GBM model predicts respiratory failure in pneumoconiosis patients with C-index 0.794, but drops on external validation

In a retrospective cohort of 1367 pneumoconiosis patients, a gradient boosting survival model predicted respiratory failure with a C-index of 0.794 (3-year AUC 0.788) on internal testing, but dropped to 0.644 on external validation.

• Retrospective, single-center cohort with external validation set; median follow-up 2.69 years, 14.4% developed respiratory failure.
• Top predictors: pneumoconiosis stage, age, and body mass index; model showed higher net benefit on decision curve analysis.
• Performance declined on external validation (C-index 0.644), highlighting need for broader testing before clinical use.

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