A Comparison of Postmortem Serum and Pericardial Fluid Total Bilirubin Levels With Antemortem Data

The accuracy of total bilirubin (T-Bil) measurement in postmortem specimens is unclear because most forensic autopsy cases lack recent antemortem biochemical data to serve as references.

This study compared T-Bil concentrations between antemortem serum values, postmortem serum, and pericardial fluid values in 37 forensic autopsy cases (postmortem interval within 67 hours) and evaluated their efficacy. Moreover, these values were compared between cases with and without liver cirrhosis (LC).

No significant difference was observed between antemortem and postmortem serum T-Bil levels. Although postmortem pericardial fluid T-Bil concentrations correlated with antemortem values, the pericardial fluid concentrations were significantly lower. The median postmortem pericardial fluid to antemortem serum T-Bil ratio was 0.41 ± 0.27. Although antemortem and postmortem serum T-Bil concentrations were significantly higher in the LC group than in the control group, no significant difference was observed in postmortem pericardial fluid T-Bil values.

This article highlights the utility of measuring serum and pericardial fluid T-Bil levels postmortem. To the best of our knowledge, this study is the first to evaluate the postmortem pericardial fluid to antemortem serum T-Bil ratio. Our results showed that this ratio was close to that reported in living patients. Therefore, postmortem pericardial fluid may serve as a significant alternative sampling source in cases where serum is unavailable. However, further evaluation of its diagnostic efficacy in LC is warranted.