Applying the electronic nose for pre-operative SARS-CoV-2 screening

Anne G.W.E. Wintjens, Kim F.H. Hintzen, Sanne M.E. Engelen, Tim Lubbers, Paul H.M. Savelkoul, Geertjan Wesseling, Job A.M. van der Palen, Nicole D. Bouvy*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    48 Citations (Scopus)
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    Background: Infection with SARS-CoV-2 causes corona virus disease (COVID-19). The most standard diagnostic method is reverse transcription-polymerase chain reaction (RT-PCR) on a nasopharyngeal and/or an oropharyngeal swab. The high occurrence of false-negative results due to the non-presence of SARS-CoV-2 in the oropharyngeal environment renders this sampling method not ideal. Therefore, a new sampling device is desirable. This proof-of-principle study investigated the possibility to train machine-learning classifiers with an electronic nose (Aeonose) to differentiate between COVID-19-positive and negative persons based on volatile organic compounds (VOCs) analysis. Methods: Between April and June 2020, participants were invited for breath analysis when a swab for RT-PCR was collected. If the RT-PCR resulted negative, the presence of SARS-CoV-2-specific antibodies was checked to confirm the negative result. All participants breathed through the Aeonose for five minutes. This device contains metal-oxide sensors that change in conductivity upon reaction with VOCs in exhaled breath. These conductivity changes are input data for machine learning and used for pattern recognition. The result is a value between − 1 and + 1, indicating the infection probability. Results: 219 participants were included, 57 of which COVID-19 positive. A sensitivity of 0.86 and a negative predictive value (NPV) of 0.92 were found. Adding clinical variables to machine-learning classifier via multivariate logistic regression analysis, the NPV improved to 0.96. Conclusions: The Aeonose can distinguish COVID-19 positive from negative participants based on VOC patterns in exhaled breath with a high NPV. The Aeonose might be a promising, non-invasive, and low-cost triage tool for excluding SARS-CoV-2 infection in patients elected for surgery.

    Original languageEnglish
    Number of pages8
    JournalSurgical endoscopy
    Early online date2 Dec 2020
    Publication statusPublished - Dec 2021


    • COVID-19
    • Electronic nose
    • Exhaled air
    • Innovative diagnostics
    • Volatile organic compounds


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