From Bedside to Autopsy Table: Biomarkers Bridging Clinical Toxicology and Forensic Death Investigation
DOI:
https://doi.org/10.48165/jfmt.2026.43.02.20Abstract
Background: Toxicological deaths present a formidable diagnostic and forensic challenge. The accurate identification of the cause and manner of death in poisoning cases requires integration of clinical biomarker data obtained antemortem with postmortem chemical analyses. However, the physiological and biochemical gap between these two settings remains poorly characterized. Objective: This review aims to systematically evaluate the diagnostic, prognostic, and forensic utility of antemortem and postmortem biomarkers in toxicological deaths, with particular emphasis on inflammatory mediators (pentraxin-3, C-reactive protein, cytokines), cardiac biomarkers (troponins), organ-specific markers, and vitreous humor analytes. Methods: A comprehensive narrative review was conducted using PubMed, Scopus, and Web of Science databases. Studies examining biomarkers in acute poisoning, forensic toxicology, postmortem chemistry, and fatal toxic exposures published between 1985 and 2024 were included. Results: Inflammatory biomarkers, particularly pentraxin-3 (PTX3), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), demonstrate early and robust elevations following acute poisoning and correlate with severity and mortality. Cardiac troponins serve as reliable indicators of cardiotoxicity. Postmortem biomarker interpretation is complicated by postmortem redistribution (PMR), autolytic degradation, and variable postmortem interval (PMI). Vitreous humor offers greater analytical stability compared to cardiac or peripheral blood. Conclusion: A combined antemortem–postmortem biomarker strategy, incorporating inflammatory markers, vitreous chemistry, and advanced toxicological screening, offers the most robust framework for forensic diagnosis of poisoning deaths. Standardization of postmortem sampling protocols and establishment of postmortem reference ranges are critically needed.
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