TY - JOUR

T1 - The utility of lung weight to heart weight ratio as a means to identify suspected drug intoxication deaths in a medico-legal autopsy population

AU - Gustafsson, Torfinn

AU - Eriksson, Anders

AU - Clinical Sciences, Malmö, Sweden, Department

N1 - © 2021 The Authors. Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.

PY - 2021/7

Y1 - 2021/7

N2 - Fatal intoxications are common in a medico-legal autopsy setting and are associated with sparse findings during autopsy. It has been suggested that an increased lung weight may be associated with such fatalities. Previous literature is generally limited to a descriptive approach, including only opioid deaths, and lacking a definition of "heavy" lungs. Our aim was to create a model to identify cases with heavy lungs and to assess the predictive power of "heavy" lungs in identifying cases of different types of fatal intoxications during autopsy in an unselected medico-legal autopsy population. We identified all medico-legal autopsy cases ≥18 years in Sweden from 2000 through 2013. The lung weight to heart weight (LWHW) ratio was calculated. The positive predictive values (PPV) and negative predictive values (NPV) of both lung weight and LWHW ratio were calculated. Mean lung weight was higher in the intoxication group but the predictive power in the individual case was limited. Lung weight to heart weight ratio had better predictive power than lung weight alone, with a PPV of at most 0.15(0.14, 0.16 95% CI), while the NPV was 0.96 (0.95, 0.96 95% CI). The association between fatal intoxication and increased lung weight was positive, regardless of method and cutoffs used. While the PPV was poor, the NPV could reduce suspicion of fatal intoxication in the absence of other information. LHWH ratio is only a probability factor for fatal intoxication; accurate cause of death determination-as always-requires consideration of circumstances, autopsy, and toxicologic findings.

AB - Fatal intoxications are common in a medico-legal autopsy setting and are associated with sparse findings during autopsy. It has been suggested that an increased lung weight may be associated with such fatalities. Previous literature is generally limited to a descriptive approach, including only opioid deaths, and lacking a definition of "heavy" lungs. Our aim was to create a model to identify cases with heavy lungs and to assess the predictive power of "heavy" lungs in identifying cases of different types of fatal intoxications during autopsy in an unselected medico-legal autopsy population. We identified all medico-legal autopsy cases ≥18 years in Sweden from 2000 through 2013. The lung weight to heart weight (LWHW) ratio was calculated. The positive predictive values (PPV) and negative predictive values (NPV) of both lung weight and LWHW ratio were calculated. Mean lung weight was higher in the intoxication group but the predictive power in the individual case was limited. Lung weight to heart weight ratio had better predictive power than lung weight alone, with a PPV of at most 0.15(0.14, 0.16 95% CI), while the NPV was 0.96 (0.95, 0.96 95% CI). The association between fatal intoxication and increased lung weight was positive, regardless of method and cutoffs used. While the PPV was poor, the NPV could reduce suspicion of fatal intoxication in the absence of other information. LHWH ratio is only a probability factor for fatal intoxication; accurate cause of death determination-as always-requires consideration of circumstances, autopsy, and toxicologic findings.

KW - Adolescent

KW - Adult

KW - Forensic Pathology

KW - Humans

KW - Likelihood Functions

KW - Lung/pathology

KW - Male

KW - Myocardium/pathology

KW - Organ Size

KW - Pharmaceutical Preparations

KW - Poisoning/diagnosis

KW - Predictive Value of Tests

KW - Sensitivity and Specificity

KW - Substance-Related Disorders/mortality

KW - Sweden

U2 - 10.1111/1556-4029.14726

DO - 10.1111/1556-4029.14726

M3 - Journal article

C2 - 33956990

VL - 66

SP - 1329

EP - 1333

JO - Journal of Forensic Sciences

JF - Journal of Forensic Sciences

SN - 0022-1198

IS - 4

ER -