Financial support
Slingers G was supported by the Limburg Clinical Research Center (LCRC)
UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk,
province of Limburg, Flemish government, Hasselt University, Jessa
Hospital and Ziekenhuis Oost-Limburg.
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.