Predictive Accuracy of CROP Index, RSBI, and Integrative Weaning Index for Successful Extubation in Mechanically Ventilated ICU Patients: A Prospective Observational Study

<title>Abstract</title> <p> <bold>Background:</bold> Timely and accurate prediction of successful weaning from mechanical ventilation (MV) is a critical and consistently challenging aspect of intensive care unit (ICU) management. Both premature extubation (reintubation rate 10–25%) and delayed liberation carry significant morbidity and mortality risk. <bold>Objective:</bold> To compare the predictive accuracy of RSBI, CROP Index, and IWI for successful extubation in mechanically ventilated adult ICU patients. <bold>Methods:</bold> Single-centre prospective observational study (November 2025–April 2026). Ninety-three adults who were mechanically ventilated for&gt;24 hours and met standardised weaning readiness criteria were enrolled. All three indices were measured simultaneously before the Spontaneous Breathing Trial (SBT). ROC curve analysis (DeLong method), univariate and multivariate logistic regression, and chi-square tests were used. <bold>Results:</bold> Weaning success rate: 64.5% (n=60/93). CROP Index: AUC 0.973 (95% CI: 0.946–0.999; excellent); sole independent predictor on multivariate logistic regression (OR: 1.43, 95% CI: 1.21–1.69, p&lt;0.001; pseudo-R²: 0.696). IWI: AUC 0.550 (poor). RSBI: AUC 0.280 (inverse). No demographic or comorbid variable significantly predicted outcome. <bold>Conclusion:</bold> The CROP Index demonstrated outstanding predictive superiority over RSBI and IWI. Its multidimensional composite structure, integrating compliance, muscle strength, oxygenation, and breathing pattern, provides clinically decisive accuracy that single-domain indices cannot achieve. These findings support systematic integration of the CROP Index into ICU weaning protocols, particularly in settings where clinical decision-making is uncertain </p>