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The Cox proportional hazards (CPH) method and random survival forest (RSF) algorithm were used for developing a mortality risk prediction model in the derivation cohort (n\u00a0=\u00a0763). The optimal model was simplified into a scoring system and validated in an external cohort of 431 patients from two institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The model constructed using the CPH method in the training cohort incorporated five prognostic factors: age at onset, lactate dehydrogenase, albumin, respiratory failure, and neutrophil\u2010to\u2010lymphocyte ratio. This model demonstrated better performance than the model developed using the RSF algorithm in the internal validation cohort and was subsequently transformed into a simplified scoring system, termed the ALARN score. The ALARN model achieved time\u2010dependent areas under the receiver operating characteristic curves of 0.914 (95% confidence interval [CI] 0.866\u20130.955), 0.867 (95% CI 0.829\u20130.906), 0.839 (95% CI 0.789\u20130.885), and 0.854 (95% CI 0.789\u20130.909) for predicting 1\u2010, 3\u2010, 5\u2010, and 10\u2010year mortality, respectively. Moreover, patients were effectively stratified into low\u2010, intermediate\u2010, and high\u2010risk groups (ALARN scores of 0\u20132, 3\u20135, and 6\u20138, respectively) with significantly different survival outcomes (log\u2010rank\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Internal and external validation confirmed the robustness of the ALARN score in predicting overall mortality in ASyS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ALARN score incorporates five readily available clinical parameters and provides a simple, practical tool for predicting mortality risk in patients with ASyS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.70249","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:15:53Z","timestamp":1781003753000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of the\n                    <scp>ALARN<\/scp>\n                    Model: A Predictive Mortality Score for Antisynthetase Syndrome"],"prefix":"10.1002","author":[{"given":"Shiyu","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Key Lab of Myositis China\u2010Japan Friendship Hospital  Beijing China"},{"name":"Department of Rheumatology and Immunology Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hourong","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology The First Affiliated Hospital of Zhengzhou University  Zhengzhou 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