Journal
Journal of Breath Research
Volume 10, Issue 4, Pages -Publisher
IOP PUBLISHING LTD
DOI: 10.1088/1752-7155/10/4/046010
Keywords
breath analysis; cirrhosis; limonene; hepatic encephalopathy; PTR-MS; volatile organic compound
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Funding
- Proton Ionisation Molecular Mass Spectrometry (PIMMS) Initial Training Network - European Commission [287382]
- Daphne Jackson Trust
- Engineering and Physical Sciences Research Council
- University of Birmingham
- Wellcome Trust through the University of Birmingham's Institutional Strategic Support Fund [ISSF 097825/Z/11/B]
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit (BRU)
- National Institute for Health Research
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Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol(-1) in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol(-1), respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10-44) and 42 (32-58) nmol mol(-1).
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