Zaizao Shengxue capsule for anemia: a prospective multicenter real-world study of hemoglobin response and predictive modeling
- 1Dongzhimen Hospital of Beijing University of Chinese Medicine
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: This prospective multicenter study included 440 patients from 14 centers who received ZSC for 8 weeks. Response was defined as an increase in hemoglobin of at least 20 g/L from baseline at week 8. The development cohort ( n = 338) was divided into a training cohort ( n = 238) and an internal validation cohort ( n = 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.
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BibTeX
@article{xing2026zaizao,
title = {{Zaizao Shengxue capsule for anemia: a prospective multicenter real-world study of hemoglobin response and predictive modeling}},
author = {Fuwei Xing and Jiaxin Wu and Cheng Cheng and Siyu Chen and Zihan Qin and Yuzhuo Wang and Yuqian Zhang and Junzi Tang and Xiao Li},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1957386},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1957386/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Zaizao Shengxue capsule for anemia: a prospective multicenter real-world study of hemoglobin response and predictive modeling
AU - Fuwei Xing
AU - Jiaxin Wu
AU - Cheng Cheng
AU - Siyu Chen
AU - Zihan Qin
AU - Yuzhuo Wang
AU - Yuqian Zhang
AU - Junzi Tang
AU - Xiao Li
PY - 2026
DA - 2026/10/19
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1957386
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1957386/full
AB - 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: This prospective multicenter study included 440 patients from 14 centers who received ZSC for 8 weeks. Response was defined as an increase in hemoglobin of at least 20 g/L from baseline at week 8. The development cohort ( n = 338) was divided into a training cohort ( n = 238) and an internal validation cohort ( n = 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.
SN - 1663-9812
ER -