Meeting News Coverage

Trimethylamine breath concentrations identified patients with acute alcoholic hepatitis

ORLANDO, Fla. — Acute alcoholic hepatitis can be identified via a noninvasive test measuring concentrations of trimethylamine in exhaled breath, according to data presented at Digestive Disease Week.

In a prospective, single-center study, researchers evaluated volatile breath compounds in 22 patients with acute alcoholic hepatitis (AH), 25 with acute nonalcoholic hepatitis, 30 with chronic alcoholic liver disease and 42 with chronic nonalcoholic liver disease, along with 10 healthy alcoholic and 32 healthy nonalcoholic controls. Samples were analyzed via selected-ion flow-tube mass spectrometry.

“AH is a common disease that happens in young individuals, typically after binge drinking,” researcher Ibrahim A. Hanouneh, MD, chief fellow in the gastroenterology and hepatology department of the Digestive Disease Institute at Cleveland Clinic, told Healio.com. “It’s a life-threatening disease; mortality can reach 40% to 60% in severe cases. The gold standard for the diagnosis of AH right now is liver biopsy, which can be challenging in these individuals. … We tried to come up with a noninvasive test that hopefully can replace liver biopsy.”

Of 14 evaluated compounds, seven were more prominent among patients with liver disease than controls, including acetaldehyde (P=.004), acetone (P<.001), ammonia (P<.001), ethanol (P<.001), pentane (P=.02), trimethylamine (TMA; P<.001) and 2-propanol (P<.001). TMA in particular was significantly elevated among patients with AH compared with controls and participants with other liver diseases (P<.001).

ROC analysis indicated a specificity of 94% and sensitivity of 98% for AH diagnosis with a TMA cutoff value of 31 ppb (AUC=0.99; 95% CI, 0.977-1). Researchers also observed a correlation between TMA concentration and MELD score among patients with AH (0.53; 95% CI, 0.04-1).

“If this is validated in larger trials, we can hopefully rely on breath test analysis to diagnose AH without performing invasive tests such as liver biopsy,” Hanouneh said. “When [physicians] face difficulty in making the diagnosis of AH; particularly when the patient cannot provide accurate history of alcohol intake … the breath test would be the way to go.”

Hanouneh said additional patients have been recruited for the study, and results remain unchanged. He hopes to observe a correlation between liver disease severity and the three compounds during future analysis.

Disclosure: The researchers report numerous financial disclosures.

For more information:

Hanouneh IA. Su1282: A Novel Noninvasive Breath Test in Patients with Acute Alcoholic Hepatitis. Presented at: Digestive Disease Week 2013; May 18-21, Orlando, Fla.

ORLANDO, Fla. — Acute alcoholic hepatitis can be identified via a noninvasive test measuring concentrations of trimethylamine in exhaled breath, according to data presented at Digestive Disease Week.

In a prospective, single-center study, researchers evaluated volatile breath compounds in 22 patients with acute alcoholic hepatitis (AH), 25 with acute nonalcoholic hepatitis, 30 with chronic alcoholic liver disease and 42 with chronic nonalcoholic liver disease, along with 10 healthy alcoholic and 32 healthy nonalcoholic controls. Samples were analyzed via selected-ion flow-tube mass spectrometry.

“AH is a common disease that happens in young individuals, typically after binge drinking,” researcher Ibrahim A. Hanouneh, MD, chief fellow in the gastroenterology and hepatology department of the Digestive Disease Institute at Cleveland Clinic, told Healio.com. “It’s a life-threatening disease; mortality can reach 40% to 60% in severe cases. The gold standard for the diagnosis of AH right now is liver biopsy, which can be challenging in these individuals. … We tried to come up with a noninvasive test that hopefully can replace liver biopsy.”

Of 14 evaluated compounds, seven were more prominent among patients with liver disease than controls, including acetaldehyde (P=.004), acetone (P<.001), ammonia (P<.001), ethanol (P<.001), pentane (P=.02), trimethylamine (TMA; P<.001) and 2-propanol (P<.001). TMA in particular was significantly elevated among patients with AH compared with controls and participants with other liver diseases (P<.001).

ROC analysis indicated a specificity of 94% and sensitivity of 98% for AH diagnosis with a TMA cutoff value of 31 ppb (AUC=0.99; 95% CI, 0.977-1). Researchers also observed a correlation between TMA concentration and MELD score among patients with AH (0.53; 95% CI, 0.04-1).

“If this is validated in larger trials, we can hopefully rely on breath test analysis to diagnose AH without performing invasive tests such as liver biopsy,” Hanouneh said. “When [physicians] face difficulty in making the diagnosis of AH; particularly when the patient cannot provide accurate history of alcohol intake … the breath test would be the way to go.”

Hanouneh said additional patients have been recruited for the study, and results remain unchanged. He hopes to observe a correlation between liver disease severity and the three compounds during future analysis.

Disclosure: The researchers report numerous financial disclosures.

For more information:

Hanouneh IA. Su1282: A Novel Noninvasive Breath Test in Patients with Acute Alcoholic Hepatitis. Presented at: Digestive Disease Week 2013; May 18-21, Orlando, Fla.

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