Immunohistochemical insights into hyperthermia‑related deaths: a systematic review

The diagnosis of hyperthermia-related death presents a significant challenge in the field of forensic medicine due to the lack of pathognomonic signs and the complexity of the variables involved. This systematic review analyzes research on the role of immunohistochemistry (IHC) in postmortem diagnosis of hyperthermia, considering studies related to environmental hyperthermia, fire-related fatalities, and substance-induced hyperthermia. A total of 36 studies were included, selected according to PRISMA guidelines and critically evaluated using JBI tools. The results highlighted significant methodological heterogeneity, with differences in the tissues studied, the immunohistochemical markers used, and the analytical techniques employed. Some markers showed diagnostic potential in cases of fire exposure, but in deaths due to environmental or substance-induced hyperthermia, the markers examined were neither specific nor reliable. Common methodological weaknesses included small sample sizes, biases, and insufficient statistical analysis, which influenced the interpretation of the results. Considering these issues, IHC cannot be considered a valid diagnostic technique for hyperthermia-related deaths. Future studies with greater methodological rigor, validation of specific markers, and standardization of procedures are necessary.