Non-invasive diagnosis of liver diseases by breath analysis using an optimized ion–molecule reaction-mass spectrometry approach: a pilot study

Abstract

Breath composition is altered in liver diseases. We tested if ion–molecule-reaction mass spectrometry (IMR-MS) combined with a new statistical modality improves the diagnostic accuracy of breath analysis in liver diseases. We analysed 114 molecules in the breath of 126 individuals (healthy controls, and patients with non-alcoholic and alcoholic fatty liver disease and liver cirrhosis) by IMR-MS. Characteristic exhalation patterns were identified for each group. Combining two to seven molecules in the new stacked feature ranking model reached a diagnostic accuracy (area under the curve) for individual liver diseases between 0.88 and 0.97. IMR-MS followed by sophisticated statistical analysis is a promising tool for liver diagnostics by breath analysis.

Keywords::

• Diagnostics
• mass spectrometry
• foetor hepaticus
• fatty liver
• exhalation

Acknowledgements

We thank Gisela Egg and Dr Margit Egg for their help with breath sampling, Julia Rössler-Graf for performing analysis and documentation and Dr Thomas Walch from the Department of Psychiatry for his help recruiting the patients. This project was supported by the ‘Kompetenzzentrum Medizin Tirol’ (KMT 09), the ‘Verein zur Förderung wissenschaftlicher Arbeit in Gastroenterologie und Hepatologie in Innsbruck’, and the Austrian GEN-AU project ‘Bioinformatics Integration Network’. G.M. is a recipient of an Olympia-Morata-Fellowship from the Medical School of Heidelberg.

Declaration of interest

J.V., S.P. and A.D. have financial interests regarding the IMR-MS system. None of the other authors have received funding or other financial support from V&F Medical Development; this includes contracts, equity interest, stock options, direct or indirect salary support, consultant fees, lecture/travel fees, or honoraria received within a period of 5 years of the date of submission of this manuscript. The funding sources had no role in the study design, in the collection, analysis, and interpretation of data, or in the decision to submit the manuscript for publication.