t2a_v2/tests/test_nutrition_has2021.py

"""Tests unitaires pour la détection dénutrition HAS/FFN 2021."""

import re
import pytest

from src.config import BiologieCle, Diagnostic, DossierMedical, Sejour
from src.medical.diagnostic_extraction import _detect_nutrition_has2021, _DAS_PATTERNS
from src.medical.cim10_dict import normalize_text


# ── Helpers ──────────────────────────────────────────────────────────


def _make_dossier(age=None, imc=None, albumine=None, existing_codes=None):
    """Construit un DossierMedical minimal pour les tests."""
    dossier = DossierMedical()
    dossier.sejour = Sejour(age=age, imc=imc)
    if albumine is not None:
        dossier.biologie_cle.append(
            BiologieCle(
                test="Albumine",
                valeur=str(albumine),
                valeur_num=float(albumine),
                anomalie=True,
                quality="ok",
            )
        )
    for code in (existing_codes or []):
        dossier.diagnostics_associes.append(
            Diagnostic(texte="existant", cim10_suggestion=code, source="test")
        )
    return dossier


# ── Tests _detect_nutrition_has2021 ──────────────────────────────────


class TestDetectNutritionHAS2021:
    """Tests de la détection déterministe basée sur IMC/âge/albumine."""

    def test_adulte_imc17_albumine28_gives_E43(self):
        """Adulte IMC 17.0 + albumine 28 → E43 (sévère via IMC ≤17 ET albumine <30)."""
        dossier = _make_dossier(age=50, imc=17.0, albumine=28)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E43" in codes

    def test_adulte_imc18_sans_albumine_gives_E44(self):
        """Adulte IMC 18.0 sans albumine → E44.0 (modéré, 17 < IMC < 18.5)."""
        dossier = _make_dossier(age=45, imc=18.0)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E44.0" in codes

    def test_personne_agee_75_imc21_gives_E44(self):
        """≥70 ans IMC 21.0 → E44.0 (seuil gériatrique < 22)."""
        dossier = _make_dossier(age=75, imc=21.0)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E44.0" in codes

    def test_personne_agee_75_imc19_gives_E43(self):
        """≥70 ans IMC 19.0 → E43 (sévère, IMC < 20)."""
        dossier = _make_dossier(age=75, imc=19.0)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E43" in codes

    def test_adulte_imc25_no_das(self):
        """Adulte IMC 25.0 → aucun DAS (au-dessus du seuil)."""
        dossier = _make_dossier(age=40, imc=25.0)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert not any(c in codes for c in ("E43", "E44.0", "E46"))

    def test_e46_deja_code_no_ajout(self):
        """E46 déjà codé → aucun ajout."""
        dossier = _make_dossier(age=50, imc=16.0, existing_codes=["E46"])
        _detect_nutrition_has2021(dossier)
        e_codes = [d.cim10_suggestion for d in dossier.diagnostics_associes
                   if d.cim10_suggestion in ("E43", "E44.0", "E46")]
        # Seul le E46 existant doit être présent
        assert e_codes == ["E46"]

    def test_pas_imc_no_ajout(self):
        """Pas d'IMC → aucun ajout (dégradation gracieuse)."""
        dossier = _make_dossier(age=50, imc=None)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert not any(c in codes for c in ("E43", "E44.0", "E46"))

    def test_albumine_upgrade_severity(self):
        """IMC modéré + albumine < 30 → upgrade vers E43."""
        dossier = _make_dossier(age=50, imc=18.0, albumine=25)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E43" in codes  # Albumine < 30 → sévère

    def test_alerte_codage_added(self):
        """Vérifie qu'une alerte codage est ajoutée."""
        dossier = _make_dossier(age=50, imc=17.0)
        _detect_nutrition_has2021(dossier)
        assert any("HAS 2021" in a for a in dossier.alertes_codage)

