Glycemic indicators influence hypercoagulability via multisystem pathways in psychiatric inpatients: Structural equation modeling

Table 1 Composite indices, observed variables, and theoretical directions in the main structural equation model¹

Composite index	Observed variable	Theoretical direction
Lipid pathway (lipid index)	Triglycerides (TG)	Positive: Higher TG → higher lipid index → theoretically higher hypercoagulability/thrombotic risk
	Total cholesterol (TC)	Positive: Higher TC → higher lipid index → theoretically higher hypercoagulability/thrombotic risk
	Low-density lipoprotein cholesterol (LDL-C)	Positive: Higher LDL-C → higher lipid index → theoretically higher hypercoagulability/thrombotic risk
	High-density lipoprotein cholesterol (HDL-C)	Negative: Higher HDL-C → lower lipid index (protective) → theoretically lower hypercoagulability risk
Blood pressure pathway (BP index)	Systolic blood pressure (SBP)	Positive: Higher SBP → higher BP index → theoretically higher hypercoagulability risk
	Diastolic blood pressure (DBP)	Positive: Higher DBP → higher BP index → theoretically higher hypercoagulability risk
Inflammation pathway (inflamm index)	C-reactive protein (CRP)	Positive: Higher CRP → higher inflamm index→ theoretically higher hypercoagulability risk
	Serum amyloid A (SAA)	Positive: Higher SAA → higher inflamm index → theoretically higher hypercoagulability risk
	Total white blood cell count (WBC)	Positive: Higher WBC → higher inflamm index → theoretically higher hypercoagulability risk
Nutritional pathway (nutrition index)	Hemoglobin (HB, marker of anemia and nutritional status)	Negative: Higher HB → lower nutrition index (better nutrition) → theoretically lower hypercoagulability risk
	Prealbumin (PAB, short-term nutritional marker)	Negative: Higher PAB → lower nutrition index (better nutrition) → theoretically lower hypercoagulability risk
	Total protein (TP, hepatic synthetic function and nutritional status)	Negative: Higher TP → lower nutrition index (better synthetic/nutritional status) → theoretically lower hypercoagulability risk
Coagulation substrate [coag (substrate) index]	Fibrinogen (FIB)	Positive: Higher FIB → higher endocoag index → theoretically higher hypercoagulability risk
	Platelet count (PLT)	Positive: Higher PLT → higher endocoag index → theoretically higher hypercoagulability risk
Coagulation function/time [coag (time) index]	Activated partial thromboplastin time (APTT)	Negative: Longer APTT → stronger anticoagulation/insufficient coagulation factors → theoretically lower hypercoagulability risk
	Prothrombin time (PT)	Negative: Longer PT → stronger anticoagulation/insufficient coagulation factors → theoretically lower hypercoagulability risk
	Thrombin time (TT)	Negative: Longer TT → more pronounced anticoagulation/fibrinolysis → theoretically lower hypercoagulability risk

¹Composite indices were defined to represent major biological pathway domains hypothesized to link glycemic dysregulation with hypercoagulability in the main structural equation model. Theoretical directions indicate the expected contribution of each observed variable to its corresponding composite index based on established physiological and clinical evidence. For most indices, higher values were specified to reflect greater pathway activity and, consequently, a higher theoretical propensity toward hypercoagulability. The nutrition index was oriented inversely, such that higher values indicate poorer nutritional status and potentially increased prothrombotic risk. Prior to structural equation model estimation, all observed variables were standardized and directionally aligned according to these theoretical assumptions to ensure interpretability and consistency of the composite indices.

TG: Triglycerides; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; BP: Blood pressure; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; CRP: C-reactive protein; SAA: Serum amyloid A; WBC: Total white blood cell count; HB: Hemoglobin; PAB: Prealbumin; TP: Total protein; FIB: Fibrinogen; PLT: Platelet count; APTT: Activated partial thromboplastin time; PT: Prothrombin time; TT: Thrombin time.