title: Breath-print analysis by e-nose may refine risk stratification for adverse outcomes in cirrhotic patients.
abstract: The spectrum of volatile organic compounds in the exhaled breath (breath-print, BP) has been shown to characterize patients with cirrhosis and with worse hepatic function. However, the association of different BPs with clinically relevant outcomes has not been described yet. Hence, we aimed to evaluate the association between BPs, mortality and hospitalization in cirrhotic patients and to compare it with that of the "classical" prognostic indices (Child-Pugh Classification [CPC] and MELD).
  
  
  
  Eighty-nine cirrhotic patients (M/F 59/30, mean age 64.8 ± 11.3, CPC A/B/C 37/33/19) were recruited and followed up for a median time of 23 months. Clinical and biochemical data were collected. Breath collection and analysis were obtained through Pneumopipe®and BIONOTE e-nose respectively.
  
  
  
  Four different BP clusters (A, B, C, D) were identified. BP clusters A and D were associated with a significantly increased risk of mortality (HR 2.9, 95% confidence intervals [CI] 1.5-5.6) and hospitalization (HR 2.6, 95% CI 1.4-4.6), even in multiple adjusted models including CPC and MELD score (adjusted [a]HR 2.8, 95% CI 1.1-7.0 for mortality and aHR 2.2, 95% CI 1.1-4.2 for hospitalization). CPC C maintained the strongest association with both mortality (aHR 17.6, 95% CI 1.8-174.0) and hospitalization (aHR 12.4, 95% CI 2.0-75.8).
  
  
  
  This pilot study demonstrates that BP clusters are associated with significant clinical endpoints (mortality and hospitalization) even independently from "classical" prognostic indices. Even though further studies are warranted on this topic, our findings suggest that the e-nose may become an adjunctive aid to stratify the risk of adverse outcomes in cirrhotic patients.
authors: Clinical Medicine and Hepatology Department, Campus Bio-Medico University, Rome, Italy.
authors: Antonio
authors: A
authors: De Vincentis
authors: Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy.
authors: Giorgio
authors: G
authors: Pennazza
authors: Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy.
authors: Marco
authors: M
authors: Santonico
authors: Clinical Medicine and Hepatology Department, Campus Bio-Medico University, Rome, Italy.
authors: Umberto
authors: U
authors: Vespasiani-Gentilucci
authors: Clinical Medicine and Hepatology Department, Campus Bio-Medico University, Rome, Italy.
authors: Giovanni
authors: G
authors: Galati
authors: Clinical Medicine and Hepatology Department, Campus Bio-Medico University, Rome, Italy.
authors: Paolo
authors: P
authors: Gallo
authors: Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy.
authors: Alessandro
authors: A
authors: Zompanti
authors: Chair of Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University, Rome, Italy.
authors: Claudio
authors: C
authors: Pedone
authors: Chair of Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University, Rome, Italy.|San Raffaele- Cittadella della Carità Foundation, Taranto, Italy.
authors: Raffaele
authors: R
authors: Antonelli Incalzi
authors: Clinical Medicine and Hepatology Department, Campus Bio-Medico University, Rome, Italy.
authors: Antonio
authors: A
authors: Picardi
mesh_terms: D000368:Aged; D001944:Breath Tests / Q000295:instrumentation*; D062609:Electronic Nose; D005260:Female; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008111:Liver Function Tests / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D055549:Volatile Organic Compounds / Q000032:analysis
chemical_list: D055549:Volatile Organic Compounds
keywords: cirrhosis; e-nose; exhaled breath analysis; hospitalization; survival