Exhaled volatile biomarkers for differentiating noisy breathing infants:
a pilot study
Abstract
Background Early differentiation of rattling infants, frequently
misdiagnosed as wheezing, is important to prevent under- and
overtreatment. Exhaled breath biomarkers reflect metabolic processes and
can potentially aid differential diagnosis. This study investigated the
potential of exhaled biomarkers in differentiating rattling infants.
Methods Exhaled breath collected from infants (2-18months) with an
adjusted breath sampler was analysed using gas chromatography mass
spectrometry (GC-MS) and selected ion flow tube mass spectrometry
(SIFT-MS). Linear discriminant analysis was used to classify recovered,
mild, moderate and severe rattling infants in a one-vs-all approach. The
potential of parent reported outcome about symptoms and burden to
improve the discriminant models was also investigated. Results
Classifying the diagnostic groups (recovered, mild, moderate, severe
rattling) based on exhaled breath showed potential with accuracies
between 69.12-75.0% for GC-MS and 59.21-69.74% for SIFT-MS. Highest
accuracy and specificity was achieved for severe rattling vs all other
diagnostic groups. Adding parent reported symptoms in past the three
days to the discriminant model increased accuracies (69.12-86.76%
GC-MS; 65.79-88.16% SIFT-MS), particularly for moderate and severe
rattling infants. The differentiating VOCs were of the type alkane,
acids, amine, imine, triazine and ketone. Conclusion Exhaled breath
analysis has potential to differentiate infants with different rattling
severities and recovered infants. Additionally, combining parent
reported symptoms in the past three days with exhaled breath biomarkers
improved the performance of the diagnostic models.