    def test_source_is_has2021(self):
        """Vérifie que la source est 'has2021'."""
        dossier = _make_dossier(age=50, imc=17.0)
        _detect_nutrition_has2021(dossier)
        has_diags = [d for d in dossier.diagnostics_associes if d.source == "has2021"]
        assert len(has_diags) == 1

    def test_age_inconnu_seuils_adulte(self):
        """Âge inconnu → seuils adulte par défaut."""
        dossier = _make_dossier(age=None, imc=17.0)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E43" in codes  # IMC ≤ 17 → sévère (seuils adulte)

    def test_personne_agee_70_exact_seuil(self):
        """70 ans exactement → utilise les seuils gériatriques."""
        dossier = _make_dossier(age=70, imc=21.5)
        _detect_nutrition_has2021(dossier)
        codes = [d.cim10_suggestion for d in dossier.diagnostics_associes]
        assert "E44.0" in codes  # < 22 → modéré avec seuils ≥70


# ── Tests regex albumine (bio_extraction) ────────────────────────────


class TestAlbumineRegex:
    """Vérifie l'extraction regex de l'albumine."""

    ALBUMINE_PATTERN = r"(?:[Aa]lbumin[ée]?(?:mie)?|[Aa]lb(?:u)?[ée]?(?:mie)?)\s*[=:àa]?\s*(\d+(?:[.,]\d+)?)\s*(?:g/[Ll])?"
    PREALBUMINE_PATTERN = r"(?:[Pp]r[ée]albumine|[Tt]ransthyr[ée]tine)\s*[=:àa]?\s*(\d+(?:[.,]\d+)?)\s*(?:mg/[Ll]|g/[Ll])?"

    def test_albumine_standard(self):
        m = re.search(self.ALBUMINE_PATTERN, "Albumine = 28 g/L")
        assert m and m.group(1) == "28"

    def test_albumine_colon(self):
        m = re.search(self.ALBUMINE_PATTERN, "albumine: 32.5 g/L")
        assert m and m.group(1) == "32.5"

    def test_albumine_sans_unite(self):
        m = re.search(self.ALBUMINE_PATTERN, "Albumine 28")
        assert m and m.group(1) == "28"

    def test_albuminemie(self):
        m = re.search(self.ALBUMINE_PATTERN, "Albuminémie à 25 g/L")
        assert m and m.group(1) == "25"

    def test_prealbumine(self):
        m = re.search(self.PREALBUMINE_PATTERN, "Préalbumine = 0.15 g/L")
        assert m and m.group(1) == "0.15"

    def test_transthyretine(self):
        m = re.search(self.PREALBUMINE_PATTERN, "Transthyrétine: 180 mg/L")
        assert m and m.group(1) == "180"


# ── Tests regex texte dénutrition (DAS patterns) ────────────────────


class TestDenutritionRegexSeverity:
    """Vérifie que les patterns textuels de dénutrition détectent la sévérité."""

    def _match_pattern(self, text):
        """Retourne le (label, code) du premier pattern DAS matché."""
        text_norm = normalize_text(text.lower())
        for pat, label, code in _DAS_PATTERNS:
            if re.search(pat, text_norm):
                return label, code
        return None, None

    def test_denutrition_severe_gives_E43(self):
        _, code = self._match_pattern("denutrition severe")
        assert code == "E43"

    def test_denutrition_moderee_gives_E44(self):
        _, code = self._match_pattern("denutrition moderee")
        assert code == "E44.0"

    def test_denutrition_generic_gives_E46(self):
        _, code = self._match_pattern("denutrition")
        assert code == "E46"

    def test_malnutrition_severe_gives_E43(self):
        _, code = self._match_pattern("malnutrition severe")
        assert code == "E43"

    def test_denutrition_grade_iii_gives_E43(self):
        _, code = self._match_pattern("denutrition grade III")
        assert code == "E43"

    def test_hypoalbuminemie_severe_gives_E46(self):
        """hypoalbuminemie severe → E46 (pattern générique)."""
        _, code = self._match_pattern("hypoalbuminemie severe")
        assert code == "E46"