Muscle and bile may provide additional specimens for detecting ethanol after death, but similar group results do not prove that either can replace blood quantitatively. A 2024 retrospective study reported both correlations and nonsignificant differences. Those findings require separate interpretation and do not establish specimen equivalence.
The alternative-matrix groups were smaller than the full cohort
The Lithuanian study selected 378 nonconsecutive autopsies from 1,504 examinations during 2016–2023. Selection required ethanol findings across body fluids or tissues; cases with ethanol detected only in blood or urine were excluded. Minors and people treated in hospital before death were also excluded.
The blood–muscle comparison involved 177 cases, whereas blood–bile involved 77. The muscle was lumbar striated muscle. The article does not give a clear separate denominator for every cross-comparison involving muscle and bile. It would therefore be incorrect to describe all 378 decedents as having all four matrices measured.
Muscle findings were not a demonstrated blood substitute
For the 177-case group, Table 2 reports mean blood ethanol of 0.69 ± 0.66‰ and mean muscle ethanol of 0.86 ± 0.85‰. The authors stated that muscle concentrations were higher in 75% of cases, but the reported blood–muscle difference was not statistically significant, p = 0.78.
The blood–muscle Spearman correlation was r = 0.47, p = 0.06. The association did not reach the authors’ p < 0.05 significance criterion. It should not be relabeled a statistically significant relationship simply because its direction was positive.
Bile showed a different statistical pattern
For the 77 blood–bile cases, Table 3 gives mean blood ethanol of 0.84 ± 0.74‰ and mean bile ethanol of 1.06 ± 1.02‰. The authors reported bile higher than blood in 90% of cases, while the difference was nonsignificant, p = 0.41. Blood and bile nevertheless had a significant rank correlation, r = 0.85, p < 0.05.
Correlation and a test of difference answer different questions. A significant association does not establish that two matrices yield the same number; a nonsignificant difference does not demonstrate equivalence. The study did not report a prespecified equivalence margin or a validated individual conversion formula.
Preserve the publication’s numerical limitations
The narrative reports mean blood–muscle and blood–bile differences of 0.06‰ and 0.14‰. These do not match the respective differences of 0.17‰ and 0.22‰ between the printed group means. Without raw data or clarification, the discrepancy cannot be resolved by selecting a convenient subtraction factor.
The authors also reported a significant muscle–bile rank correlation, r = 0.78, p < 0.05, alongside nonsignificant difference tests. None establishes that the matrices are interchangeable. The reported per-mille units are retained here; the paper does not provide a complete matrix-specific validation that would justify treating a solid-tissue measurement as an automatically equivalent blood result.
Decomposition and analytical details remain material
Fifty-three cases in the overall cohort showed decay. The study found no significant difference between decay groups for muscle, p = 0.24, or bile, p = 0.42. These comparisons did not directly measure microbial production or demonstrate that either specimen is immune to it.
Headspace gas chromatography was used for ethanol. The actual blood collection vessel, uniform postmortem interval, muscle preparation procedure, and detailed preservation or storage histories were not specified sufficiently to reproduce every matrix comparison. Complete matrix-specific detection limits, precision and recovery data were not reported.
Detection and reconstruction remain different tasks
An additional matrix may document ethanol in the material collected. Reconstructing blood ethanol, an earlier living-person concentration, impairment or contribution to death requires further support. The study’s data do not supply a universal multiplier or establish the origin of each positive result.
Our discussion of ethanol change in a retained specimen addresses why postcollection history can remain important even when a chemical result is repeatable.
Primary source
Okulevičiūtė A, Chmieliauskas S, Laubner-Sakalauskienė G, Badaras R, Laima S, Vasiljevaitė D, Stasiūnienė J. Postmortem Analysis of Ethyl Alcohol Concentration in Blood, Urine, Muscle and Bile. Acta Medica Lituanica. 2024;31(2):207–216. doi:10.15388/Amed.2024.31.2.6.
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