Chronic liver disease-associated severe thrombocytopenia in Spain: Results from a retrospective study using machine learning and natural language processing / Trombocitopenia grave asociada a enfermedad hepática crónica en España: Resultados de un estudio retrospectivo utilizando aprendizaje automático y procesamiento de lenguaje natural

Background Patients with chronic liver disease (CLD) often develop thrombocytopenia (TCP) as a complication. Severe TCP (platelet count<50×109/L) can increase morbidity and complicate CLD management, increasing bleeding risk during invasive procedures. Objectives To describe the real-world scenario of CLD-associated severe TCP patients’ clinical characteristics. To evaluate the association between invasive procedures, prophylactic treatments, and bleeding events in this group of patients. To describe their need of medical resource use in Spain. Methods This is a retrospective, multicenter study including patients who had confirmed diagnosis of CLD and severe TCP in four hospitals within the Spanish National Healthcare Network from January 2014 to December 2018. We analyzed the free-text information from Electronic Health Records (EHRs) of patients using Natural Language Processing (NLP), machine learning techniques, and SNOMED-CT terminology. Demographics, comorbidities, analytical parameters and characteristics of CLD were extracted at baseline and need for invasive procedures, prophylactic treatments, bleeding events and medical resources used in the follow up period. Frequency tables were generated for categorical variables, whereas continuous variables were described in summary tables as mean (SD) and median (Q1–Q3). Results Out of 1,765,675 patients, 1787 had CLD and severe TCP; 65.2% were male with a mean age of 54.7 years old. Cirrhosis was detected in 46% (n=820) of patients and 9.1% (n=163) had hepatocellular carcinoma. Invasive procedures were needed in 85.6% of patients during the follow up period. Patients undergoing procedures compared to those patients without invasive procedures presented higher rates of bleeding events (33% vs 8%, p<0.0001) and higher number of bleedings. While prophylactic platelet transfusions were given to 25.6% of patients undergoing procedures, TPO receptor agonist use was only detected in 3.1% of them... (AU)

Antecedentes Los pacientes con enfermedad hepática crónica (EHC) a menudo desarrollan trombocitopenia (TCP) como agravante de su enfermedad. La TCP grave (definida por un recuento de plaquetas < 50 x 109/L) puede aumentar la morbilidad y complicar el manejo de la EPC, incrementando el riesgo de hemorragia durante los procedimientos invasivos. Objetivos Describir el escenario de mundo real de las características clínicas de los pacientes con TCP grave asociado a EHC. Evaluar la asociación entre procedimientos invasivos, tratamientos profilácticos y eventos hemorrágicos en este grupo de pacientes, así como describir el uso de recursos médicos en España. Métodos Se plantea un estudio multicéntrico retrospectivo que incluye pacientes con diagnóstico confirmado de EHC y TCP grave en cuatro hospitales de la Red Nacional de Salud de España desde enero de 2014 hasta diciembre de 2018. Analizamos la información de texto libre de la Historia Clínica Electrónica (HCE) de pacientes que utilizan procesamiento de lenguaje natural (PLN), técnicas de aprendizaje automático y terminología de SNOMED-CT. Los datos demográficos, las comorbilidades, los parámetros analíticos y las características de la EHC se extrajeron al inicio del estudio, así como la necesidad de procedimientos invasivos, tratamientos profilácticos, eventos hemorrágicos y recursos médicos utilizados en el periodo de seguimiento. Se generaron tablas de frecuencia para las variables categóricas, mientras que las variables continuas se describieron en tablas resumen como media (SD) y mediana (Q1-Q3). Resultados De 1.765.675 pacientes identificados, 1.787 tenían EHC y TCP grave, siendo el 65,2% varones con una edad media de 54,7 años. Se detectó cirrosis en el 46% (n = 820) de los pacientes y el 9,1% (n = 163) de ellos presentaron un diagnóstico de carcinoma hepatocelular... (AU)

[Hepatic encephalopathy]. / Encefalopatía hepática.

Hepatic encephalopathy (EH) is a severe complication of hepatic cirrhosis that is characterized by multiple neuropsychiatric manifestations. EH is usually triggered by a precipitating factor and occurs in patients with severely impaired hepatic function. Minimal EH is characterized by minor cognitive impairments that are difficult to specify but represent a risk for the patients. The primary pathophysiological mechanism of EH is considered to be an increase in blood ammonia with an impairment in the patency of the blood-brainbarrier and its metabolism to glutamine in astrocytes. The diagnosis is clinical and neuroimaging techniques can be complementary. The diagnosis of minimal EH requires specific neurocognitive tests. The clinical evaluation should be directed towards identifying the trigger. Nonabsorbable disaccharides and rifaximin constitute the treatment of choice, along with prophylaxis for new episodes.