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.

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.

Table 3 Descriptive summary of clinical variables and observed laboratory measures¹

Variable	Unit	Missing (n)	Missing (%)	mean ± SD	Distribution
Glycemic exposures
FPG	mmol/L	0	0	6.5 ± 3.0	5.6 (5.0-6.8)
FA	mmol/L	0	0	1.7 ± 0.4	1.6 (1.5-1.8)
HbA1c	%	0	0	5.7 ± 1.0	5.4 (5.2-5.8)
FA-ALBcorr		4	0.08	3.90 ± 0.82	3.72 (3.42-4.12)
Outcomes
D-dimer	μg/mL	663	13.32	0.3 ± 0.8	0.1 (0.1-0.3)
log(D-dimer)		663	13.32	0.24 ± 0.29	0.14 (0.06-0.29)
D-dimer (+)		663	13.32		622 (14.4)
Components/derived measures
TG	mmol/L	3	0.06	1.7 ± 1.4	1.3 (0.9-2.0)
TC	mmol/L	70	1.41	4.5 ± 1.0	4.4 (3.8-5.0)
LDL-C	mmol/L	3	0.06	2.6 ± 0.9	2.5 (2.0-3.1)
HDL-C	mmol/L	3	0.06	1.3 ± 0.4	1.3 (1.1-1.5)
SBP	mmHg	1	0.02	125 ± 17	124 (114-135)
DBP	mmHg	1	0.02	80 ± 11	80 (72-87)
Hb	g/L	33	0.66	135 ± 16	134 (125-146)
PAB	mg/L	5	0.1	286 ± 73	278 (236-327)
TP	g/L	4	0.08	70 ± 6	71 (66-74)
ALB	g/L	4	0.08	44 ± 4	44 (41-47)
FIB	g/L	641	12.88	2.7 ± 0.7	2.6 (2.2-3.0)
PLT	× 109/L	33	0.66	239 ± 69	233 (193-281)
APTT	seconds	641	12.88	28.8 ± 4.9	28.1 (25.8-31.0)
PT	seconds	641	12.88	11.4 ± 1.3	11.3 (10.8-11.9)
TT	seconds	641	12.88	15.3 ± 3.9	16.8 (11.1-18.6)
ALT	U/L	0	0	25 ± 26	17 (12-27)
AST	U/L	0	0	24 ± 19	19 (16-25)
GGT	U/L	73	1.47	25 ± 30	17 (12-27)
ALP	U/L	5	0.1	81 ± 32	75 (61-93)
TBIL	µmol/L	1	0.02	10.5 ± 6.3	8.9 (6.4-12.6)
DBIL	µmol/L	2	0.04	3.1 ± 2.3	2.5 (1.8-3.6)
BUN	mmol/L	1	0.02	4.8 ± 1.8	4.5 (3.7-5.6)
Cr	µmol/L	1	0.02	63.6 ± 17.1	61.0 (53.0-72.0)
WBC	× 109/L	33	0.66	7.3 ± 2.4	6.9 (5.6-8.6)
CRP	mg/L	612	12.3	3.1 ± 9.0	0.8 (0.5-2.5)
SAA	mg/L	37	0.74	13.6 ± 38.1	5.8 (3.9-9.5)
LDH	U/L	3	0.06	173 ± 47	164 (144-190)
NEU	× 109/L	101	2.03	4.8 ± 2.1	4.3 (3.3-5.8)
MONO	× 109/L	101	2.03	0.5 ± 0.2	0.5 (0.4-0.6)
LYM	× 109/L	101	2.03	1.9 ± 0.7	1.8 (1.4-2.3)
AIP		3	0.06	0.02 ± 0.31	0.00 (-0.20-0.23)
SIRI		101	2.03	1.56 ± 1.57	1.12 (0.71-1.84)
CONUT		105	2.11
Normal (0-1)					4144 (85.1)
Mild malnutrition (2-4)					721 (14.8)
Moderate severe (5-8)					6 (0.1)
PNI		105	2.11	53.4 ± 5.5	53.2 (49.6-56.8)
Covariates
Age	years	0	0	41 ± 18	39 (26-56)
Gender, male		0	0		1762 (35.4)
BMI	kg/m2	0	0	23.1 ± 4.3	22.7 (20.1-25.5)
Hypertension (+)		0	0		893 (17.9)
Diabetes (+)		0	0		595 (12.0)
Hyperlipidemia (+)		0	0		210 (4.2)
Smoking Status		0	0
No history					4189 (84.2)
Current					705 (14.2)
Former					82 (1.6)
Alcohol Status		0	0
No history					4312 (86.7)
Current					629 (12.6)
Former					35 (0.7)
Body temperature (+)		0	0		912 (18.3)
Psychiatric duration	years	0	0	9 ± 10	5 (1-12)

