The use of Natural Language Processing as a tool to help exploit hospital data

peer reviewedLe CHU de Liège dispose d’un Dossier Médical Informatisé dans lequel coexistent des données structurées et non structurées. Depuis plus de 10 ans, il a aussi développé un large entrepôt de données clinques compilant l’ensemble de l’information clinique et paraclinique de l’institution. De plus, une équipe d’analystes est devenue experte de l’exploitation des données, essentiellement des données structurées. La question qui se pose actuellement est de savoir comment tirer et exploiter la richesse de toute l’information contenue dans les données non structurées du Dossier Patient Informatisé. Plus particulièrement, les nouvelles technologies de traitement du langage naturel (NLP Natural Langage Processing) apportent-elles une plus-value significative dans l’exploitation des données médicales

Développement d’un outil de pilotage des patients oncologiques au CHU de Liège

peer reviewedLe nombre de cas de cancer est en augmentation constante, en Belgique comme partout dans le monde. Plusieurs services du CHU de Liège se sont regroupés au sein d’un Institut de Cancérologie, afin d’assurer une gestion intégrée multidisciplinaire de cette masse de patients. Cet article présente comment les données de l’entrepôt de données cliniques institutionnel ont été exploitées afin de développer un outil de pilotage transversal de l’activité des patients oncologiques

Développement et évaluation d’un outil d’aide à la décision clinique pour le suivi des patients hospitalisés pour COVID-19 au CHU de Liège

peer reviewedLes vagues de COVID-19 ont engendré une forte pression sur les hôpitaux, particulièrement sur les unités de soins intensifs, et une mortalité importante. Cette étude menée au CHU de Liège vise aur développement et à l’évaluation d’un outil d’aide à la décision clinique (DCSS) pour le suivi des patients hospitalisés pour COVID-19. Le DCSS « Bio Logbook » est basé sur une méthode de détection des dérives précoces des paramètres de biologie. Il établit des scores de risque liés à la COVID-19 à partir de tests de laboratoire mesurés à l’admission du patient et identifie parmi ces tests ceux liés à la sévérité de la COVID-19. Des modèles prédictifs des risques liés à la COVID-19 ont été élaborés et validés pour le décès, l’admission aux soins intensifs, la ventilation mécanique et la transfusion. La plus-value clinique du CDSS a été évaluée à l’aide d’une étude rétrospective de cas. L’outil d’aide à la décision clinique développé et validé spécifiquement lors de cette étude montre des résultats encourageants, en particulier pour la détection précoce des patients particulièrement à risque de décès lors de leur hospitalisation. L’outil fournit ainsi au clinicien une aide lui permettant d’optimiser la rapidité et la qualité de la prise en charge des patients à partir de l’analyse des résultats de laboratoire à l’admission ; il permet aussi d’augmenter la capacité du médecin à identifier les patients à haut ou à plus faible risque de décès dans le séjour. L’étude de cas met en évidence l’importance de la synergie médecin-CDSS. Enfin, cette étude a permis de mettre en place une méthode complète de validation d’un CDSS, y compris de sa plus-value clinique, avant son déploiement

Systematic analysis of COVID-19 infection and symptoms in a systemic lupus erythematosus population: correlation with disease characteristics, hydroxychloroquine use and immunosuppressive treatments.

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Annals of Intensive Care

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The feasibility of an allergy management support system (AMSS) for IgE-mediated allergy in primary care

