Abstract
Since the liver plays a key metabolic role, volatile organic compounds in the exhaled breath might change with type and severity of chronic liver disease (CLD). In this study we analysed breath-prints (BPs) of 65 patients with liver cirrhosis (LC), 39 with non-cirrhotic CLD (NC-CLD) and 56 healthy controls by the e-nose. Distinctive BPs characterized LC, NC-CLD and healthy controls, and, among LC patients, the different Child-Pugh classes (sensitivity 86.2% and specificity 98.2% for CLD vs healthy controls, and 87.5% and 69.2% for LC vs NC-CLD). Moreover, the area under the BP profile, derived from radar-plot representation of BPs, showed an area under the ROC curve of 0.84 (95% CI 0.76–0.91) for CLD, of 0.76 (95% CI 0.66–0.85) for LC, and of 0.70 (95% CI 0.55–0.81) for decompensated LC. By applying the cut-off values of 862 and 812, LC and decompensated LC could be predicted with high accuracy (PPV 96.6% and 88.5%, respectively). These results are proof-of-concept that the e-nose could be a valid non-invasive instrument for characterizing CLD and monitoring hepatic function over time. The observed classificatory properties might be further improved by refining stage-specific breath-prints and considering the impact of comorbidities in a larger series of patients.
Highlights
The electronic nose (e-nose) technology is a novel technique, that consist of a gas sensor array and provides a sort of fingerprint of exhaled breath by detecting VOCs through multiple sensors
8 patients were affected by COPD (1 in NC-chronic liver disease (CLD) group and 7 in LC group, p = ns)
In this study BP analysis by e-nose was used for the first time to analyse exhaled breath of patients with CLD aiming at verifying its discriminative and classificatory properties
Summary
The electronic nose (e-nose) technology is a novel technique, that consist of a gas sensor array and provides a sort of fingerprint of exhaled breath (breath-print, BP) by detecting VOCs through multiple sensors. The e-nose has been able to separate asthmatics from healthy controls[16] and from COPD patients, based on well distinguished exhaled breath patterns, likely reflecting the well-known differences in pathogenic mechanisms of asthma and COPD17 All together, these findings suggest that exhaled breath qualifies as a sort of BP of selected diseases, and, might be useful for diagnostic purposes as well as to monitor the response to therapy. Alternative diagnostic methods able to achieve these goals are eagerly awaited The aim of this proof of concept study was to assess discriminative and classificatory properties of the e-nose in CLD by comparing the BPs of patients with and without LC and hepatocellular failure. Verifying whether VOCs pattern changes depending upon the infective or non-infective origin of the liver disease represents a secondary outcome of the study
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