In this study, a risk prediction model for nonresponse to prone position ventilation in acute respiratory distress syndrome (ARDS) patients was constructed, which demonstrated good predictive value and clinical utility.

Early identification of the response to prone position ventilation is needed to enable timely adoption of other possible treatment options, leading to improved patient prognosis and improved efficiency for health care professionals.

The overall rate of non-response to PPV in ARDS patients was approximately 32.6 %.

In the training cohort and validation cohort, the rate are 29.9 % and 34.5 % respectively.

Murray score ≥ 2.5 (OR: 4.29), procalcitonin (PCT) ≥ 2 ng/mL (OR: 2.52), N-terminal pro-B-type natriuretic peptide (Nt-proBNP) ≥ 2000 pg/ml (OR: 2.44), and hemoglobin ≤ 90 g/L (OR: 2.39) were independently associated with the rate of non-response to PPV and combined in prediction model. The model demonstrated good predictive value with AUC of 0.817 and 0.828 in the train and validation cohort.

Calibration curve showed good calibration and decision curve analysis indicated favorable clinical utility.

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