Factors Associated with Frailty in Patients with Active Inflammatory Bowel Disease: A Single-Center Observational...

Background and Objectives: Frailty is increasingly recognized as a clinically relevant condition in inflammatory bowel disease (IBD), yet available data remain limited and are often derived from indirect assessment methods. This study aimed to assess frailty using a Fried-derived index and to identify factors associated with frailty in adults with active IBD. Materials and Methods: We analyzed baseline data from a prospective, single-center cohort of adult patients hospitalized with active IBD who required initiation of biologic therapy or small molecules. Frailty was assessed using a modified Fried frailty index comprising shrinking, exhaustion, weakness, slowness, and low physical activity. Patients fulfilling ≥3 criteria were classified as frail, while those meeting 1-2 criteria were classified as pre-frail. Clinical, anthropometric, functional, laboratory, and questionnaire-based patient-reported measures were compared between frail and non-frail patients. Multivariate logistic regression was used to identify factors independently associated with frailty. Results: Seventy-five patients were included, of whom 45 (60%) were male and 44 (58.7%) had ulcerative colitis. The median age was 37 years. Frailty was identified in 17 (22.7%) patients, and 47 (62.7%) were pre-frail. Frail patients were younger (p = 0.001) and had a shorter disease duration (p = 0.036), higher disease activity scores (p = 0.005), higher C-reactive protein levels (p = 0.006), lower hemoglobin levels (p = 0.030) and serum albumin concentrations (p < 0.001), and lower body mass index (p < 0.001). In multivariate analysis, shorter disease duration (OR = 0.83, 95% CI: 0.70-0.97, p = 0.021) and lower serum albumin levels (OR = 0.17, 95% CI: 0.05-0.59, p = 0.005) were independently associated with frailty, whereas severe disease (OR = 2.14, 95% CI: 0.52-8.86, p = 0.294) was not significant after adjustment. Conclusions: Frailty and pre-frailty were highly prevalent in this selected cohort of relatively young adults with active IBD. Shorter disease duration and lower albumin levels were independently associated with frailty. Assessing frailty status may help identify vulnerable patients who could benefit from closer monitoring and multidisciplinary interventions.