Postmortem determination of HbA1c and glycated albumin concentrations using the UHPLC-QqQ-MS/MS method for the purposes of medicolegal opinions

Abstract

Postmortem diagnosis of hyperglycaemia is a challenge in forensic medicine. Glycated haemoglobin (HbA1c) is considered one of the markers providing an alternative to postmortem determinations of glucose concentration. On the other hand, glycated albumin (GA) may be determined in cases of difficulty in determining HbA1c.The aim of this study was to implement and evaluate the usefulness of methods enabling determination of HbA1c an GA in postmortem material (HbA1c–peripheral blood, GA–serum, urine, vitreous humour) using the UHPLC-QqQ-MS/MS. The material consisted of samples collected during autopsy. The study group consisted of 50 people with antemortem diagnosis of diabetes. The control group consisted of 50 people who died a sudden death, with negative test results for the presence of ethanol, without suspected carbohydrate metabolism disorders, and not resuscitated before death. Statistical analysis was performed using the IBM SPSS Statistics 25 software package. We failed to implement a method for determining the concentration of glycated albumin, but we successfully modified the method for determining HbA1c using the UHPLC-QqQ-MS/MS. We have proven that our method is useful in determination of HbA1c in postmortem blood by forensic laboratories and we are convinced that it could be implemented by clinical laboratories. The demonstrated differences between the study and control groups with respect to HbA1c concentration may indicate the usefulness of this marker in diagnosis of long-term glycaemic disorders occurring prior to death. However, for the purposes of medico-legal assessment, we recommend comparing postmortem levels of HbA1c to the results of determinations of other hyperglycaemia markers, toxicological tests, autopsy results, circumstances of death, and the medical history of the deceased.