Pre-extubation calculated serum osmolality and early invasive reintubation in critically ill adults: a dual-database study with multicenter external replication
- 1Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- 2Department of Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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.
Methods: 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.
Results: 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.
Conclusion: 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.
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BibTeX
@article{huang2026preextubation,
title = {{Pre-extubation calculated serum osmolality and early invasive reintubation in critically ill adults: a dual-database study with multicenter external replication}},
author = {Weibin Huang and Jiaxiang Bian and Youli Chen and Baolin Huang and Chuling Liu and Cunrong Chen},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1984164},
url = {https://doi.org/10.3389/fmed.2026.1984164},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pre-extubation calculated serum osmolality and early invasive reintubation in critically ill adults: a dual-database study with multicenter external replication
AU - Weibin Huang
AU - Jiaxiang Bian
AU - Youli Chen
AU - Baolin Huang
AU - Chuling Liu
AU - Cunrong Chen
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1984164
UR - https://doi.org/10.3389/fmed.2026.1984164
AB - 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. Methods: 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. Results: 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. Conclusion: 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.
SN - 2296-858X
ER -