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Identification of Symptom Clusters and Core Symptoms in Inflammatory Bowel Disease: A Network Analysis in Chinese
Zhihang Zhong1,2, Yu Luo1, Qin Xie2
1School of Nursing, Army Medical University/Third Military Medical University, Chongqing, China, tmmu.edu.cn.
Background:
Research on symptom clustering in patients with inflammatory bowel disease (IBD) using network analysis is limited. Core symptom clusters in Chinese patients with IBD have not been clearly defined, and comparative evidence between Crohn's disease (CD) and ulcerative colitis (UC) remains scarce, limiting the development of targeted symptom management strategies.
Methods:
Data were collected from three hospitals using the Chinese version of the symptom scale for IBD to assess symptom frequency, severity, and distress. Exploratory factor analysis was performed to identify symptom clusters. Symptom networks for CD and UC were constructed using JASP 0.19.1.0 to identify core and bridge symptoms. Bootstrap methods were applied to evaluate edge-weight accuracy and the stability of centrality indices.
Results:
Abdominal pain (78.3%) was the most prevalent symptom in patients with CD, whereas mucopurulent bloody stool (75.2%) was most common in patients with UC. Five symptom clusters were identified. In CD, diarrhea (Rs = 1.700) emerged as the core symptom, whereas diarrhea (Rb = 1.812) and abdominal pain (Rb = 1.812) functioned as bridge symptoms. In UC, weight loss (Rs = 1.421) was the core symptom, with nutritional deficiency serving as the primary bridge symptom (Rb = 1.931). Bootstrap analysis showed narrow confidence intervals for edge weights, and the stability coefficients for strength and closeness centrality exceeded 0.25, indicating robust and reliable networks.
Conclusion:
Five distinct symptom clusters were identified, and separate symptom networks were established for CD and UC. These findings provide evidence for disease-specific symptom prioritization and may support the development of targeted symptom management strategies.
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