Diagnostic meaning of blood p-cresol concentration in forensic autopsy cases

[Display omitted] •Diagnostic meaning of p-cresol in blood was investigated in forensic autopsy cases.•Prolonged colonic transit time may increase the production of p-cresol.•Liver function disorder may compromise the metabolism of p-cresol.•Renal failure may compromise the excretion of p-cresol to...

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Published in:Legal medicine (Tokyo, Japan) Japan), 2018-09, Vol.34, p.27-35
Main Authors: Ikematsu, Natsuki, Kashiwagi, Masayuki, Hara, Kenji, Waters, Brian, Matsusue, Aya, Takayama, Mio, Kubo, Shin-ichi
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antemortem pathophysiology
Atherosclerosis - diagnosis
Autopsy
Biomarker
Biomarkers - blood
Body Mass Index
Cause of death
Coronary Stenosis - diagnosis
Cresols - blood
Fasting
Female
Forensic autopsy case
Forensic Medicine
Glomerulosclerosis, Focal Segmental - diagnosis
Humans
Male
Middle Aged
p-Cresol in blood
Postmortem Changes
Tandem Mass Spectrometry
Time Factors
Young Adult
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Summary:[Display omitted] •Diagnostic meaning of p-cresol in blood was investigated in forensic autopsy cases.•Prolonged colonic transit time may increase the production of p-cresol.•Liver function disorder may compromise the metabolism of p-cresol.•Renal failure may compromise the excretion of p-cresol to urine by the kidneys.•It was confirmed that cardiovascular damage relates to high conjugated p-cresol. In some forensic autopsy cases there are high concentrations of p-cresol in the blood. In vivo, p-cresol is the only isomer yielded by intestinal bacteria and is excreted into urine. We investigated the diagnostic meaning of p-cresol in the blood of forensic autopsy cases. Blood samples from 110 autopsy cases within 48 h of the postmortem interval (PMI) and 10 healthy adults were examined. Blood with p-cresol-d8 as an internal standard was analyzed using a GC–MS/MS method. Using acid and heat deproteinization, free (F) and conjugated (non-protein bound: C; protein bound: PC) p-cresol were individually analyzed. The p-cresol concentrations were 1.39 ± 0.86 µg/ml [mean ± SD] and 1.18 (0.19–18.80) µg/ml [median (range)] in healthy adults and autopsy cases, respectively. The p-cresol showed no significant relationship to age, sex, fasting duration, survival duration, or PMI. No significant differences were found between causes of death. Significantly higher levels of C p-cresol were found in cases with atherosclerosis in the basilar or renal arteries, or stenosis in the coronary artery. Significantly higher levels of p-cresol except F were found in cases with hyalinosis of the kidney. Cases with low BMI also showed significantly higher p-cresol concentrations. The 22 cases of abnormally high total p-cresol were investigated. It was considered that high concentrations of p-cresol could be an indicator of certain diseases and physical conditions that effect the production, absorption, metabolism, circulation, and excretion of p-cresol. Measuring the levels of p-cresol may provide valuable information about the antemortem physical conditions.
ISSN:1344-6223
1873-4162
DOI:10.1016/j.legalmed.2018.08.003