Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov 4:2:106.
doi: 10.1038/s41746-019-0179-9. eCollection 2019.

Language impairment in adults with end-stage liver disease: application of natural language processing towards patient-generated health records

Affiliations

Language impairment in adults with end-stage liver disease: application of natural language processing towards patient-generated health records

Lindsay K Dickerson et al. NPJ Digit Med. .

Abstract

End-stage liver disease (ESLD) is associated with cognitive impairment ranging from subtle alterations in attention to overt hepatic encephalopathy that resolves after transplant. Natural language processing (NLP) may provide a useful method to assess cognitive status in this population. We identified 81 liver transplant recipients with ESLD (4/2013-2/2018) who sent at least one patient-to-provider electronic message pre-transplant and post-transplant, and matched them 1:1 to "healthy" controls-who had similar disease, but had not been evaluated for liver transplant-by age, gender, race/ethnicity, and liver disease. Messages written by patients pre-transplant and post-transplant and controls was compared across 19 NLP measures using paired Wilcoxon signed-rank tests. While there was no difference overall in word length, patients with Model for End-Stage Liver Disease Score (MELD) ≥ 30 (n = 31) had decreased word length in pre-transplant messages (3.95 [interquartile range (IQR) 3.79, 4.14]) compared to post-transplant (4.13 [3.96, 4.28], p = 0.01) and controls (4.2 [4.0, 4.4], p = 0.01); there was no difference between post-transplant and controls (p = 0.4). Patients with MELD ≥ 30 had fewer 6+ letter words in pre-transplant messages (19.5% [16.4, 25.9] compared to post-transplant (23.4% [20.0, 26.7] p = 0.02) and controls (25.0% [19.2, 29.4]; p = 0.01). Overall, patients had increased sentence length pre-transplant (12.0 [9.8, 13.7]) compared to post-transplant (11.0 [9.2, 13.3]; p = 0.046); the same was seen for MELD ≥ 30 (12.3 [9.8, 13.7] pre-transplant vs. 10.8 [9.6, 13.0] post-transplant; p = 0.050). Application of NLP to patient-generated messages identified language differences-longer sentences with shorter words-that resolved after transplant. NLP may provide opportunities to detect cognitive impairment in ESLD.

Keywords: Language; Liver diseases; Machine learning; Neurological manifestations.

PubMed Disclaimer

Conflict of interest statement

Competing interestsD.L.S. receives speaking and advisory honoraria from Novartis, Sanofi, and CSL Behring. The remaining authors declare no competing interests.

References

    1. Vilstrup H, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guidelines by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715–735. doi: 10.1002/hep.27210. - DOI - PubMed
    1. Weissenborn K, et al. Attention, memory, and cognitive function in hepatic encephalopathy. Metab. Brain Dis. 2005;20:359–367. doi: 10.1007/s11011-005-7919-z. - DOI - PubMed
    1. Bajaj JS. Minimal hepatic encephalopathy matters in daily life. World J. Gastroenterol. 2008;14:3609–3615. doi: 10.3748/wjg.14.3609. - DOI - PMC - PubMed
    1. Rakoski MO, et al. Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study. Hepatology. 2012;55:184–191. doi: 10.1002/hep.24616. - DOI - PMC - PubMed
    1. Kandiah PA, Kumar G. Hepatic encephalopathy—the old and the new. Crit. Care Clin. 2016;32:311–329. doi: 10.1016/j.ccc.2016.03.001. - DOI - PubMed