Alfonso Baldi 2, Dimitrios Varvarousis 3, Theodoros Xanthos 4, Fabio De‐Giorgio. Asphyxia results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence. The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA. In addition to subjective elements, such as circumstantial details and the experience of a single pathologist, the differential diagnosis of asphyxial deaths relies on histopathological analysis, extremely sensitive in identifying the signs of cardiac arrest (CA), but lacking specificity as it cannot discriminate between different causes of CA and, different manners of death. Evidence of asphyxial deaths is mainly provided through the satisfaction of an exclusion criteria associated with exogenous findings (e.g. ligature mean or strangulation marks)
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