ArticleThe clinical respiratory journal2026
D-Dimer: A Mediator of the Association Between Lymphocyte and Dissemination of Pulmonary Tuberculosis: A Retrospective Cohort Study.
Article in The clinical respiratory journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
introductionThis study aimed to examine whether D-dimer and lymphocyte counts predict the risk of concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) and to identify critical thresholds for clinical use. We also investigated whether D-dimer mediates the protective effect of lymphocytes against tuberculosis (TB) dissemination.
methodsOne thousand nine hundred (1318 PTB and 582 PTB + EPTB) patients diagnosed between 2022 and 2024 were analyzed. Multiple regression analysis, smooth curve fitting, threshold effect analysis, and causal mediation analysis were conducted using EasyStat and R software to evaluate the association between lymphocyte counts (exposure), D-dimer (mediator), and PTB + EPTB risk (outcome) and to determine the critical value of lymphocyte counts and D-dimer.
resultsPTB + EPTB patients had higher D-dimer and lower lymphocyte counts. Elevated D-dimer increased the risk of PTB + EPTB (adjusted OR = 2.28, 95% CI: 1.99-2.60). High lymphocyte counts reduced the risk (adjusted OR = 0.25, 95% CI: 0.13-0.46). Threshold effects showed increased risk when D-dimer exceeded 0.170 mg/L (OR = 2.35, 95% CI: 2.05-2.70) and reduced risk when lymphocyte counts exceeded 750 cells/μL (OR = 0.15, 95% CI: 0.07-0.32). D-dimer mediated 36.473% (95% CI: 25.469-53.168) of the protective effect of lymphocytes.
conclusionsD-dimer is an independent risk factor and lymphocyte counts a protective factor for PTB + EPTB, with D-dimer mediating 36.473% of the lymphocyte effect. Clinically actionable thresholds (D-dimer > 0.170 mg/L and lymphocytes < 750 cells/μL) provide concrete targets for early intervention to prevent TB dissemination and improve outcomes.
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