PMID- 31701020 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 2398-6352 (Electronic) IS - 2398-6352 (Linking) VI - 2 DP - 2019 TI - Language impairment in adults with end-stage liver disease: application of natural language processing towards patient-generated health records. PG - 106 LID - 10.1038/s41746-019-0179-9 [doi] LID - 106 AB - 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. CI - (c) The Author(s) 2019. FAU - Dickerson, Lindsay K AU - Dickerson LK AUID- ORCID: 0000-0001-6509-8393 AD - 1Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Rouhizadeh, Masoud AU - Rouhizadeh M AD - 2Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Korotkaya, Yelena AU - Korotkaya Y AD - 3Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Bowring, Mary Grace AU - Bowring MG AD - 4Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Massie, Allan B AU - Massie AB AD - 4Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 AD - 5Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - McAdams-Demarco, Mara A AU - McAdams-Demarco MA AD - 4Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Segev, Dorry L AU - Segev DL AD - 4Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 AD - 5Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Cannon, Alicia AU - Cannon A AD - 6Kennedy Krieger Institute, Baltimore, MD USA. ISNI: 0000 0004 0427 667X. GRID: grid.240023.7 FAU - Guerrerio, Anthony L AU - Guerrerio AL AUID- ORCID: 0000-0003-2458-7160 AD - 3Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Chen, Po-Hung AU - Chen PH AD - 7Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Philosophe, Benjamin N AU - Philosophe BN AD - 5Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 FAU - Mogul, Douglas B AU - Mogul DB AD - 3Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA. ISNI: 0000 0001 2171 9311. GRID: grid.21107.35 LA - eng GR - K08 HS023876/HS/AHRQ HHS/United States GR - K24 DK101828/DK/NIDDK NIH HHS/United States GR - KL2 TR001077/TR/NCATS NIH HHS/United States GR - R01 DK114074/DK/NIDDK NIH HHS/United States PT - Journal Article DEP - 20191104 PL - England TA - NPJ Digit Med JT - NPJ digital medicine JID - 101731738 PMC - PMC6828779 OTO - NOTNLM OT - Language OT - Liver diseases OT - Machine learning OT - Neurological manifestations COIS- Competing interestsD.L.S. receives speaking and advisory honoraria from Novartis, Sanofi, and CSL Behring. The remaining authors declare no competing interests. EDAT- 2019/11/09 06:00 MHDA- 2019/11/09 06:01 PMCR- 2019/11/04 CRDT- 2019/11/09 06:00 PHST- 2019/05/10 00:00 [received] PHST- 2019/09/23 00:00 [accepted] PHST- 2019/11/09 06:00 [entrez] PHST- 2019/11/09 06:00 [pubmed] PHST- 2019/11/09 06:01 [medline] PHST- 2019/11/04 00:00 [pmc-release] AID - 179 [pii] AID - 10.1038/s41746-019-0179-9 [doi] PST - epublish SO - NPJ Digit Med. 2019 Nov 4;2:106. doi: 10.1038/s41746-019-0179-9. eCollection 2019.