Abstract
Liver diseases are currently diagnosed through liver biopsy. Its invasiveness, costs, and relatively low diagnostic accuracy require new techniques to be sought. Analysis of volatile organic compounds (VOCs) in human bio-matrices has received a lot of attention. It is known that a musty odour characterises liver impairment, resulting in the elucidation of volatile chemicals in the breath and other body fluids such as urine and stool, which may serve as biomarkers of a disease. Aims: This study aims to review all the studies found in the literature regarding VOCs in liver diseases, and to summarise all the identified compounds that could be used as diagnostic or prognostic biomarkers. The literature search was conducted on ScienceDirect and PubMed, and each eligible publication was qualitatively assessed by two independent evaluators using the SANRA critical appraisal tool. Results: In the search, 58 publications were found, and 28 were kept for inclusion: 23 were about VOCs in the breath, one in the bile, three in urine, and one in faeces. Each publication was graded from zero to ten. A graphical summary of the metabolic pathways showcasing the known liver disease-related VOCs and suggestions on how VOC analysis on liver impairment could be applied in clinical practice are given.
Highlights
Published: 11 September 2021Fetor hepaticus, a musty breath aroma, has been among the most prominent liver insufficiency signs available to clinicians, and it was in the 1970s when Chen et al [1]identified the first responsible compounds
Hiroshi et al [43], Tangerman et al [66], and Friedman et al [42] paved the way for modern liver breath analysis by comparing cirrhotic patients to healthy controls, aiming to identify compounds that differ between the two cohorts by exploiting advances of the gas chromatographymass spectrometry (GC-MS) technology
The analysis showed that urinary volatile organic compounds (VOCs) could distinguish between non-alcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) with a sensitivity and specificity of 73% and 79%, respectively
Summary
Published: 11 September 2021Fetor hepaticus, a musty breath aroma, has been among the most prominent liver insufficiency signs available to clinicians, and it was in the 1970s when Chen et al [1]identified the first responsible compounds. The authors reported that several mercaptans and aliphatic acids (i.e., predominantly acetic and propionic acid) were elevated in the exhaled breath of individuals with liver cirrhosis [2] Tangerman et al [3] pinpointed dimethyl-sulphide as the primary source of fetor hepaticus. These studies [1,2,3] were the first liver-related volatile organic compound (VOC) analyses in the breath and paved the way for further research in the field. Many pathophysiological conditions in the liver alter various hepatic metabolic pathways, modifying the abundance of specific exhaled VOCs. Derivatives of cell membrane peroxidation can generate different
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