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Breath testing may be useful to predict ascites, liver-related death

In a pilot study, researchers found that methacetin breath testing could be more accurate at predicting the risk of liver-related deaths and the development of ascites than the MELD score, according to new study data published in the Journal of Hepatology.

“In the current study, we present data that explore a possible role for [methacetin breath testing] to predict liver-related death and other complications of cirrhosis in stable patients with advanced liver disease,” the researchers wrote. “We evaluated the diagnostic accuracy of methacetin breath test, an assay of liver metabolic function, and the MELD score.”

Researchers administered oral C-methacetin to 165 patients with cirrhosis waitlisted for liver transplant (LT, 29%) or undergoing evaluation for listing, with CO₂ being measured via the BreathID test (Exalenz Biosciences Ltd.). The researchers used a cumulative percent dose recovery of CO₂ at 20 minutes with a threshold greater than or equal to 0.55% considered high risk and less than or equal to 0.55% considered low risk to predict liver-related death and the risk of cirrhotic complications at 1 year, as it did so with the most accuracy, according to the research. MELD thresholds greater than or equal to 15 and 19 were used to predict the same endpoints. The patients were followed for 1 year or until death or LT.

Analyses showed that dose recovery less than 0.55% and MELD score greater than 19 were accurate in predicting liver-related death (HR = 12.6; 95% CI, 1.6-98.3; P = .016 and HR = 5.5; 95% CI, 1.6-18.9; P = .007, respectively). A MELD score greater than 15 did not predict these factors.

In addition, dose recovery of less than 0.55% predicted the risk of one or more complications (HR = 1.9; 95% CI, 1.1-3.2; P = .03), including the risk of development or exacerbation of ascites (HR = 4.7; 95% CI, 1.8-11.9; P = .001). Both MELD thresholds were unable to predict these factors, according to the researchers.

In patients with a MELD score less than 19, a dose recovery threshold of less than 0.55% predicted the risk of death (P = .017), development at least one complication from cirrhosis (P = .062) and development or exacerbation of ascites (P = .0009).

“Our data suggest that [methacetin breath testing] may provide an early warning to clinicians beyond the information inherent in a MELD score that a patient is at increased risk of deterioration, and requires more frequent surveillance for decompensation and recalculation of the MELD in order to maintain highest possible priority on the LT waiting list. … Further assessment of the [methacetin breath testing] using BreathID is needed to validate this pilot study, and to prove that, by identifying such patients, earlier intervention decreases morbidity and mortality of cirrhotic patients on the LT waiting list.” – by Melinda Stevens

Disclosures: The study was supported by Exalenz Biosciences, Ltd. The researchers report no relevant financial disclosures.