Abstract:

Objective To investigate the prevalence of social frailty among patients with inflammatory bowel disease（IBD） and identify key characteristics associated with social frailty，to provide evidence for early recognition and targeted intervention for social frailty in this population. Methods Using convenience sampling，260 patients with IBD who were hospitalized in the Department of Gastroenterology at a tertiary A hospital in Bengbu City，Anhui Province，between June 1，2025 and April 10，2026 were selected as study subjects. General Information Questionnaire，Social Frailty Index，Family APGAR Index Questionnaire，eHealth Literacy Scale，Inflammatory Bowel Disease Psychosocial Adaptation Questionnaire，Inflammatory Bowel Disease Disk，and Medical Coping Modes Questionnaire were used for investigation. A random forest model was established based on repeated stratified nested five-fold cross-validation. Within the outer training folds，univariate screening，recursive feature elimination，and hyperparameter tuning were conducted to determine the optimal decision threshold. The outer test folds were used to evaluate model performance，and a Shapley additive explanation（SHAP） analysis was also performed to identify the critical features associated with social frailty. Results A total of 257 patients were included in the study，with a prevalence of social frailty of 17.51% and pre-social frailty of 29.96%. The area under the receiver-operating characteristic curve （ROC-AUC） of the random forest model was 0.991（95%CI：0.982-0.997），and the area under the precision-recall curve（PR-AUC） was 0.960（95%CI：0.920-0.987），and the F1 score was 0.888. The SHAP factors were ranked in order of importance as follows：disease burden（0.078），level of family care（0.076），number of comorbid chronic conditions（0.074），e-health literacy（0.062）and psychological adaptation（0.053）. Conclusion Social frailty is highly prevalent in patients with IBD. Disease burden，level of family care，number of comorbid chronic conditions，e-health literacy and psychosocial adaptation are vital correlates of social frailty in this population. The findings of this study can serve as a reliable basis for recognizing high risk and early targeted screening for social frailty among patients with IBD.

Key words: Inflammatory Bowel Disease, Social Frailty, Random Forest, Root Cause Analysis, Nursing Care

摘要：

目的 调查炎症性肠病患者的社会衰弱现状并探讨与社会衰弱相关的重要特征，旨在为其社会衰弱的早期识别和精准干预提供依据。方法 采用便利抽样法，选取2025年6月1日—2026年4月10日在安徽省蚌埠市某三级甲等医院消化内科住院的260例炎症性肠病患者作为调查对象，采用一般资料调查表、社会衰弱指数量表、家庭关怀度指数问卷、电子健康素养量表、炎症性肠病心理社会适应问卷、炎症性肠病疾病负担程度量表、医学应对方式问卷进行调查。采用重复分层嵌套5折交叉验证构建随机森林模型，在外层训练折完成单因素变量筛选、递归特征消除、超参数优化与决策阈值确定，外层测试折评价模型性能，并通过沙普利可加性特征解释（Shapley additive explanations，SHAP）分析社会衰弱相关的重要特征。结果 共纳入257例患者，社会衰弱发生率为17.51%，社会衰弱前期发生率为29.96%。随机森林模型受试者工作特征曲线下面积为0.991（95%CI：0.982~0.997），查准-查全曲线下面积为0.960（95%CI：0.920~0.987），F1值为0.888。SHAP重要性排序依次为疾病负担程度（0.078）、家庭关怀度（0.076）、合并慢性病数量（0.074）、电子健康素养（0.062）、心理社会适应程度（0.053）。结论 炎症性肠病患者社会衰弱的发生率较高，疾病负担程度、家庭关怀度、合并慢性病数量、电子健康素养和心理社会适应是社会衰弱相关的重要特征，可为该人群的高危识别与早期筛查提供参考依据。

关键词: 炎症性肠病, 社会衰弱, 随机森林, 影响因素分析, 护理