Background: The allergy management support system (AMSS) was developed to assist general practitioners (GPs) to handle the increasing burden of allergic diseases and facilitates the diagnosis and management of allergy. The aim of this cluster-randomized controlled pilot study was to test the feasibility of this AMSS for primary care. Methods: GPs received diagnostic and management recommendations generated by the AMSS in addition to sIgE-test results (intervention) or GPs received sIgE-test results only (control). The AMSS recommendations are based on the previously developed patient-completed AMSS questionnaire and sIgE-test results. The AMSS was considered feasible when > 70% of the AMSS recommendations were sent to the GP within ten working days of sIgE-testing. GPs completed a questionnaire on their diagnosis and management before (T1) and after (T2) receiving sIgE test results. Agreement and disagreement concerning diagnosis, medication and referrals between GPs and AMSS was investigated at T1 and T2. A total agreement score between GPs and AMSS was calculated. GPs in the intervention group completed a questionnaire to evaluate the utility of the AMSS. Semi-structured interviews were used to explore the motivation of GPs who did not include patients in this pilot study. Results: Twenty-seven GPs included 101 patients. Forty-two patients (72%) completed the AMSS questionnaire in the intervention group. The majority of the AMSS recommendations (93%) were returned to the GP within 10 working days after sIgE-test results were known [mean (SD) 4.7 (4.0) working days]. GPs in the intervention group reported largely following the AMSS recommendations in 71% of cases. The total agreement scores concerning diagnosis were significantly higher (p < 0.001) in the intervention group than the control group [mean (SD); 0.9 (1.8) vs - 0.8 (1.0)]. The agreement concerning medication or referral between GPs and AMSS did not differ between the intervention and the control group. GPs in the intervention group were reasonably positive about the AMSS. Not enrolling patients was not caused by anticipated ineffectiveness of the AMSS. Conclusion: The AMSS can be considered to be feasible for primary care. GPs tend to follow the AMSS recommendations. The AMSS may contribute to the empowerment of GPs to better manage allergy patients in primary care.Trial registration ISRCTN ISRCTN36780877. Registered 23 November 2017 (retrospectively registered)

Progressive fibrosing interstitial lung disease in rheumatoid arthritis: A retrospective study

peer reviewedBackground and objectiveRheumatoid arthritis associated-interstitial lung disease (RA-ILD) is the most common pulmonary manifestation of rheumatoid arthritis (RA) and an important cause of mortality. In patients suffering from interstitial lung diseases (ILD) from different etiologies (including RA-ILD), a significant proportion is exhibiting a fibrotic progression despite immunosuppressive therapies, defined as progressive fibrosing interstitial lung disease (PF-ILD). Here, we report the frequency of RA-ILD and PF-ILD in all RA patients’ cohort at University Hospital of Liège and compare their characteristics and outcomes.MethodsPatients were retrospectively recruited from 2010 to 2020. PF-ILD was defined based on functional, clinical and/or iconographic progression criteria within 24 months despite specific anti-RA treatment.ResultsOut of 1,500 RA patients, about one third had high-resolution computed tomography (HRCT) performed, 89 showed RA-ILD and 48 PF-ILD. RA-ILD patients were significantly older than other RA patients (71 old of median age vs. 65, p &lt; 0.0001), with a greater proportion of men (46.1 vs. 27.7%, p &lt; 0.0001) and of smoking history. Non-specific interstitial pneumonia pattern was more frequent than usual interstitial pneumonia among RA-ILD (60.7 vs. 27.0%) and PF-ILD groups (60.4 vs. 31.2%). The risk of death was 2 times higher in RA-ILD patients [hazard ratio 2.03 (95% confidence interval 1.15–3.57), p &lt; 0.01] compared to RA.ConclusionWe identified a prevalence of PF-ILD of 3% in a general RA population. The PF-ILD cohort did not seem to be different in terms of demographic characteristics and mortality compared to RA-ILD patients who did not exhibit the progressive phenotype yet

Bone Marrow-Derived Mesenchymal Stromal Cell Therapy in Severe COVID-19: Preliminary Results of a Phase I/II Clinical Trial

peer reviewedBackground: Treatment of acute respiratory distress syndrome (ARDS) associated with COronaVIrus Disease-2019 (COVID-19) currently relies on dexamethasone and supportive mechanical ventilation, and remains associated with high mortality. Given their ability to limit inflammation, induce immune cells into a regulatory phenotype and stimulate tissue repair, mesenchymal stromal cells (MSCs) represent a promising therapy for severe and critical COVID-19 disease, which is associated with an uncontrolled immune-mediated inflammatory response. Methods: In this phase I-II trial, we aimed to evaluate the safety and efficacy of 3 intravenous infusions of bone marrow (BM)-derived MSCs at 3-day intervals in patients with severe COVID-19. All patients also received dexamethasone and standard supportive therapy. Between June 2020 and September 2021, 8 intensive care unit patients requiring supplemental oxygen (high-flow nasal oxygen in 7 patients, invasive mechanical ventilation in 1 patient) were treated with BM-MSCs. We retrospectively compared the outcomes of these MSC-treated patients with those of 24 matched control patients. Groups were compared by paired statistical tests. Results: MSC infusions were well tolerated, and no adverse effect related to MSC infusions were reported (one patient had an ischemic stroke related to aortic endocarditis). Overall, 3 patients required invasive mechanical ventilation, including one who required extracorporeal membrane oxygenation, but all patients ultimately had a favorable outcome. Survival was significantly higher in the MSC group, both at 28 and 60 days (100% vs 79.2%, p = 0.025 and 100% vs 70.8%, p = 0.0082, respectively), while no significant difference was observed in the need for mechanical ventilation nor in the number of invasive ventilation-free days, high flow nasal oxygenation-free days, oxygen support-free days and ICU-free days. MSC-treated patients also had a significantly lower day-7 D-dimer value compared to control patients (median 821.0 µg/L [IQR 362.0-1305.0] vs 3553 µg/L [IQR 1155.0-6433.5], p = 0.0085). Conclusions: BM-MSC therapy is safe and shows very promising efficacy in severe COVID-19, with a higher survival in our MSC cohort compared to matched control patients. These observations need to be confirmed in a randomized controlled trial designed to demonstrate the efficacy of BM-MSCs in COVID-19 ARDS. Clinical Trial Registration (www.ClinicalTrials.gov), identifier NCT0444545

