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PLoS One

Title:		Rapid 'breath-print' of liver cirrhosis by proton transfer reaction time-of-flight mass spectrometry. A pilot study
Author(s):		Morisco F; Aprea E; Lembo V; Fogliano V; Vitaglione P; Mazzone G; Cappellin L; Gasperi F; Masone S; De Palma GD; Marmo R; Caporaso N; Biasioli F;
Address:		"Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. filomena.morisco@unina.it"
Journal Title:		PLoS One
Year:		2013
Volume:		20130403
Issue:		4
Page Number:		e59658 -
DOI:		10.1371/journal.pone.0059658
ISSN/ISBN:		1932-6203 (Electronic) 1932-6203 (Linking)
Abstract:		"The aim of the present work was to test the potential of Proton Transfer Reaction Time-of-Flight Mass Spectrometry (PTR-ToF-MS) in the diagnosis of liver cirrhosis and the assessment of disease severity by direct analysis of exhaled breath. Twenty-six volunteers have been enrolled in this study: 12 patients (M/F 8/4, mean age 70.5 years, min-max 42-80 years) with liver cirrhosis of different etiologies and at different severity of disease and 14 healthy subjects (M/F 5/9, mean age 52.3 years, min-max 35-77 years). Real time breath analysis was performed on fasting subjects using a buffered end-tidal on-line sampler directly coupled to a PTR-ToF-MS. Twelve volatile organic compounds (VOCs) resulted significantly differently in cirrhotic patients (CP) compared to healthy controls (CTRL): four ketones (2-butanone, 2- or 3- pentanone, C8-ketone, C9-ketone), two terpenes (monoterpene, monoterpene related), four sulphur or nitrogen compounds (sulfoxide-compound, S-compound, NS-compound, N-compound) and two alcohols (heptadienol, methanol). Seven VOCs (2-butanone, C8-ketone, a monoterpene, 2,4-heptadienol and three compounds containing N, S or NS) resulted significantly differently in compensate cirrhotic patients (Child-Pugh A; CP-A) and decompensated cirrhotic subjects (Child-Pugh B+C; CP-B+C). ROC (Receiver Operating Characteristic) analysis was performed considering three contrast groups: CP vs CTRL, CP-A vs CTRL and CP-A vs CP-B+C. In these comparisons monoterpene and N-compound showed the best diagnostic performance. CONCLUSIONS: Breath analysis by PTR-ToF-MS was able to distinguish cirrhotic patients from healthy subjects and to discriminate those with well compensated liver disease from those at more advanced severity stage. A breath-print of liver cirrhosis was assessed for the first time"
Keywords:		"Adult Aged Aged, 80 and over Alkadienes/metabolism Biomarkers/metabolism Breath Tests/methods Case-Control Studies Exhalation Female Humans Ketones/metabolism Liver Cirrhosis/*diagnosis/metabolism Male Mass Spectrometry/*methods Middle Aged Monoterpenes/m;"
Notes:		"MedlineMorisco, Filomena Aprea, Eugenio Lembo, Vincenzo Fogliano, Vincenzo Vitaglione, Paola Mazzone, Giovanna Cappellin, Luca Gasperi, Flavia Masone, Stefania De Palma, Giovanni Domenico Marmo, Riccardo Caporaso, Nicola Biasioli, Franco eng Research Support, Non-U.S. Gov't 2013/04/11 PLoS One. 2013; 8(4):e59658. doi: 10.1371/journal.pone.0059658. Epub 2013 Apr 3"