Postmortem Blood Procalcitonin (PCT) for identifying sepsis as a cause of death: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the diagnostic accuracy of postmortem blood procalcitonin (PCT) in identifying sepsis as a cause of death through a systematic review and meta-analysis. METHODS: A comprehensive literature search of PubMed, Scopus, ScienceDirect and Cochrane library was performed. Studies evaluating postmortem PCT levels were included. Data were extracted from all studies for diagnostic accuracy parameters and study quality was assessed. Pooled sensitivity and specificity were estimated. Diagnostic accuracy was further evaluated using a Reitsma bivariate random-effects model and hierarchical summary receiver operating characteristic (HSROC) analysis. RESULT: 11 studies met the inclusion criteria, of which eight studies provided sufficient data for pooled analysis. Most studies used peripheral (femoral) blood, while some used different matrices such as pericardial fluid, cerebrospinal fluid, and aqueous humour. The pooled analysis of postmortem blood-based studies demonstrated a sensitivity of 91.0% (95% CI: 80.8-98.1) and a specificity of 94.9% (95% CI: 89.9-98.5). HSROC analysis demonstrated good diagnostic performance with an area under the curve (AUC) of 0.937. Funnel plot interpretation was limited by the small number of included studies. CONCLUSION: Postmortem blood PCT shows high diagnostic accuracy for identifying sepsis as a cause of death, with robust performance across variable postmortem intervals. Peripheral blood remained the preferred choice for sample collection. Despite assay heterogeneity and limited study numbers, PCT is a promising biomarker when correlated with autopsy, histopathology, and postmortem microbiology. Future studies should focus on standardized cut-offs, validation across different biological sample types, and further evaluation of its role in forensic diagnostic practice.