Observational studyNeurosurgical review2025
Prognostic factors in aneurysmal subarachnoid hemorrhage during the clazosentan era: a multicenter study using multivariate analyses and machine learning model.
Observational study in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Machine learning versus conventional grading systems for prognostication in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.Neuroradiology · 2026Pooled it
- Subarachnoid Hemorrhage: Clazosentan vs. Fasudil for Vasospasm Prevention (SAVIOR) Study: Study Protocol for a Prospective, Multicenter, Randomized Trial.Neurocritical care · 2026Article
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Authors and funding
13 authors.
Funding
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Abstract
backgroundControlling delayed cerebral ischemia (DCI) is crucial for improving the prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to identify prognostic factors in patients with aSAH in Japan.
methodsA multicenter, retrospective, observational cohort study was conducted from April 2021 to March 2024. Patients underwent surgical repair of ruptured aneurysms within 48 h of onset, followed by postoperative treatment with multiple drugs, including clazosentan and fasudil, to prevent cerebral vasospasm. The primary outcome was the proportion of patients with a good outcome, defined as a modified Rankin Scale score of 0 to 2 at discharge. Multivariate logistic regression and stepwise model selection were applied to identify prognostic factors. SHapley Additive exPlanations (SHAP) analysis was used to visualize the relative importance of predictors and their impact on outcomes.
resultsAmong 506 patients (mean age 63.5 years, 66.6% female), 53.0% achieved a favorable outcome. In multivariate analysis, treatment with clazosentan was associated with 1.84 times higher odds of a favorable outcome (p = 0.021), increasing to 1.97 when clazosentan was administered without fluid retention complications (p = 0.010). SHAP analysis further highlighted the impact of each factor on prognosis, identifying a lower WFNS grade, lower Fisher grade, younger age, clazosentan, cilostazol, and statin use as significant predictors of favorable outcomes.
conclusionClinical status at aSAH onset and age are uncontrollable factors; therefore, improving prognosis requires targeted prevention of DCI and effective management of brain edema. The administration of therapies such as clazosentan, cilostazol, and statins may contribute to favorable outcomes. CLINICAL TRIAL NUMBER: Not applicable.
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