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Analysis of volatile organic compounds in exhaled breath to diagnose ventilator-associated pneumonia.

Schnabel R, Fijten R, Smolinska A, Dallinga J, Boumans ML, Stobberingh E, Boots A, Roekaerts P, Bergmans D, van Schooten FJ - Sci Rep (2015)

Bottom Line: The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(-)].Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(-) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively.These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.

ABSTRACT
Ventilator-associated pneumonia (VAP) is a nosocomial infection occurring in the intensive care unit (ICU). The diagnostic standard is based on clinical criteria and bronchoalveolar lavage (BAL). Exhaled breath analysis is a promising non-invasive method for rapid diagnosis of diseases and contains volatile organic compounds (VOCs) that can differentiate diseased from healthy individuals. The aim of this study was to determine whether analysis of VOCs in exhaled breath can be used as a non-invasive monitoring tool for VAP. One hundred critically ill patients with clinical suspicion of VAP underwent BAL. Before BAL, exhaled air samples were collected and analysed by gas chromatography time-of-flight mass spectrometry (GC-tof-MS). The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(-)]. Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(-) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively. These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP.

No MeSH data available.


Related in: MedlinePlus

ROC and PCA plots visualizing the separation of the VAP(+) andVAP(−) groups.(A) Receiver operating characteristic (ROC) curve of VAP(+) vs.VAP(−). It consists of 1-sensitivity on the x-axis andspecificity on the y-axis. (B) The PCA plot is based on theproximities between samples of VAP(+) (white) and VAP(−)(black).
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f1: ROC and PCA plots visualizing the separation of the VAP(+) andVAP(−) groups.(A) Receiver operating characteristic (ROC) curve of VAP(+) vs.VAP(−). It consists of 1-sensitivity on the x-axis andspecificity on the y-axis. (B) The PCA plot is based on theproximities between samples of VAP(+) (white) and VAP(−)(black).

Mentions: GC-MS measurements produced 100 chromatograms: one for each patient. Afterprocessing, these chromatograms consisted of >1000 chemically differentVOCs. RF was used to filter VOCs that were discriminatory between VAP(+) andVAP(−). The final RF classification model was based on 12discriminatory VOCs and correctly classified74.2% ± 13.8% of all individuals with asensitivity and specificity of 75.8% ± 13.5%and 73.0% ± 11.8% respectively. Thecorresponding ROC curve depicted in Fig. 1A had an AUC of0.87. The PCA score plot of proximities between the individual samples based onthe 12 most important VOCs (Fig. 1B) showed that theVAP(+) and VAP(−) patients are separated with small overlap. Thisindicates that patients suffering from VAP can be identified based on thiscombination of 12 VOCs with high accuracy.


Analysis of volatile organic compounds in exhaled breath to diagnose ventilator-associated pneumonia.

Schnabel R, Fijten R, Smolinska A, Dallinga J, Boumans ML, Stobberingh E, Boots A, Roekaerts P, Bergmans D, van Schooten FJ - Sci Rep (2015)

ROC and PCA plots visualizing the separation of the VAP(+) andVAP(−) groups.(A) Receiver operating characteristic (ROC) curve of VAP(+) vs.VAP(−). It consists of 1-sensitivity on the x-axis andspecificity on the y-axis. (B) The PCA plot is based on theproximities between samples of VAP(+) (white) and VAP(−)(black).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660425&req=5

f1: ROC and PCA plots visualizing the separation of the VAP(+) andVAP(−) groups.(A) Receiver operating characteristic (ROC) curve of VAP(+) vs.VAP(−). It consists of 1-sensitivity on the x-axis andspecificity on the y-axis. (B) The PCA plot is based on theproximities between samples of VAP(+) (white) and VAP(−)(black).
Mentions: GC-MS measurements produced 100 chromatograms: one for each patient. Afterprocessing, these chromatograms consisted of >1000 chemically differentVOCs. RF was used to filter VOCs that were discriminatory between VAP(+) andVAP(−). The final RF classification model was based on 12discriminatory VOCs and correctly classified74.2% ± 13.8% of all individuals with asensitivity and specificity of 75.8% ± 13.5%and 73.0% ± 11.8% respectively. Thecorresponding ROC curve depicted in Fig. 1A had an AUC of0.87. The PCA score plot of proximities between the individual samples based onthe 12 most important VOCs (Fig. 1B) showed that theVAP(+) and VAP(−) patients are separated with small overlap. Thisindicates that patients suffering from VAP can be identified based on thiscombination of 12 VOCs with high accuracy.

Bottom Line: The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(-)].Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(-) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively.These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.

ABSTRACT
Ventilator-associated pneumonia (VAP) is a nosocomial infection occurring in the intensive care unit (ICU). The diagnostic standard is based on clinical criteria and bronchoalveolar lavage (BAL). Exhaled breath analysis is a promising non-invasive method for rapid diagnosis of diseases and contains volatile organic compounds (VOCs) that can differentiate diseased from healthy individuals. The aim of this study was to determine whether analysis of VOCs in exhaled breath can be used as a non-invasive monitoring tool for VAP. One hundred critically ill patients with clinical suspicion of VAP underwent BAL. Before BAL, exhaled air samples were collected and analysed by gas chromatography time-of-flight mass spectrometry (GC-tof-MS). The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(-)]. Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(-) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively. These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP.

No MeSH data available.


Related in: MedlinePlus