Observational studyClinical and translational gastroenterology2020
Breath Biopsy Assessment of Liver Disease Using an Exogenous Volatile Organic Compound-Toward Improved Detection of Liver Impairment.
Observational study in Clinical and translational gastroenterology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- Pooled it
- Electronic nose versus gas chromatography - mass spectrometry for diagnostic discrimination of advanced hepatocellular carcinoma by volatolomic analysis.BMC gastroenterology · 2026Article
- [Advances in the application of exhaled breath analysis technology in the detection and diagnosis of liver failure].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2026Review
- Breath-Based Diagnostics in Liver Diseases: Dynamic Assessment of Hepatic Metabolic Reserve and Liver Fibrosis.Gastro hep advances · 2026Review
- Microelements and biochemical biomarkers-based machine learning for predicting adverse pregnancy outcomes in Wilson's disease: risk stratification by integrating hepatic fibrosis and cerebral function.Frontiers in nutrition · 2026Article
- Optimized breath analysis: customized analytical methods and enhanced workflow for broader detection of VOCs.Metabolomics : Official journal of the Metabolomic Society · 2025Article
- Non-Invasive Biomarkers and Breath Tests for Diagnosis and Monitoring of Chronic Liver Diseases.Diagnostics (Basel, Switzerland) · 2024Review
- Prospect and Challenges of Volatile Organic Compound Breath Testing in Non-Cancer Gastrointestinal Disorders.Biomedicines · 2024Review
- NAFLD (MASLD)/NASH (MASH): Does It Bother to Label at All? A Comprehensive Narrative Review.International journal of molecular sciences · 2024Review
- Progress and challenges of developing volatile metabolites from exhaled breath as a biomarker platform.Metabolomics : Official journal of the Metabolomic Society · 2024Review
- Volatile organic compounds for the detection of hepatocellular carcinoma-A scoping review.iLIVER · 2024Review
- Diagnosis of Carcinogenic Pathologies through Breath Biomarkers: Present and Future Trends.Biomedicines · 2023Review
- Exogenous Volatile Organic Compound (EVOCBiomedicines · 2023Article
- Article
- Breath BiopsyJournal of clinical and translational hepatology · 2023Article
- Breath Testing in the Surgical Setting: Applications, Challenges, and Future Perspectives.European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes · 2023Review
- Novel breath biomarkers identification for early detection of hepatocellular carcinoma and cirrhosis using ML tools and GCMS.PloS one · 2023Article
- The Use of Breath Analysis in the Management of Lung Cancer: Is It Ready for Primetime?Current oncology (Toronto, Ont.) · 2022Review
- pyAIR-A New Software Tool for Breathomics Applications-Searching for Markers in TD-GC-HRMS Analysis.Molecules (Basel, Switzerland) · 2022Article
- A pilot study for the prediction of liver function related scores using breath biomarkers and machine learning.Scientific reports · 2022Article
Corrections and comments
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Authors and funding
18 authors at 4 institutions in 3 countries.
Funding
Abstract
introductionLiver cirrhosis and its complication - hepatocellular carcinoma (HCC) - have been associated with increased exhaled limonene. It is currently unclear whether this increase is more strongly associated with the presence of HCC or with the severity of liver dysfunction.
methodsWe compared the exhaled breath of 40 controls, 32 cirrhotic patients, and 12 cirrhotic patients with HCC using the Breath Biopsy platform. Breath samples were analyzed by thermal desorption-gas chromatography-mass spectrometry. Limonene levels were compared between the groups and correlated to bilirubin, albumin, prothrombin time international normalized ratio, and alanine aminotransferase.
resultsBreath limonene concentration was significantly elevated in subjects with cirrhosis-induced HCC (M: 82.1 ng/L, interquartile range [IQR]: 16.33-199.32 ng/L) and cirrhosis (M: 32.6 ng/L, IQR: 6.55-123.07 ng/L) compared with controls (M: 6.2 ng/L, IQR: 2.62-9.57 ng/L) (P value = 0.0005 and 0.0001, respectively) with no significant difference between 2 diseased groups (P value = 0.37). Levels of exhaled limonene correlated with serum bilirubin (R = 0.25, P value = 0.0016, r = 0.51), albumin (R = 0.58, P value = 5.3e-8, r = -0.76), and international normalized ratio (R = 0.29, P value = 0.0003, r = 0.51), but not with alanine aminotransferase (R = 0.01, P value = 0.36, r = 0.19). DISCUSSION: Exhaled limonene levels are primarily affected by the presence of cirrhosis through reduced liver functional capacity, as indicated by limonene correlation with blood metrics of impaired hepatic clearance and protein synthesis capacity, without further alterations observed in subjects with HCC. This suggests that exhaled limonene is a potential non-invasive marker of liver metabolic capacity (see Visual abstract, Supplementary Digital Content 1, http://links.lww.com/CTG/A388).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.