¹Continuous variables are presented as mean ± SD and median (interquartile range), whereas categorical variables are reported as number (percentage). Percentages were calculated based on non-missing observations for each variable. D-dimer positivity [D-dimer (+)] was defined as a plasma D-dimer concentration > 0.5 μg/mL. Log-transformed D-dimer values were calculated as log(D-dimer + 1) to accommodate zero values and reduce skewness. Albumin-corrected fructosamine (FA-ALBcorr) denotes albumin-corrected fructosamine. The atherogenic index of plasma was calculated as log₁₀(triglyceride to high-density lipoprotein cholesterol ratio), and the systemic inflammation response index was defined as neutrophil × monocyte/ lymphocyte counts. Nutritional status was assessed using the Controlling Nutritional Status score and categorized as normal (0-1), mild malnutrition (2-4), or moderate to severe malnutrition (5-8). Abnormal body temperature [body temperature (+)] was defined as any recorded body temperature > 37.3 °C within the first 3 days after hospital admission and was treated as a binary variable (1 = criterion met; 0 = not met).

FPG: Fasting plasma glucose; FA: Fructosamine; HbA1c: Glycated hemoglobin; FA-ALBcorr: Albumin-corrected fructosamine; D-dimer (+): D-dimer positivity; TG: Triglycerides; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; Hb: Hemoglobin; PAB: Prealbumin; TP: Total protein; ALB: Albumin; FIB: Fibrinogen; PLT: Platelet count; APTT: Activated partial thromboplastin time; PT: Prothrombin time; TT: Thrombin time; 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; WBC: White blood cell count; CRP: C-reactive protein; SAA: Serum amyloid A; LDH: Lactate dehydrogenase; NEU: Absolute neutrophil count; MONO: Absolute monocyte count; LYM: Lymphocyte count; AIP: Atherogenic index of plasma; SIRI: Systemic inflammation response index; CONUT: Controlling nutritional status; PNI: Prognostic nutritional index; BMI: Body mass index.

Table 4 Explained variance (R²) of the composite index and outcome across diagnostic groups

Composite index/outcome	Overall (ALL)	Schizophrenia (SCZ)	Bipolar disorder (BD)	Depression (MDD)
Lipid index	0.207	0.231	0.251	0.171
BP index	0.186	0.209	0.275	0.134
Inflammation index	0.084	0.064	0.094	0.096
Nutrition index	0.291	0.286	0.295	0.265
Coagulation substrate index	0.265	0.234	0.27	0.303
Coagulation time index	0.048	0.019	0.101	0.113
D-dimer (+)	0.184	0.191	0.185	0.223

ALL: Overall; SCZ: Schizophrenia; BD: Bipolar disorder; MDD: Major depressive disorder.

Table 5 Standardized direct, indirect, and total effects of glycemic markers on D-dimer (+) across diagnostic groups (structural equation modeling)

