Postmortem serum endotoxin level in relation to the causes of death

Serum endotoxin is a clinical marker of sepsis. However, it is vulnerable to bacterial contamination, and the postmortem stability has not been established. In the present study, to evaluate the forensic pathological significance of postmortem endotoxemia in relation to the causes of death, we investigated a series of 111 autopsy cases (postmortem interval<48 h), in part, using bacteriological investigations. Systemic endotoxemia involving both the cardiac and peripheral blood was observed in some specific causes of death, including pneumonia (n=1/3), peritonitis (n=2/5), delayed traumatic death with severe secondary infection (n=7/33), drownings (freshwater, n=3/9; saltwater, n=3/16), fire deaths (n=3/16), and also in protracted deaths under critical medical care (n=2). Most cases of fatal blunt injury (n=4/5) showed sporadic endotoxemia in cardiac or peripheral blood, whereas there was no elevation of serum endotoxin in acute hemorrhagic death from sharp instrument injury (n=6). The bacteriological investigation showed some characteristic profiles in infections and drownings. These observations suggested that, although endotoxin is a vulnerable serum marker to ante and postmortem interference, systemic postmortem endotoxemia involving peripheral blood may be a possible indicator of antemortem bacteremia related to some specific causes of death accompanied by advanced infection or pulmonary alveolar damage in the dying process especially due to drownings and fires.