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

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.