COVID-19: breath biochemistry is highly specific and sensitive

  • Ruszkiewicz DM & al
  • EClinicalMedicine
  • 26.10.2020

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • Breath signatures could be used to diagnose COVID-19 at point-of-care.
  • Gas chromatography-ion mobility spectrometry (GC-IMS) testing appears to detect COVID-19-related changes in volatile organic compounds (VOCs).

Why this matters

  • GC-IMS-based strategies for COVID-19 rule-in/rule-out may facilitate rapid, point-of-care testing for emergency or office settings.
  • Higher-powered, time series data are needed to define the VOC profiles associated with infection.

Key results

  • 98 SARS-CoV-2-positive patients. 
    • 63.6% (21/33), Edinburgh, UK. 
    • 15.4% (10/65), Dortmund, Germany.
  • Non-COVID-19 diagnoses: asthma exacerbation, COPD, bacterial pneumonia, cardiac conditions.
  • Principal component analysis identified increased ketone and aldehyde with decreased methanol in both cohorts.
  • "Feature 144," a mystery compound in the Edinburgh data, was associated with more severe disease.
  • Principal component analysis modeling was used to define VOC-based patient groups.
    • In the Dortmund cohort, the model had:
      • 90% sensitivity, 80% specificity for distinguishing COVID-19.
      • Area under the curve: 0.91 (95% CI, 0.87-1.00).
    • In the Edinburgh cohort:
      • 82.4% sensitivity, 75% specificity.
      • Area under the curve: 0.87 (95% CI, 0.67-1).
  • Edinburgh VOC-based scoring: breath scores were 1.13-fold above the mean in patients with COVID-19 vs those without.
  • Dortmund VOC-based scoring: scores 1.24-fold higher in patients with COVID-19.

Study design

  • Observational prevalence studies in 2 hospitals.
  • Funding: NHS Research Scotland; University of Edinburgh.

Limitations

  • Unable to resolve coeluted signals.
  • Misaligned techniques across sites.