Necrosis (Necrotic) Markers




Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. Necrosis is less orderly than apoptosis, which is part of programmed cell death. In contrast with apoptosis, cleanup of cell debris by phagocytes of the immune system is generally more difficult, as the disorderly death generally does not send cell signals which tell nearby phagocytes to engulf the dying cell. This lack of signaling makes it harder for the immune system to locate and recycle dead cells which have died through necrosis than if the cell had undergone apoptosis. The release of intracellular content after cellular membrane damage is the cause of inflammation in necrosis.




Morphological Markers

  • always pathological

  • involves sheets of cells

  • energy independent

  • cell swelling and mitochondrial damage leading to rapid depletion of energy levels

  • a breakdown of homeostatic control

  • cell membrane integrity lost

  • nuclei lost, no DNA cleavage.

  • cell release of the intracellular contents, leading to an inflammatory response.

  • dead cells ingested by neutrophils and macrophages

  • references: necrosis vs. apoptosis, apoptosis&necrosis, cell death: necrosis&apoptosis


  • a lysosomal hydrolase, is a possible serological marker for histological hepatic cell necrosis and to predict the histological progression of hepatitis. PMID: 1655603


  • a specific marker of avian programmed cell death in both apoptosis and necrosis. PMID: 8078937

Cardiac Troponin

  • a biological marker for the diagnosis of myocardial necrosis. PMID: 15776693

Cardiac Troponin I (cTnI)

  • the best way to detect and quantify the size of myocardial necrosis created by radiofrequency ablation. PMID: 9842005

C-reactive protein

  • predict myocardial necrosis after successful coronary stenting in patients with stable angina. PMID: 16781234

  • an important prognostic marker of pancreatic necrosis with the highest sensitivity and negative prognostic value given the cut-off is 110 mg/l. The patients with C-reactive protein below 110 mg/l are low risk to develop pancreatic necrosis. PMID: 15007272

Creatine Kinase MB (CPK-MB)

  • an early diagnostic biochemical marker of myocardial necrosis in patients with acute coronary syndrome. PMID: 17151819

  • may be used to estimate the volume of the necrosis. PMID: 9842005

Factor VIII procoagulant (FVIIIPC)

  • a plasma glycoprotein cofactor for activated factor IX, is a marker of fibrinoid necrosis in normal term human placentae. PMID: 1901088

H-FABP (Heart-type fatty acid-binding protein)

  • a new biochemical marker of sarcolemmal injury due to acute myocardial ischemia, can be used as an early diagnostic biochemical marker of myocardial necrosis in patients with acute coronary syndrome. PMID: 17151819

  • We review the strengths and weaknesses of H-FABP as a clinically applicable marker of myocyte necrosis in the context of acute coronary syndromes. PMID: 15028848


  • a new marker for thin ascending loop of Henle and tubular injury in acute tubular necrosis. PMID: 16401697

Isocitrate Dehydrogenase (ICDH)

  • a marker of centrilobular hepatic necrosis in patients with hyperthyroidism. PMID: 11468437

  • a marker of centrilobular hepatic necrosis in the experimental model of rats. PMID: 11339426


  • serum interleukin-6 is a very reliable marker of necrosis in the first 48 hours of acute biliary pancreatitis. PMID: 9148369

IL-18 (Interleukin-18)

Lactate Dehydrogenase (LDH)


  • an oxygen-binding protein, is synthesized exclusively in striated and cardiac muscle, and is normally found in blood, is released only after muscular necrosis. Serum myoglobin assessment constitutes a very early marker of myocardial damage. PMID: 3594945


Procalcitonin (PCT)

  • PCT and IL-6 combination might be surrogate marker of infected pancreatic necrosis and should be preferred to other markers assay especially in severe pancreatitis. PMID: 15230799

S-IRPH (serum immunoreactive prolyl 4-hydroxylase)


  • a marker of piecemeal necrosis activity in patients with chronic hepatitis C. PMID: 16584393


  • Amniotic fluid tumor necrosis factor-alpha is a marker for the prediction of early-onset neonatal sepsis in patients with preterm labor and intact membranes. PMID: 15148449

  • a marker of complicated parapneumonic effusions. PMID: 14718436

  • a marker for peritoneal adhesion formation. PMID: 7745964


  • serum concentration of sTNF-R1 can be a sensitive marker of activity of psoriasis vulgaris and decreases following the effective treatment. PMID: 16095152

Troponin I

  • a newly available biochemical marker with a high cardiac specificity. Monitoring of cTnI is the best way to detect and quantify the size of myocardial necrosis created by radiofrequency ablation. PMID: 9842005

Troponin T

Other Necrosis Markers

  • Propidium Iodide (PI): apoptotic cells undergo secondary necrosis, which could be recognized with PI, is late apoptosis/necrosis marker. PMID: 10639571

  • AIVR (accelerated idioventricular rhythm) occurring during persistent ischemic chest pain is a marker for both myocardial necrosis and reperfusion of the infarct vessel. PMID: 3341199