Development and Temporal Validation of Staged Prediction Models for Acute Respiratory Distress Syndrome After Thymic Epithelial Tumour Resection

Background/Objectives: To develop and temporally validate staged models for predicting acute respiratory distress syndrome (ARDS) after thymic epithelial tumour resection.

Methods

This single-centre retrospective study included 596 adults with pathologically confirmed thymic epithelial tumours. Patients treated in 2005–2020 formed the development cohort (n = 395), and those treated in 2021–2026 formed the temporal validation cohort (n = 201). Postoperative ARDS was adjudicated using the 2024 global definition. A preoperative model and a postoperative landmark model incorporating intraoperative, pathological, and early postoperative variables were developed using least absolute shrinkage and selection operator and multivariable logistic regression. Performance was assessed using discrimination, calibration, Brier score, decision curve analysis, bootstrap internal validation, and temporal validation.