Effect	Marker	Overall β (95%CI)	Std.β	SCZ β (95%CI)	SCZ Std.β	BD β (95%CI)	BD Std.β	MDD β (95%CI)	MDD Std.β
Direct	FPG	0.044 (0.017 to 0.071)	0.115	0.036 (-0.004 to 0.076)	0.11	0.057 (-0.007 to 0.121)	0.128	0.045 (-0.005 to 0.095)	0.094
Direct	FA	-0.640 (-0.879 to -0.402)	-0.192	-0.682 (-1.035 to -0.329)	-0.235	-0.665 (-1.257 to -0.073)	-0.172	-0.634 (-1.063 to -0.205)	-0.162
Direct	HbA1c	0.037 (-0.059 to 0.134)	0.035	0.026 (-0.126 to 0.179)	0.03	0.069 (-0.160 to 0.298)	0.059	0.085 (-0.090 to 0.259)	0.059
Indirect	FPG	-0.001 (-0.002 to -0.000)	-0.004	-0.001 (-0.002 to 0.000)	-0.003	0.000 (-0.003 to 0.003)	0	-0.001 (-0.003 to 0.002)	-0.001
Indirect	FA	-0.012 (-0.021 to -0.004)	-0.004	-0.003 (-0.010 to 0.004)	-0.001	-0.020 (-0.047 to 0.008)	-0.005	-0.019 (-0.043 to 0.005)	-0.005
Indirect	HbA1c	-0.002 (-0.004 to 0.001)	-0.002	-0.000 (-0.003 to 0.002)	0	-0.008 (-0.019 to 0.003)	-0.007	-0.016 (-0.028 to -0.003)	-0.011
Total	FPG	0.043 (0.016-0.070)	0.112	0.035 (-0.005 to 0.075)	0.107	0.056 (-0.008 to 0.121)	0.127	0.045 (-0.005 to 0.095)	0.093
Total	FA	-0.652 (-0.891 to -0.414)	-0.196	-0.685 (-1.037 to -0.332)	-0.236	-0.684 (-1.278 to -0.091)	-0.178	-0.653 (-1.081 to -0.225)	-0.167
Total	HbA1c	0.035 (-0.061 to 0.133)	0.033	0.026 (-0.126 to 0.178)	0.029	0.061 (-0.169 to 0.291)	0.052	0.069 (-0.104 to 0.242)	0.048

CI: Confidence interval; SCZ: Schizophrenia; BD: Bipolar disorder; MDD: Major depressive disorder; FPG: Fasting plasma glucose; FA: Fructosamine; HbA1c: Glycated hemoglobin.

Table 6 Stability of structural equation modeling structural pathways across diagnostic subgroups

