Usefulness of Mast Cell Tryptase Analysis for Postmortem Diagnosis of Anaphylactic Shock

Korean J Leg Med 2020;44:17-23

Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Korea,

Division of Forensic Medicine, National Forensic Service Daegu Institute, Chilgok, Korea,

Division of Forensic Medicine, National Forensic Service Daejeon Institute, Daejeon, Korea

E-mail: parkjp@yuhs.ac

Anaphylactic shock (AS) is a systemic and life-threatening type I hypersensitivity reaction and is often encountered at an autopsy. However, postmortem diagnosis of AS can be difficult due to non-specific autopsy findings. Clinically, the analysis of serum mast cell tryptase (MCT) is well known as a useful ancillary test for the diagnosis of AS. However, in order to apply this test to forensic autopsy, it is necessary to confirm its usefulness due to postmortem changes. We carried out serum MCT analysis in 299 autopsy cases including nine AS cases at National Forensic Service from January 2013 to May 2015 and analyzed the difference according to the cause of death and degree of postmortem change. As a result, the MCT level in AS was significantly increased compared to others, and the appropriate cutoff value for postmortem diagnosis of AS was 63.0 μg/L (sensitivity 88.9%, specificity 98.6%). Conclusively, serum MCT analysis is a useful test for postmortem diagnosis of AS and seems to be more appropriate for screening rather than confirmation.

Key Words: Anaphylaxis; Tryptases; Autopsy