{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:32:00Z","timestamp":1793226720624,"version":"4.5.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To identify the composition and dynamic changes of symptom clusters in hospitalized acute pancreatitis (AP) patients, and to explore core and bridge symptoms via symptom network analysis, thereby providing a basis for precise symptom management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 194 AP patients admitted to a tertiary hospital in Mianyang, Sichuan from September 2024 to September 2025 were included. General information and the MD Anderson Symptom Inventory-Gastrointestinal Module were used for daily assessment. Exploratory factor analysis was applied to identify symptom clusters, and symptom networks were constructed using R software to analyze centrality indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three symptom clusters were identified: gastrointestinal symptom cluster, sleep-fatigue symptom cluster, and oropharyngeal-psychological distress symptom cluster. The acute pancreatitis symptom network exhibits a dynamic shift during hospitalization, evolving from an initial predominance of gastrointestinal symptoms to a later profile characterized by oropharyngeal-psychological discomfort and sleep-fatigue clusters. At T0, nausea had the highest strength centrality (rs\u202f=\u202f1.698), while fatigue was the strongest bridge symptom (rb\u202f=\u202f0.95). At T1, abdominal pain (rs\u202f=\u202f1.302) and pain (rb\u202f=\u202f0.913) were the most central and bridging symptoms, respectively. At T2, dry mouth (rs\u202f=\u202f1.018) and bloating (rb\u202f=\u202f0.683) exhibited the highest values. By T3, fatigue (rs\u202f=\u202f1.621) and pain (rb\u202f=\u202f1.59) again showed the highest centrality and bridge strength. Fatigue and abdominal pain are persistent core symptoms, with pain also serving as a crucial bridge symptom.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Symptom experiences in AP patients change dynamically during hospitalization. Targeting core and bridge symptoms can enhance precision and efficiency in symptom management, reducing the overall symptom burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1723941","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:33Z","timestamp":1768205973000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The dynamic trajectory of symptom networks in patients with acute pancreatitis during hospitalization"],"prefix":"10.3389","volume":"12","author":[{"given":"Xue","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hairong","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Decai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guirong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1016\/S0140-6736(20)31310-6","article-title":"Acute pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1038\/s41575-018-0087-5","article-title":"Global epidemiology and holistic prevention of pancreatitis","volume":"16","author":"Petrov","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1007\/s40265-022-01766-4","article-title":"Acute pancreatitis: diagnosis and treatment","volume":"82","author":"Szatmary","year":"2022","journal-title":"Drugs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"782151","DOI":"10.3389\/fmed.2021.782151","article-title":"Pain management in acute pancreatitis: a systematic review and meta-analysis of randomised controlled trials","volume":"8","author":"Cai","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"328","DOI":"10.4037\/ajcc2013533","article-title":"Thirst in critically ill patients: from physiology to sensation","volume":"22","author":"Arai","year":"2013","journal-title":"Am J Crit Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.sopen.2022.06.005","article-title":"Pancreatitis associated anxiety, depression, and stress: hypothesis, definition, and intervention","volume":"10","author":"McGuire","year":"2022","journal-title":"Surg Open Sci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e060107","DOI":"10.1136\/bmjopen-2021-060107","article-title":"Psychological experience of inpatients with acute pancreatitis: a qualitative study","volume":"12","author":"Ma","year":"2022","journal-title":"BMJ Open"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.genhosppsych.2017.09.008","article-title":"Diseases of the pancreas and suicide mortality: a nationwide nested case-control study among patients with mental health disorders in Taiwan","volume":"50","author":"Chen","year":"2018","journal-title":"Gen Hosp Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1177\/0269216310367842","article-title":"Symptom clusters: myth or reality?","volume":"24","author":"Aktas","year":"2010","journal-title":"Palliat Med [Internet]"},{"key":"ref10","first-page":"270","article-title":"Symptom clusters: concept analysis and clinical implications for cancer nursing","volume-title":"Cancer Nurs","author":"Kim","year":"2005"},{"key":"ref11","first-page":"465","article-title":"Symptom clusters and their effect on the functional status of patients with cancer","volume":"28","author":"Dodd","year":"2001","journal-title":"Oncol Nurs Forum"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3363","DOI":"10.1007\/s11136-024-03778-x","article-title":"Symptom clusters and impact on quality of life in lung cancer patients undergoing chemotherapy","volume":"33","author":"Luo","year":"2024","journal-title":"Qual Life Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2713","DOI":"10.1111\/jan.15302","article-title":"The prognostic impact of symptom clusters in patients with heart failure: a systematic review and meta-analysis","volume":"78","author":"Qiu","year":"2022","journal-title":"J Adv Nurs"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1146\/annurev-clinpsy-050212-185608","article-title":"Network analysis: an integrative approach to the structure of psychopathology","volume":"9","author":"Borsboom","year":"2013","journal-title":"Annu Rev Clin Psychol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2539","DOI":"10.1038\/s41598-024-84642-3","article-title":"Symptom clusters and networks analysis in acute-phase stroke patients: a cross-sectional study","volume":"15","author":"Zhou","year":"2025","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1007\/s00520-024-08918-0","article-title":"Symptom clusters and symptom network analysis during immunotherapy in lung cancer patients","volume":"32","author":"Yang","year":"2024","journal-title":"Support Care Cancer"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","article-title":"Estimating psychological networks and their accuracy: a tutorial paper","volume":"50","author":"Epskamp","year":"2018","journal-title":"Behav Res Methods"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2147\/DNND.S535306","article-title":"Symptom networks and associations with quality of life in patients with early to mid-stage Parkinson\u2019s disease: a network analysis","volume":"15","author":"Deng","year":"2025","journal-title":"Degener Neurol