Mid-infrared spectroscopy of serum, a promising non-invasive method to assess prognosis in patients with ascites and cirrhosis

PLoS One. 2017 Oct 11;12(10):e0185997. doi: 10.1371/journal.pone.0185997. eCollection 2017.

Abstract

Background & aims: Prognostic tests are critical in the management of patients with cirrhosis and ascites. Biological tests or scores perform poorly in that situation. Mid-infrared fibre evanescent wave spectroscopy (MIR-FEWS) which allows for global serum metabolic profiling may provide more relevant information by measuring a wider range of metabolic parameters in serum. Here we present the accuracy of a MIR-FEWS based predictive model for the prognosis of 6 months survival in patients with ascites and cirrhosis.

Methods: Patients with ascites were prospectively included and followed up for 6 months. MIR-FEWS spectra were measured in serum samples. The most informative spectral variables obtained by MIR-FEWS were selected by FADA algorithm and then used to build the MIR model. Accuracy of this model was assessed by ROC curves and 90%/10% Monte Carlo cross-validation. MIR model accuracy for 6 months survival was compared to that of the Child-Pugh and MELD scores.

Results: 119 patients were included. The mean age was 57.36±13.70, the MELD score was 16.32±6.26, and the Child-Pugh score was 9.5±1.83. During follow-up, 23 patients died (20%). The MIR model had an AUROC for 6 months mortality of 0.90 (CI95: 0.88-0.91), the MELD 0.77 (CI95: 0.66-0.89) and Child-Pugh 0.76 (CI95: 0.66-0.88). MELD and Child-Pugh AUROCs were significantly lower than that of the MIR model (p = 0.02 and p = 0.02 respectively). Multivariate logistic regression analysis showed that MELD (p<0.05, OR:0.86;CI95:0.76-0.97), Beta blockers (p = 0.036;OR:0.20;CI95:0.04-0.90), and the MIR model (p<0.001; OR:0.50; CI95:0.37-0.66), were significantly associated with 6 months mortality.

Conclusions: In this pilot study MIR-FEWS more accurately assess the 6-month prognosis of patients with ascites and cirrhosis than the MELD or Child-Pugh scores. These promising results, if confirmed by a larger study, suggest that mid infrared spectroscopy could be helpful in the management of these patients.

MeSH terms

  • Algorithms
  • Area Under Curve
  • Ascites / blood*
  • Ascites / diagnosis*
  • Ascites / mortality
  • Biomarkers / blood
  • Female
  • Fibrosis / blood*
  • Fibrosis / diagnosis*
  • Fibrosis / mortality
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • ROC Curve
  • Reproducibility of Results
  • Risk Assessment
  • Sensitivity and Specificity
  • Serum / metabolism*
  • Spectrophotometry, Infrared / methods*

Substances

  • Biomarkers

Grants and funding

This study was funded the French National Association Research Technology (ANRT). This funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The Diafir company provided financial support in the form of salary of authors NF, CC and HT, and provided research material (The Diafir SPIDTM FTIR portable spectrometer used in this study to acquire data). This funder did not have any additional role in the study design, data analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the “author contributions” section.