Path	ALL Std.β (95%CI)	SCZ Std.β (95%CI)	BD Std.β (95%CI)	MDD Std.β (95%CI)
FPG → Lipid index	-0.04 (-0.09 to 0.01)	-0.06 (-0.15 to 0.02)	-0.07 (-0.20 to 0.06)	0.04 (-0.04 to 0.11)
FPG → BP index	0.11 (0.06, 0.16)	0.06 (-0.01 to 0.14)	0.08 (-0.02 to 0.19)	0.10 (0.02, 0.18)
FPG → Inflamm index	0.08 (0.02, 0.15)	0.14 (0.02, 0.26)	0.02 (-0.08 to 0.11)	-0.01 (-0.11 to 0.07)
FPG → Nutrition index	-0.04 (-0.09 to 0.00)	-0.00 (-0.09 to 0.08)	-0.02 (-0.12 to 0.08)	-0.10 (-0.19 to 0.00)
FA → Lipid index	0.23 (0.17, 0.27)	0.30 (0.24, 0.38)	0.17 (0.08, 0.26)	0.18 (0.10, 0.26)
FA → BP index	0.09 (0.05, 0.13)	0.06 (-0.01 to 0.14)	0.11 (0.03, 0.20)	0.06 (-0.00 to 0.13)
FA → Inflamm index	-0.00 (-0.06 to 0.06)	-0.04 (-0.14 to 0.08)	-0.02 (-0.11 to 0.11)	0.03 (-0.07 to 0.15)
FA → Nutrition index	-0.32 (-0.37 to -0.29)	-0.31 (-0.38 to -0.24)	-0.32 (-0.39 to -0.24)	-0.33 (-0.41 to -0.26)
HbA1c → Lipid index	0.06 (0.01, 0.12)	-0.00 (-0.10 to 0.09)	0.16 (0.03, 0.28)	0.06 (-0.03 to 0.16)
HbA1c → BP index	-0.05 (-0.11 to 0.00)	-0.03 (-0.13 to 0.06)	-0.02 (-0.12 to 0.08)	-0.01 (-0.09 to 0.08)
HbA1c → Inflamm index	0.04 (-0.01 to 0.10)	0.00 (-0.10 to 0.13)	0.11 (-0.02 to 0.24)	0.19 (0.10, 0.29)
HbA1c → Nutrition index	0.17 (0.11, 0.23)	0.18 (0.08, 0.28)	0.11 (0.00, 0.20)	0.16 (0.02, 0.26)
Lipid → Coag (substrate)	0.12 (0.08, 0.15)	0.11 (0.05, 0.16)	0.09 (0.03, 0.16)	0.14 (0.08, 0.19)
BP → Coag (substrate)	0.08 (0.05, 0.12)	0.08 (0.03, 0.13)	0.11 (0.03, 0.17)	0.05 (-0.00 to 0.09)
Inflamm → Coag (substrate)	0.42 (0.38, 0.46)	0.40 (0.35, 0.45)	0.41 (0.32, 0.51)	0.45 (0.39, 0.50)
Nutrition → Coag (substrate)	-0.01 (-0.04 to 0.02)	0.03 (-0.03 to 0.09)	-0.02 (-0.08 to 0.05)	-0.05 (-0.10 to 0.00)
Lipid → Coag (time)	0.07 (0.03, 0.11)	0.03 (-0.02 to 0.10)	0.12 (0.03, 0.20)	0.10 (0.05, 0.16)
BP → Coag (time)	0.07 (0.04, 0.11)	0.07 (0.03, 0.14)	0.04 (-0.03 to 0.11)	0.07 (0.02, 0.13)
Inflamm → Coag (time)	-0.02 (-0.06 to 0.01)	0.01 (-0.03 to 0.04)	-0.07 (-0.15 to 0.00)	-0.06 (-0.14 to 0.03)
Nutrition → Coag (time)	-0.01 (-0.07 to 0.04)	0.04 (-0.07 to 0.10)	-0.06 (-0.14 to 0.01)	-0.05 (-0.12 to 0.00)
FPG → D-dimer	0.12 (0.04, 0.18)	0.11 (-0.02 to 0.24)	0.13 (-0.03 to 0.28)	0.09 (0.00, 0.19)
FA → D-dimer	-0.19 (-0.27 to -0.13)	-0.24 (-0.38 to -0.12)	-0.17 (-0.33 to -0.02)	-0.16 (-0.28 to -0.06)
HbA1c → D-dimer	0.03 (-0.04 to 0.11)	0.03 (-0.10 to 0.17)	0.06 (-0.11 to 0.21)	0.06 (-0.05 to 0.16)
Lipid → D-dimer	0.00 (-0.05 to 0.06)	0.01 (-0.08 to 0.11)	-0.11 (-0.23 to 0.01)	0.06 (-0.03 to 0.14)
BP → D-dimer	-0.03 (-0.08 to 0.02)	-0.07 (-0.14 to 0.01)	-0.04 (-0.18 to 0.10)	-0.02 (-0.11 to 0.05)
Inflamm → D-dimer	0.16 (0.09, 0.26)	0.16 (0.06, 0.29)	0.21 (-0.02 to 0.38)	0.11 (-0.03 to 0.35)
Nutrition → D-dimer	0.08 (0.03, 0.13)	0.06 (-0.03 to 0.15)	0.16 (0.03, 0.27)	0.07 (-0.01 to 0.16)
Coag (substrate) → D-dimer	-0.09 (-0.15 to -0.03)	-0.06 (-0.15 to 0.02)	-0.12 (-0.25 to 0.02)	-0.12 (-0.26 to -0.03)
Coag (time) → D-dimer	-0.02 (-0.07 to 0.03)	-0.05 (-0.15 to 0.05)	-0.05 (-0.15 to 0.06)	0.05 (-0.02 to 0.14)

BP: Blood pressure; FPG: Fasting plasma glucose; FA: Fructosamine; HbA1c: Glycated hemoglobin.

Table 7 Model fit indices for the main structural equation modeling and sensitivity analyses¹

