Postmortem measurement of C-reactive protein and interpretation of results in ketoacidosis

C-reactive protein (CRP) is a widely used acute phase protein that reacts to various tissue-destroying stimuli. Its forensic applications have been established in prior studies. We show that CRP can be successfully measured even after a long postmortem period, up to 18 days, which has not previously been reported. Information on elevated CRP levels can be very valuable for the forensic pathologist in autopsy cases with scarce findings. The interpretation of results can be very challenging, as the elevation can originate from many different reasons, and due to the biochemical changes in cadavers. One less studied possible reason for elevated CRP is ketoacidosis. Here, we present a study on the effect of both alcoholic and diabetic ketoacidosis on blood CRP elevation in forensic autopsy material. Our results imply that ketoacidosis itself can cause a rise in CRP without other underlying causes, such as infection or trauma. However, more comprehensive studies are required to confirm the relationship between ketoacidosis and CRP level elevation.