Automatized lung disease quantification in patients with COVID-19 as a predictive tool to assess hospitalization severity

peer reviewedThe pandemic of COVID-19 led to a dramatic situation in hospitals, where staff had to deal with a huge number of patients in respiratory distress. To alleviate the workload of radiologists, we implemented an artificial intelligence (AI) - based analysis named CACOVID-CT, to automatically assess disease severity on chest CT scans obtained from those patients. We retrospectively studied CT scans obtained from 476 patients admitted at the University Hospital of Liege with a COVID-19 disease. We quantified the percentage of COVID-19 affected lung area (% AA) and the CT severity score (total CT-SS). These quantitative measurements were used to investigate the overall prognosis and patient outcome: hospital length of stay (LOS), ICU admission, ICU LOS, mechanical ventilation, and in-hospital death. Both CT-SS and % AA were highly correlated with the hospital LOS, the risk of ICU admission, the risk of mechanical ventilation and the risk of in-hospital death. Thus, CAD4COVID-CT analysis proved to be a useful tool in detecting patients with higher hospitalization severity risk. It will help for management of the patients flow. The software measured the extent of lung damage with great efficiency, thus relieving the workload of radiologists

The Role of Imaging in the Detection of Non-COVID-19 Pathologies during the Massive Screening of the First Pandemic Wave

peer reviewedDuring the COVID-19 pandemic induced by the SARS-CoV-2, numerous chest scans were carried out in order to establish the diagnosis, quantify the extension of lesions but also identify the occurrence of potential pulmonary embolisms. In this perspective, the performed chest scans provided a varied database for a retrospective analysis of non-COVID-19 chest pathologies discovered de novo. The fortuitous discovery of de novo non-COVID-19 lesions was generally not detected by the automated systems for COVID-19 pneumonia developed in parallel during the pandemic and was thus identified on chest CT by the radiologist. The objective is to use the study of the occurrence of non-COVID-19-related chest abnormalities (known and unknown) in a large cohort of patients having suffered from confirmed COVID-19 infection and statistically correlate the clinical data and the occurrence of these abnormalities in order to assess the potential of increased early detection of lesions/alterations. This study was performed on a group of 362 COVID-19-positive patients who were prescribed a CT scan in order to diagnose and predict COVID-19-associated lung disease. Statistical analysis using mean, standard deviation (SD) or median and interquartile range (IQR), logistic regression models and linear regression models were used for data analysis. Results were considered significant at the 5% critical level (p < 0.05). These de novo non-COVID-19 thoracic lesions detected on chest CT showed a significant prevalence in cardiovascular pathologies, with calcifying atheromatous anomalies approaching nearly 35.4% in patients over 65 years of age. The detection of non-COVID-19 pathologies was mostly already known, except for suspicious nodule, thyroid goiter and the ascending thoracic aortic aneurysm. The presence of vertebral compression or signs of pulmonary fibrosis has shown a significant impact on inpatient length of stay. The characteristics of the patients in this sample, both from a demographic and a tomodensitometric point of view on non-COVID-19 pathologies, influenced the length of hospital stay as well as the risk of intra-hospital death. This retrospective study showed that the potential importance of the detection of these non-COVID-19 lesions by the radiologist was essential in the management and the intra-hospital course of the patients