Significance of postmortem biochemistry in determining the cause of death

There have been an abundance of challenging publications on biochemical procedures for investigating death. However, such procedures do not appear to have been effectively incorporated in routine casework. Biochemical profiles at autopsy may show considerable case variations due to various factors involving preexisting disorders, the cause of death, complications, the survival period, and postmortem changes, distributions and localizations of analytes. Postmortem interference may also be caused by various factors, including the status at the time of death, possible supravital reactions, leakage from cell deterioration, diffusion/redistribution, and analytical procedures. Thus, analyses of topographic distribution are also important. When these factors are taken into consideration, biochemical procedures provide useful findings for investigating the cause and process of death, contributory conditions, and predisposing disorders. Meanwhile, recent studies showed that postmortem molecular biological analyses of mRNA of biological reactants in the tissues using RT-PCR are potentially useful for investigating the pathophysiology of death. As above, the use of postmortem biochemistry and molecular biology has advantages for investigating systemic pathophysiological functional changes involved in the dying process. For this purpose, the usefulness of comprehensive analyses of pathological and biochemical findings is suggested as part of laboratory investigations, comprising morphology, toxicology, microbiology, biochemistry and molecular biology, along with diagnostic imaging procedures. These procedures can be effectively incorporated into a 'full autopsy' in the context of risk management. The application of these procedures may depend on the concept of medicolegal autopsy, and it is essential to establish postmortem databases through routine casework.