Model	NPAR	df	CFI	TLI	RMSEA	SRMR	RMSEA (CI)	NOBS
Main model	119	6	0.990	0.966	0.041	0.001	0.041 (0.030-0.053)	3783
SCZ subgroup model	119	6	0.988	0.960	0.037	0.001	0.037 (0.019-0.057)	1511
BD subgroup model	119	6	0.983	0.941	0.049	0.004	0.049 (0.025-0.075)	876
MDD subgroup model	119	6	0.989	0.962	0.053	0.003	0.053 (0.035-0.073)	1396
Sensitivity model
Sensitivity partial mediation (direct-coag) model	125	0	1	1	0	0	0.000 (0.000-0.000)	3783
Sensitivity full mediation model	112	13	0.958	0.933	0.057	0.026	0.057 (0.050-0.065)	3783
Sensitivity log(D-dimer) outcome model	120	6	0.949	0.821	0.044	0.141	0.044 (0.035-0.054)	3783
Sensitivity lipid (AIP) model	119	6	0.987	0.955	0.045	0.001	0.045 (0.034-0.057)	3783
Sensitivity inflammation (Winsor) model	119	6	0.987	0.956	0.040	0.001	0.040 (0.030-0.052)	3783
Sensitivity inflammation (SIRI) model	119	6	0.973	0.907	0.049	0.002	0.049 (0.039-0.060)	4284
Sensitivity inflammation (extended) model	119	6	0.986	0.952	0.042	0.001	0.042 (0.031-0.053)	3783
Sensitivity nutrition (CONUT) model	119	6	0.991	0.969	0.038	0.001	0.038 (0.027-0.050)	3783
Sensitivity nutrition (PNI) model	119	6	0.990	0.965	0.04	0.003	0.040 (0.030-0.052)	3783
Sensitivity coag (substrate) model	101	3	0.993	0.966	0.042	0.001	0.042 (0.027-0.059)	3783
Sensitivity coag (time) model	101	3	0.973	0.865	0.041	0.000	0.041 (0.026-0.058)	3783
Sensitivity coag (composite) model	101	3	0.994	0.968	0.051	0.001	0.051 (0.037-0.068)	3783
Sensitivity covars (extended) model	133	6	0.990	0.964	0.042	0.001	0.042 (0.031-0.054)	3783
Sensitivity single-sugar (FPG) model	109	2	0.997	0.973	0.038	0.001	0.038 (0.020-0.059)	3783
Sensitivity single-sugar (FA) model	109	2	0.985	0.839	0.089	0.002	0.089 (0.071-0.108)	3783
Sensitivity single-sugar (FA-ALBcorr) model	109	2	0.981	0.801	0.105	0.003	0.105 (0.086-0.124)	3783
Sensitivity single-sugar (HbA1c) model	109	2	0.995	0.946	0.076	0.002	0.076 (0.058-0.096)	3783
Sensitivity tri-sugar (FA-ALBcorr) model	119	6	0.992	0.972	0.039	0.002	0.039 (0.028-0.051)	3783
Sensitivity gly-composite (FA) model	109	2	0.985	0.842	0.089	0.002	0.089 (0.070-0.108)	3783
Sensitivity gly-composite (FA-ALBcorr) model	109	2	0.984	0.832	0.094	0.002	0.094 (0.075-0.113)	3783

¹This table reports global model fit indices for the main serial SEM, diagnosis-specific subgroup models, and a set of prespecified sensitivity analyses. Sensitivity analyses were designed to assess the robustness of the main mechanistic conclusions under alternative assumptions, including structural constraints (partial vs full mediation), outcome specification (binary vs continuous D-dimer), exposure definitions (single-glycemic indicators, alternative tri-sugar configurations, and glycemic composites), mediator operationalization (lipid, inflammatory, nutritional, and coagulation domains), and covariate extension. Models with zero degrees of freedom are just-identified; therefore, their fit indices (e.g., comparative fit index = 1.00, root mean square error of approximation = 0) are mathematically determined and should not be interpreted as indicators of superior model fit. The number of observations (number of observations) varies across models due to variable-specific missingness, with each model estimated using all available data under its corresponding specification. Sensitivity analyses were not intended to identify an optimal-fitting model, but rather to evaluate the stability and consistency of model fit and structural conclusions across alternative modeling scenarios.

NPAR: Number of free parameters; CFI: Comparative fit index; TLI: Tucker-Lewis index; RMSEA: Root mean square error of approximation; SRMR: Standardized root mean square residual; CI: Confidence interval; NOBS: Number of observations; SCZ: Schizophrenia; BD: Bipolar disorder; MDD: Major depressive disorder; PNI: Prognostic nutritional index; CONUT: Controlling nutritional status; FPG: Fasting plasma glucose; FA: Fructosamine; HbA1c: Glycated hemoglobin; ALB: Albumin; AIP: Atherogenic index of plasma.