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Exploration of sepsis assisting parameters in hospital autopsied-patients: a prospective study
Kunihiro Inai1, Shohei Higuchi2, Akihiro Shimada3
1Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan. kinai@u-fukui.ac.jp.
Abstract:
Although Sepsis-3 doesn't require evidence of bacteremia to diagnose sepsis, clinicians often want to identify the causative pathogen at autopsy. In principle, if the blood cultures are the same at ante- and postmortem, the cause of death is obvious. However, interpretations of postmortem blood cultures are often difficult due to discordance, negativity, mixed infection, and contamination, of pathogens occupying ≥ 50% of the tests. To increase specificity identifying agonal phase sepsis in the situations where blood cultures are discordant, multiple or negative at postmortem, we established a scoring system using blood cultures, procalcitonin (PCN) showing highest sensitivity and specificity for postmortem serum, and bone marrow polyhemophagocytosis (PHP). Histological sepsis showed significantly higher levels of culture score (2.3 ± 1.5 vs. 0.4 ± 0.5, p < 0.001), PHP score (2.5 ± 0.8 vs. 1.0 ± 1.1, p < 0.001), and PCN score (1.8 ± 0.8 vs. 0.8 ± 0.6, p < 0.01) than non-septic patients. Receiver operating characteristic curve analysis indicated that estimation of three scores was the most reliable indicator for recognizing agonal phase sepsis. These findings suggest that the combination of these three inspections enables to determine the pathological diagnoses of sepsis even it is not obvious by discordant, mixed or negative blood cultures.
Insights
Diagnosing sepsis at autopsy can be challenging due to unreliable blood cultures. A new scoring system combining blood cultures, procalcitonin (PCN), and bone marrow polyhemophagocytosis (PHP) improves sepsis identification.
Area of Science:
- Forensic Pathology
- Infectious Diseases
- Clinical Pathology
Background:
- Sepsis-3 diagnosis criteria do not require bacteremia evidence.
- Clinicians often seek causative pathogens at autopsy for definitive diagnosis.
- Postmortem blood culture interpretations are frequently complicated by discordance, negativity, or contamination.
Purpose of the Study:
- To develop a reliable scoring system for identifying agonal phase sepsis.
- To improve diagnostic specificity when postmortem blood cultures are inconclusive.
- To aid in pathological sepsis diagnosis despite challenging blood culture results.
Main Methods:
- Established a scoring system integrating blood culture results, procalcitonin (PCN) levels, and bone marrow polyhemophagocytosis (PHP).
- Assessed culture score, PCN score, and PHP score in histological sepsis versus non-septic patients.
- Utilized receiver operating characteristic (ROC) curve analysis to evaluate diagnostic reliability.
Main Results:
- Histological sepsis patients exhibited significantly higher culture scores, PHP scores, and PCN scores compared to non-septic individuals.
- The combined estimation of the three scores proved to be the most reliable indicator for recognizing agonal phase sepsis via ROC analysis.
- The scoring system demonstrated effectiveness in pathological sepsis diagnosis even with discordant, mixed, or negative blood cultures.
Conclusions:
- The developed scoring system effectively aids in diagnosing pathological sepsis.
- Combining blood cultures, PCN, and PHP provides a robust method for sepsis identification at autopsy.
- This approach enhances diagnostic certainty in cases with compromised postmortem blood culture data.
