Abstract
In 239 postmortem cases, we used liquid chromatography/time-of-flight mass spectrometry to measure urinary cortisol concentrations standardized to creatinine, which were then related to causes of death. For comparison, we also analyzed urine samples from 95 living subjects implicated in criminal cases. The median of the postmortem group (18.8 μmol cortisol/mol creatinine) was not significantly different from that of the living group (18.1 μmol cortisol/ mol creatinine), but the highest value in the postmortem group was more than ten times higher than that in the living group (3730 versus 354 μmol cortisol/mol creatinine). Among the postmortem cases, 28% had values exceeding the previously reported upper 95% range for normal living subjects (52.8 μmol cortisol/mol creatinine), as did 12%of the living group. The postmortem cases were divided into subgroups according to cause of death:asphyxiation, blunt force trauma, brain hemorrhage, cardiac-related death, drowning, fire-related death, gun or knife trauma, infection, internal bleeding, ketoacidosis, miscellaneous and poisoning. The median cortisol levels of the ketoacidosisand the infection subgroups (respectively, 152 and 243 μmol cortisol/mol creatinine) were significantly higher than the median of the other subgroups (15.5 μmol cortisol/mol creatinine); however, the spread of data does not allow for any conclusions on an individual case level.
Highlights
Except for in sudden deaths, the death process is likely to coincide with some degree of stress related to psychological and/or physical conditions, such as anxiety, pain, troubled breathing, and multiorgan failure [1]
The present study aimed to evaluate whether postmortem urine cortisol levels might be related to the cause of death
Urinary cortisol levels ranged from 0.4-3730 μmol/mol creatinine, with a median of 18.8μmol/mol for the 239 postmortem cases
Summary
Except for in sudden deaths, the death process is likely to coincide with some degree of stress related to psychological and/or physical conditions, such as anxiety, pain, troubled breathing, and multiorgan failure [1]. Stress marker measurement may be of interest in cases where the circumstances relating to death are unclear. Several studiesof postmortem cases have reported the urine or blood levels of the stress markers adrenaline and noradrenaline, or their metabolites [2,3,4,5]. The results have been somewhat unclear, but the postmortem levels have generally been higher than in living subjects. Some researchers have concluded that the elevated postmortem levels of catecholamines in blood and urine are an expression of tissue release, e.g., postmortem redistribution [6]. Others have judged that these levels relate to various causes of death [3,5]
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