Procalcitonine en Médecine Légale

Les travaux sur la procalcitonine pour orienter la cause de décès, ont fait l'objet d'un article "Procalcitonin interest to assess a septic state inducing the death" qui est publié dans "Forensic Medicine and Anatomy Research". Ces travaux ont été menés par les équipes

1- "Groupe Recherche & Expertise" de l'Association Française de la Promotion de la Recherche Médicale (AFPreMed)
2- Laboratoire Claude Bernard, Centre Hospitalier René Dubos, Pontoise.
3- Unité Médico-Judiciaire, Centre Hospitalier Emmanuel Rain, Gonesse.
4- Service des Urgences-SMUR Centre Hospitalier Léon Binet, Provins.

Mots clés: Procalcitonine, septicémie, biomarqueur, syndrome malin des neuroleptiques
Key words: Procalcitonin, sepsis, biomarker, neuroleptic malignant

In this prospective study, we evaluated the use of PCT when collecting the body which was carried out. The chosen cut-off was set at 10 ng/mL because at this level, the PCT was associated to a multiorgan failure attributable to a septic shock. For 90 cases, two groups were stratified by their final diagnosis: 33 of for non violent deaths and 57 of violent deaths. There was no significant elevation of procalcitonin rate (PCT) in the group of violent deaths. We noted 6 elevations of PCT rate above 10 ng/mL for non violent deaths (15.4%) and in 3 cases there was an evidence for an infectious context (recent anti-infectious treatments, chemotherapy in progress).
Control of CRP performed on blood samples found initial elevations above 10 mg/L in 3 of the 6 cases (including 2 of 3 cases associated with an infectious context). There is no evidence of PCT rate increase for intermediate PMI (post mortem interval), long PMI and undefined PMI. This study found a PPV (positive predictive value) and clinical specificity of 100% for a cutoff set at 10 ng/mL. By taking this threshold, no significant PCT increase was observed in presence of death cases related to a violent origin as well as a fatal multi-organ failure due to malignant hyperthermia syndrome induced by neuroleptic use. The PCT appears to remain stable over time and whatever the conservation conditions of the body.

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