Distinct Health‐Related Quality of Life Recovery Trajectories Among ICU Survivors: A Multicentre Prospective Cohort Study Using the EQ‐5D‐5L

Vollständiger Abstract

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ABSTRACT Background ICU survivors frequently experience reduced health‐related quality of life (HRQoL); however, recovery trajectories vary considerably, underscoring the need to identify distinct subgroups for targeted follow‐up. Aims To identify distinct HRQoL trajectory groups among ICU survivors, compare EQ‐5D‐5L profiles across groups and explore associated factors. Study Design This multicentre prospective study included 19 ICUs in four South Korean university hospitals. Adult survivors with admissions ≥ 24 h were assessed using the EQ‐5D‐5L over 24 months post‐discharge. Trajectory groups were identified via latent‐class mixed modelling, and associated factors via multinomial logistic regression. Results Among 609 survivors, three groups emerged: normative stable (58.3%), suboptimal (31.7%) and persistently low (10.0%). The normative stable group maintained HRQoL near the Korean population norm. The suboptimal group showed persistently reduced HRQoL, with moderate‐to‐extreme problems in mobility and pain/discomfort at 24 months. The persistently low group exhibited profound, sustained impairment, particularly in mobility, usual activities and pain/discomfort. Older age (aOR 1.72, 95% CI 1.07–2.75), lower educational attainment (aOR 2.11, 95% CI 1.34–3.32) and ICU delirium (aOR 2.14, 95% CI 1.10–4.15) were associated with suboptimal membership, whereas surgical admission showed lower odds (aOR 0.49, 95% CI 0.26–0.94). Multimorbidity (aOR 3.36, 95% CI 1.69–6.69) and discharge to an extended care facility (aOR 4.97, 95% CI 2.40–10.27) were associated with persistently low membership. Conclusions Three distinct HRQoL recovery trajectories emerged over 24 months post‐discharge. Although most survivors maintained near‐normal HRQoL, unfavourable groups experienced sustained impairment in mobility and pain/discomfort. These findings support trajectory‐based approaches for identifying high‐risk phenotypes and guiding individualised post‐ICU care. Relevance to Clinical Practice The persistent mobility and pain/discomfort problems highlight the importance of repeated assessment during post‐ICU follow‐up. Critical care nurses may consider them alongside ICU delirium history, multimorbidity and discharge destination; however, prospective validation is required before these trajectories or factors can identify high‐risk survivors. Trial Registration This study was prospectively registered with the Korean Clinical Research Information Service (KCT0004045). Registered 11 June 2019. First recruitment 11 June 2019