Neuromuscul Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2258","DOI":"10.1038\/s41598-018-36973-1","article-title":"Network analysis of the multidimensional symptom experience of oncology","volume":"9","author":"Papachristou","year":"2019","journal-title":"Sci Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1016\/j.jpainsymman.2019.01.007","article-title":"Validation and application of the Chinese version of the M. D. Anderson symptom inventory gastrointestinal Cancer module (MDASI-GI-C)","volume":"57","author":"Chen","year":"2019","journal-title":"J Pain Symptom Manag"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1007\/s00520-009-0595-5","article-title":"Changes in symptom clusters in patients undergoing radiation therapy","volume":"17","author":"Kim","year":"2009","journal-title":"Support Care Cancer"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v048.i04","article-title":"Qgraph: network visualizations of relationships in psychometric data","volume":"48","author":"Epskamp","year":"2012","journal-title":"J Stat Softw"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00127-016-1319-z","article-title":"Mental disorders as networks of problems: a review of recent insights","volume":"52","author":"Fried","year":"2017","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.brat.2016.06.006","article-title":"Can network analysis transform psychopathology?","volume":"86","author":"McNally","year":"2016","journal-title":"Behav Res Ther"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","article-title":"Estimating psychological networks and their accuracy: a tutorial paper","volume":"50","author":"Epskamp","year":"2018","journal-title":"Behav Res Methods"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2747","DOI":"10.3748\/wjg.v29.i18.2747","article-title":"Current trends in acute pancreatitis: diagnostic and therapeutic challenges","volume":"29","author":"Zerem","year":"2023","journal-title":"World J Gastroenterol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1097\/MPA.0000000000000355","article-title":"Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis","volume":"44","author":"Tan","year":"2015","journal-title":"Pancreas"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"21","DOI":"10.4037\/ccn2019544","article-title":"Palliation of thirst in intensive care unit patients: translating research into practice","volume":"39","author":"Leemhuis","year":"2019","journal-title":"Crit Care Nurse [Internet]"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.12998\/wjcc.v8.i9.1561","article-title":"Nutrition management in acute pancreatitis: clinical practice consideration","volume":"8","author":"Lakananurak","year":"2020","journal-title":"World J Clin Cases"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1485822","DOI":"10.3389\/fpsyt.2024.1485822","article-title":"Bidirectional relationship between pain and sleep disturbance in middle-aged and older adults: evidence from the China health and retirement longitudinal study","volume":"15","author":"Yi","year":"2024","journal-title":"Front Psych"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1017\/S0033291719003817","article-title":"A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive-behavioral model of eating-disorder symptoms","volume":"51","author":"Christian","year":"2021","journal-title":"Psychol Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1002\/cam4.4904","article-title":"Contemporaneous symptom networks of multidimensional symptom experiences in cancer survivors: a network analysis","volume":"12","author":"Zhu","year":"2023","journal-title":"Cancer Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"22","DOI":"10.4292\/wjgpt.v14.i3.22","article-title":"Update on the strategy for intravenous fluid treatment in acute pancreatitis","volume":"14","author":"Yaowmaneerat","year":"2023","journal-title":"World J Gastrointest Pharmacol Ther"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/MCG.0000000000001485","article-title":"Nausea and vomiting in 2021: a comprehensive update","volume":"55","author":"Heckroth","year":"2021","journal-title":"J Clin Gastroenterol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"603","DOI":"10.3945\/ajcn.116.132605","article-title":"Minor degree of hypohydration adversely influences cognition: a mediator analysis","volume":"104","author":"Benton","year":"2016","journal-title":"Am J Clin Nutr"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e82","DOI":"10.1016\/j.jpainsymman.2020.03.031","article-title":"To relieve the patient\u2019s thirst, refresh the mouth first: a pilot study using Mini mint ice cubes in severely dehydrated patients","volume":"60","author":"Lemyze","year":"2020","journal-title":"J Pain Symptom Manag"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"419","DOI":"10.14309\/ajg.0000000000002645","article-title":"American College of Gastroenterology guidelines: management of acute pancreatitis","volume":"119","author":"Tenner","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1016\/j.clnu.2024.03.008","article-title":"Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: a systematic review and meta-analysis","volume":"43","author":"Cort\u00e9s-Aguilar","year":"2024","journal-title":"Clin Nutr"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1080\/00273171.2019.1614898","article-title":"Bridge centrality: a network approach to understanding comorbidity","volume":"56","author":"Jones","year":"2021","journal-title":"Multivariate Behav Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1038\/nrendo.2011.153","article-title":"Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome","volume":"8","author":"Papadopoulos","year":"2011","journal-title":"Nat Rev Endocrinol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1093\/pm\/pnad148","article-title":"A network analysis of pain intensity and pain-related measures of physical, emotional, and social functioning in US military service members with chronic pain","volume":"25","author":"Wi","year":"2024","journal-title":"Pain Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.3390\/ijerph15122898","article-title":"Analysis of anxiety, depression and aggression in patients attending pain clinics","volume":"15","author":"Kosson","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"5019","DOI":"10.3748\/wjg.v27.i30.5019","article-title":"Gut microbiome in acute pancreatitis: a review based on current literature","volume":"27","author":"Patel","year":"2021","journal-title":"World J Gastroenterol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1177\/070674379303800703","article-title":"Anxiety and depression in patients with abdominal bloating","volume":"38","author":"Song","year":"1993","journal-title":"Can J Psychiatr"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1723941\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:33Z","timestamp":1768205973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1723941\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":45,"alternative-id":["10.3389\/fmed.2025.1723941"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1723941","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1723941"}}