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.

终末期肝病（ESLD）与认知障碍相关，从注意力的细微变化到移植后可消退的明显肝性脑病。自然语言处理（NLP）可能提供一种有用的方法来评估该人群的认知状态。我们确定了81位ESLD（4 / 2013–2 / 2018）的肝移植受者，他们在移植前和移植后至少发送了一个患者对提供者的电子消息，并以1：1的比例将其与“健康”对照者相匹配。患有相似的疾病，但尚未按年龄，性别，种族/民族和肝病进行肝移植评估。使用配对的Wilcoxon符号秩检验，在19种NLP措施中比较了患者在移植前，移植后以及对照中所写的信息。虽然整体的字长没有差异，n  = 31）与植入后（4.13 [3.96，4.28]，p  = 0.01）和对照（4.2 [4.0，4.0， 4.4]，p  = 0.01）；移植后与对照组之间没有差异（p  = 0.4）。MELD≥30的患者与移植后（23.4％[20.0，26.7] p  = 0.02）和对照组（25.0％[ 19.2，29.4]）相比，移植前消息中6个字母以上的单词（19.5％[16.4，25.9]）更少]; p  = 0.01）总体上，患者增加了句子长度移植前（12.0 [9.8，13.7]）相比，移植后（11.0 [9.2，13.3]; p = 0.046）；MELD≥30时也是如此（移植前为12.3 [9.8，13.7]，移植后为10.8 [9.6，13.0]；p  = 0.050）。将NLP应用于患者生成的消息后，可以识别出移植后解决的语言差异（较长的句子和较短的单词）。NLP可能提供检测ESLD认知障碍的机会。