ICU Survivors Show Two Distinct Paths of Dignity-Related Distress in Early Recovery

Patients leaving the intensive care unit do not all experience dignity-related distress in the same way, according to a prospective cohort study conducted at a tertiary hospital in Sichuan Province, China. Researchers tracked ICU survivors with the Patient Dignity Inventory (PDI) at four time points after ICU transfer—at transfer, three days, seven days, and fourteen days—and used latent class growth analysis to identify distinct patterns of distress over time. Among 284 patients who completed all follow-up assessments, two trajectories emerged: a low-level gradual improvement trajectory, which included 73.94% of patients, and a high-level rapid improvement trajectory, which accounted for 26.06%.

The study enrolled 305 ICU survivors who met the eligibility criteria, and the final analysis included the 284 patients who completed every follow-up assessment. Importantly, the cohort was restricted to communicative and cognitively intact survivors, since measuring dignity-related distress with a self-report inventory requires patients to understand and answer the questions. This limitation means the findings describe a specific subgroup of ICU survivors rather than all patients leaving intensive care, and the authors characterize the analysis as exploratory.

Dignity-related distress, as measured by the Patient Dignity Inventory, may represent an under-recognized aspect of psychological recovery after critical illness. With the increasing survival of critically ill patients, attention has shifted toward the long-term psychological outcomes of ICU survivors, yet longitudinal patterns of dignity-related distress during early recovery after ICU transfer had remained poorly understood. The new study aimed to identify distinct trajectories of this distress and to explore factors associated with different trajectory patterns.

The trajectory findings carry a nuanced message. 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. In other words, the roughly one in four patients on the high-level path started from a markedly more distressed position, even though their distress improved more rapidly across the fourteen-day observation window than the gradual improvement seen in the larger low-level group.

To understand why some patients fell into the high-level trajectory, the researchers applied a two-stage statistical approach. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection, followed by multivariable logistic regression to examine factors associated with trajectory class membership after adjustment. This combination helps reduce the influence of redundant variables before estimating the independent association of each factor with the trajectory a patient followed.

The adjusted analysis identified five factors significantly associated with trajectory class membership. Age was associated with higher odds of membership in the high-level trajectory, with an odds ratio of 1.103 (95% CI: 1.038–1.173), meaning each additional year of age raised the odds by roughly ten percent. The Clinical Frailty Scale (CFS) score showed an odds ratio of 0.560 (95% CI: 0.336–0.932), an inverse association in which higher frailty scores were linked to lower odds of belonging to the high-level group. ICU length of stay was associated with an odds ratio of 1.199 (95% CI: 1.028–1.398), and the number of combined systemic dysfunctions showed an odds ratio of 2.180 (95% CI: 1.123–4.232). Primary diagnosis was also significantly associated with trajectory class membership.

These statistical associations should be read as descriptive of this single-center cohort rather than as established causal effects. As an observational prospective cohort study, the design can identify factors that distinguish trajectory groups, but it cannot prove that any factor causes a particular pattern of dignity-related distress. The authors also frame the work as hypothesis-generating: the findings may help characterize variation in dignity-related psychological recovery and generate hypotheses for future studies of supportive care in this population.

The methods reflect a growing toolkit in symptom-trajectory research. Latent class growth analysis (LCGA) is a technique for identifying heterogeneous subgroups within a population that share similar developmental courses of a measured symptom, here applied to repeated PDI scores across the four time points. Combining LCGA with LASSO-based variable selection and multivariable logistic regression allowed the team to move beyond simply describing average change and instead ask which patient characteristics differentiated the two recovery patterns after adjustment for other variables.

The clinical context matters. Dignity-related distress during early post-ICU recovery has been under-recognized, and the study’s four-point measurement schedule—at ICU transfer and then three, seven, and fourteen days later—captures a period of intense physical and psychological adjustment. The observation that distress declined in both trajectory groups offers a broadly reassuring picture of early recovery among communicative, cognitively intact survivors, while the identification of a substantial minority with initially high distress levels suggests that a subset of patients may warrant closer attention to dignity-related concerns during this window.

For researchers, the study provides a template for examining psychological recovery after critical illness as a heterogeneous process rather than a single average course. For clinicians, the identified associations—with older age, longer ICU stays, more combined systemic dysfunctions, frailty scores, and primary diagnosis—may help flag which survivors could follow the higher-distress path, though the authors emphasize that these exploratory findings require confirmation in future studies before they can inform supportive care practices. The work was published in Frontiers in Medicine in the section Intensive Care Medicine and Anesthesiology.

Subject of Research: Trajectories of dignity-related distress among ICU survivors during early post-ICU recovery

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

Article References: Tang, H., Wu, Y., Yang, J., Wang, M., Lei, L., Nie, C., & Wu, X. (2026). Distinct trajectories of PDI-measured dignity-related distress and associated factors Among ICU survivors during early post-ICU recovery: a prospective cohort study. Frontiers in Medicine, 13, Article 1825732. https://doi.org/10.3389/fmed.2026.1825732

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1825732

Keywords: ICU survivors, dignity-related distress, Patient Dignity Inventory, latent class growth analysis, post-ICU recovery, prospective cohort study, psychological recovery, frailty, symptom trajectories, supportive care, Distinct, trajectories