{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:55:35Z","timestamp":1790920535109,"version":"4.1.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute exacerbation (AE) is the most lethal event of idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-ILD). This exploratory study compared clinical, radiomics, and combined predictor strategies across five survival-learning algorithms for survival risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 78 patients with AE-IIM-ILD and divided them into a training cohort (n = 54; 20 deaths) and a held-out internal testing cohort (n = 24; 9 deaths), stratified by observed mortality event status. Three predictor strategies were evaluated: a clinical strategy comprising PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      ratio, neutrophil percentage (NEU%), and arthritis-related symptoms; a radiomics strategy comprising two selected radiomics features; and a combined strategy comprising PaO\n                      <jats:sub>2<\/jats:sub>\n                      \/FiO\n                      <jats:sub>2<\/jats:sub>\n                      ratio, arthritis-related symptoms, and a composite radiomics score (Rad-score). Each strategy was evaluated using five survival-learning algorithms. Harrell\u2019s concordance index (C-index) was the primary discrimination metric, with mean time-dependent area under the curve (AUC) used as a secondary measure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 1-year follow-up, 29 deaths were observed. Performance rankings varied across predictor strategies, algorithms, and evaluation metrics. The combined-Random Survival Forest configuration demonstrated the highest training-cohort C-index among the 15 configurations. Its mean time-dependent AUC was 0.923 (95% CI: 0.860\u20130.970) in the training cohort and 0.915 (95% CI: 0.736\u20130.986) in the testing cohort, with corresponding C-indices of 0.874 (95% CI: 0.803\u20130.940) and 0.842 (95% CI: 0.673\u20130.971), respectively. The model stratified patients into high- and low-risk groups with distinct observed survival trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this exploratory cohort, integrating selected clinical variables with a quantitative CT Rad-score using RSF showed promising numerical discrimination and risk-stratification performance. These findings suggest that clinical and quantitative imaging information may provide complementary prognostic information after AE-IIM-ILD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1917500","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:36:19Z","timestamp":1790919379000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical variables and quantitative CT radiomics for mortality risk stratification after acute exacerbation of idiopathic inflammatory myopathy-associated interstitial lung disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Liyu","family":"He","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, 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University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhan","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youmin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Xi\u2019an Key Laboratory of Metabolic Disease Imaging, Xi\u2019an No.3 Hospital, Affiliated Hospital of Northwest University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenwang","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Shaanxi Engineering Research Center of Computational Imaging and Medical Intelligence","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.01.031","article-title":"Diagnosis and management of myositis-associated lung disease","volume":"163","author":"Hallowell","year":"2023","journal-title":"Chest"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-2600(24)00267-4","article-title":"Idiopathic inflammatory myopathies related lung disease in adults","volume":"13","author":"Sehgal","year":"2025","journal-title":"Lancet Respir 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