Mo1019 Breathomics - Distinguishing Minimal From Overt Hepatic Encephalopathy by Volatile Organic Compound Detection in Breath: A Pilot Study

Abstract

: Hepatic encephalopathy (HE) is a neurological manifestation of decompensated liver disease. It develops in approximately 50% of cirrhotic patients. The current challenge with the diagnosis of Hepatic encephalopathy is distinguishing those with minimal HE as opposed to the more clinically apparent covert and overt HE. Rifaximin, licensed for overt HE, is an effective therapy for these more easily diagnosed patients, but earlier identification and treatment of HE could prevent liver disease progression and hospitalisation. We conducted a pilot study to analyse the breath samples of patients with different HE grades, alongside the breath of healthy controls, using a portable type electronic nose (uvFAIMS). Methods: 42 patients were enrolled; 22 with HE and 20 healthy controls. Breath samples were captured at the bedside using a Warwick designed breath capture device. The samples were then analysed using a ultra violet FAIMS machine. This uses ultra violet light to energise electrons rather than ionising radiation in the traditional FAIMS devices. West Haven criteria were applied and MELD scores calculated. Results: Applying linear discriminant analysis, we could distinguish those with HE from controls with a sensitivity and specificity of 95% respectively. Minimal HE was distinguishable from covert/overt HE with sensitivity of 75% and specificity of 50% Conclusions: This pilot study has affirmed the potential of breath analysis to identify VOCs signatures in HE patients. Importantly this was performed utilising a non-invasive, portable bedside device and holds potential for future early diagnosis of minimal or covert HE.