Distinct trajectories of PDI-measured dignity-related distress and associated factors Among ICU survivors during early post-ICU recovery: a prospective cohort study

Background With the increasing survival of critically ill patients, attention has shifted toward the long-term psychological outcomes of ICU survivors. Dignity-related distress may represent an important but under-recognized aspect of psychological recovery after critical illness. However, longitudinal patterns of PDI-measured dignity-related distress during early recovery after ICU transfer remain poorly understood. Objective This study aimed to identify distinct trajectories of PDI-measured dignity-related distress among ICU survivors and to explore factors associated with different trajectory patterns. Methods A prospective cohort study was conducted among ICU survivors from a tertiary hospital in Sichuan Province, China. The Patient Dignity Inventory (PDI) was administered at four time points after ICU transfer: at transfer (T1), 3 days (T2), 7 days (T3), and 14 days (T4). Latent class growth analysis (LCGA) was used to identify heterogeneous trajectories of PDI-measured dignity-related distress. Least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection, followed by multivariable logistic regression to examine factors associated with trajectory class membership after multivariable adjustment. Results A total of 305 ICU survivors meeting the eligibility criteria were initially enrolled, and 284 patients who completed all follow-up assessments were included in the final analysis. Two distinct trajectories of PDI-measured dignity-related distress were identified: a low-level gradual improvement trajectory (73.94%) and a high-level rapid improvement trajectory (26.06%). Although PDI-measured dignity-related distress decreased over time in both groups, patients in the high-level trajectory presented with significantly higher initial symptom levels. Multivariate logistic regression analysis showed that age (OR=1.103, 95% CI: 1.038–1.173), Clinical Frailty Scale (CFS) score (OR=0.560, 95% CI: 0.336–0.932), ICU length of stay (OR=1.199, 95% CI: 1.028–1.398), number of combined systemic dysfunctions (OR=2.180, 95% CI: 1.123–4.232), and primary diagnosis were significantly associated with trajectory class membership. Conclusion Among communicative and cognitively intact ICU survivors included in this cohort, exploratory analysis identified heterogeneous trajectories of PDI-measured dignity-related distress during early recovery after ICU transfer. These findings may help characterize variation in dignity-related psychological recovery and generate hypotheses for future studies of supportive care in this population.