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

Table 2 Additional composite indices and observed variables included in sensitivity analyses¹

Composite index	Observed variable	Theoretical direction
Lipid pathway (lipid index)	Atherogenic index of plasma, AIP = log10(TG/HDL-C)	Positive: Higher AIP → greater atherogenic burden → theoretically higher hypercoagulability risk
Inflammation pathway (inflamm index)	Absolute neutrophil count (NEU)	Positive: Higher NEU → higher inflammatory/stress response → theoretically higher hypercoagulability risk
	Absolute monocyte count (MONO)	Positive: Higher MONO → higher chronic inflammation/monocyte–macrophage activation → theoretically higher hypercoagulability risk
	Lactate dehydrogenase (LDH)	Positive: Higher LDH → more tissue damage/inflammatory burden → theoretically higher hypercoagulability risk
	Systemic inflammation response index (SIRI = NEU × MONO / LYM)	Positive: Higher SIRI → higher immune-inflammatory burden → theoretically higher hypercoagulability risk
Nutritional/ immune sensitivity indices	CONUT score (albumin + total cholesterol + lymphocyte count)	Positive: Higher CONUT score → worse malnutrition → theoretically worse outcomes/higher hypercoagulability risk
	Prognostic nutritional index (PNI = ALB + 5 × LYM)	Negative: Higher PNI (better albumin and lymphocyte status) → better nutritional/immune status → theoretically lower hypercoagulability risk
Composite covariates	Observed variable	Theoretical direction
Hepatic burden domain (hepatic index)	Alanine aminotransferase (ALT)	Positive: Higher ALT → greater hepatocellular injury → theoretically higher hypercoagulability risk
	Aspartate aminotransferase (AST)	Positive: Higher AST → greater tissue injury → theoretically higher hypercoagulability risk
	Gamma-glutamyl transferase (GGT)	Positive: Higher GGT → greater metabolic/cholestatic burden → theoretically higher hypercoagulability risk
	Alkaline phosphatase (ALP)	Positive: Higher ALP → greater biliary/bone metabolic burden → theoretically higher hypercoagulability risk
	Total bilirubin (TBIL)	Positive: Higher TBIL → greater hepatic/cholestatic dysfunction → theoretically higher hypercoagulability risk
	Direct bilirubin (DBIL)	Positive: Higher DBIL → greater hepatobiliary dysfunction → theoretically higher hypercoagulability risk
Renal burden domain (renal index)	Blood urea nitrogen (BUN)	Positive: Higher BUN → worse renal function/protein metabolism → theoretically higher hypercoagulability risk
	Serum creatinine (Cr)	Positive: Higher Cr → worse renal function → theoretically higher hypercoagulability risk

¹The composite indices and observed variables listed in this table were incorporated exclusively in sensitivity analyses to evaluate the robustness of the main structural equation model. These indices were specified a priori as alternative or complementary operationalizations of key biological domains, including lipid-related atherogenic burden, inflammatory and immune activation, nutritional and immunological status, and hepatic and renal function. Theoretical directions indicate the expected contribution of each observed variable to its corresponding index based on established pathophysiological and clinical evidence. In general, higher index values were defined to represent greater pathway burden and a theoretically higher propensity toward hypercoagulability. The prognostic nutritional index was oriented inversely, such that higher values indicate better nutritional and immune status. Hepatic and renal indices were treated as additional composite covariates in sensitivity analyses and were not modeled as mediators in the primary structural equation model framework.

AIP: Atherogenic index of plasma; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; NEU: Absolute neutrophil count; MONO: Absolute monocyte count; LDH: Lactate dehydrogenase; SIRI: Systemic inflammation response index; LYM: Lymphocyte count; CONUT: Controlling nutritional status; PNI: Prognostic nutritional index; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; TBIL: Total bilirubin; DBIL: Direct bilirubin; BUN: Blood urea nitrogen; Cr: Creatinine.