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Zaizao Shengxue capsule for anemia: a prospective multicenter real-world study of hemoglobin response and predictive modeling

Year: 2026

Type: article

Abstract: Objective: The aim in this study was to characterize the 8-week hemoglobin response among patients with anemia receiving Zaizao Shengxue capsule (ZSC) in real-world care and develop and externally evaluate a model for estimating the individual probability of response. Methods: = 100). Baseline predictors were selected in the training cohort. Ten candidate models were trained using different algorithms and compared in the internal validation cohort. After model selection and locking, the final model was independently evaluated in 102 patients from four external centers. SHAP and LIME were used for model interpretation. Results: Overall, 204 of 440 patients (46.4%) achieved an 8-week hemoglobin response. Response rates varied across anemia etiologies: 24.0% in cancer-related anemia (60/250), 74.4% in iron-deficiency anemia (67/90), and 77.0% in anemia of chronic disease (77/100). Anemia etiology, age, and estimated glomerular filtration rate (eGFR) were retained as predictors in the final Extra Trees model. The model achieved an area under the receiver operating characteristic curve (AUC) of 0.821 (95% CI, 0.729-0.902) in internal validation and 0.769 (95% CI, 0.670-0.860) in external validation. SHAP analysis identified anemia etiology as the largest contributor to model predictions, followed by age and eGFR. Conclusion: Eight-week hemoglobin response varied across anemia etiologies among patients receiving ZSC. A model incorporating anemia etiology, age, and eGFR may support individualized pretreatment estimation of response probability based on routinely available clinical information.

Source: Frontiers in Pharmacology

DOI: 10.3389/fphar.2026.1957386