{
  "abstract": "Background: Extubation assessment focuses on respiratory, neurologic, and airway readiness, whereas osmotic-metabolic status has received less attention. We examined whether pre-extubation calculated hyperosmolarity was associated with early invasive reintubation and whether this association replicated across independent critical care databases.\n\nMethods: We analyzed the first eligible extubation in each hospital admission in MIMIC-IV and independently replicated the analysis in the multicenter eICU-CRD. Calculated serum osmolality was derived from sodium, glucose, and blood urea nitrogen measured within 24 h before extubation. Modified Poisson models estimated adjusted risk ratios (RRs) for 48-h invasive reintubation comparing calculated serum osmolality >300 with ≤300 mOsm/kg, using the same prespecified adjustment set in both databases. Secondary analyses evaluated 72-h reintubation and continuous associations, with additional sensitivity analyses addressing respiratory severity, fluid and renal status, threshold stability, and competing events.\n\nResults: We included 2,639 eligible extubations in MIMIC-IV, with 317 reintubations, and 1,390 in eICU-CRD, with 93 reintubations. In MIMIC-IV, 48-h reintubation occurred in 13.6% of index extubations with calculated serum osmolality >300 mOsm/kg and 10.8% with values ≤300 mOsm/kg (adjusted RR, 1.31; 95% CI, 1.05–1.62). The association replicated in eICU-CRD, where the corresponding risks were 10.5% and 4.6% (adjusted RR, 1.88; 95% CI, 1.27–2.77). The corresponding adjusted 72-h RRs were 1.25 (95% CI, 1.02–1.52) and 1.53 (95% CI, 1.19–1.97). Additional adjustment for respiratory severity produced little change within the corresponding measured subsets, whereas the continuous association was weaker in MIMIC-IV.\n\nConclusion: Pre-extubation calculated hyperosmolarity was associated with a higher risk of early invasive reintubation in two independent critical care databases. It may serve as an adjunctive metabolic–renal marker that complements established extubation assessment.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China",
    "Department of Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Weibin Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jiaxiang Bian"
    },
    {
      "affs": [
        1
      ],
      "name": "Youli Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Baolin Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Chuling Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Cunrong Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/aymemafjyphbd.bib",
  "cited_by": 0,
  "doi": "10.3389/fmed.2026.1984164",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731255/",
  "id": "aymemafjyphbd",
  "issns": [
    "2296-858X"
  ],
  "landing_url": "https://doi.org/10.3389/fmed.2026.1984164",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2740|Respiratory Support and Mechanisms"
    ]
  ],
  "openalex": "W7223121984",
  "pdf_url": "https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1984164/pdf",
  "pmcid": "PMC13731255",
  "pmid": "42984973",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/aymemafjyphbd.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:21:29Z",
      "native_id": "PMC13731255",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fmed.2026.1984164"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Respiratory Support and Mechanisms",
      "subfield": "general"
    }
  ],
  "title": "Pre-extubation calculated serum osmolality and early invasive reintubation in critically ill adults: a dual-database study with multicenter external replication",
  "title_text": "Pre-extubation calculated serum osmolality and early invasive reintubation in critically ill adults: a dual-database study with multicenter external replication",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:29Z",
  "url": "https://research.draconitic.com/paper/aymemafjyphbd",
  "venue": "Frontiers in Medicine",
  "versions": []
}