Background & Aims
Selected-ion flow-tube mass spectrometry (SIFT-MS) can precisely identify trace gases in the human breath, in the parts-per-billion range. We investigated whether concentrations of volatile compounds in breath samples correlate with the diagnosis of alcoholic hepatitis (AH) and the severity of liver disease in patients with AH.
Methods
We recruited patients with liver disease from a single tertiary care center. The study population was divided those with AH with cirrhosis (n=40) and those with cirrhosis with acute decompensation from etiologies other than alcohol (n=40); individuals without liver disease served as controls (n=43). We used SIFT-MS to identify and measure 14 volatile compounds in breath samples from fasted subjects. We used various statistical analyses to compare clinical characteristics and breath levels of compounds among groups, and test the correlation between levels of compounds and severity of liver disease. Logistic regression analysis was performed to build a predictive model for AH.
Results
We identified 6 compounds (2-propanol, acetaldehyde, acetone, ethanol, pentane and trimethylamine [TMA]) whose levels were increased in patients with liver disease compared with controls. Mean concentrations of TMA, acetone, and pentane were particularly high in breath samples from patients with AH, compared to those with acute decompensation or controls (for both, P<.001). Using receiver operating characteristic curve analysis, we developed a model for the diagnosis of AH based on breath levels of TMA, acetone, and pentane (TAP). TAP scores of 36 or higher identified the patients with AH (AUC=0.92), with 90% sensitivity and 80% specificity. The levels of exhaled TMA had a low level of correlation with the severity of AH based on model for end-stage liver disease score (r=0.38; 95% confidence interval, 0.07–0.69; P=.018].
Conclusion
Based on levels of volatile compounds in breath samples, we can identify patients with AH vs patients with acute decompensation or individuals without liver disease. Levels of exhaled TMA moderately correlate with the severity of AH. These findings might be used in diagnosis of AH or in determining patient prognosis.
Breathprint is different between patients with PAH and healthy control subjects. Several specific compounds, including ammonia, were elevated in the breath of patients with PAH. Exhaled ammonia levels correlated with severity of disease.
Patients with PAH showed lower sublingual microvasculature flow index and higher tortuosity compared with healthy age- and sex-matched control subjects. Further investigations are needed to assess whether this methodology can provide information on disease prognosis and/or response to therapy in this condition.
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