Endothelial activation and stress index is independently associated with arteriogenic erectile dysfunction: a cross-sectional study

Abstract Introduction Arteriogenic erectile dysfunction (AED) is the vascular subtype of erectile dysfunction and is closely linked to endothelial dysfunction. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase (LDH), creatinine, and platelet count, has been recognized as a surrogate marker of endothelial injury in several vascular-related conditions. The aim of this study is to explore the association between EASIX and AED. Methods In this cross-sectional study, 193 men were enrolled, including 94 patients diagnosed with AED and 99 controls. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5), nocturnal penile tumescence and rigidity, and color duplex Doppler ultrasonography. EASIX was calculated as LDH × creatinine/platelet count. Multivariate logistic regression analysis was performed to evaluate the association between EASIX and AED after adjusting for potential confounders. Receiver operating characteristic (ROC) curve analysis was conducted to assess diagnostic performance. Results EASIX levels were significantly higher in the AED group compared to controls (1.13 0.72–1.55 vs. 0.79 0.58–1.01, P .001). In multivariate logistic regression analysis adjusting for age, body mass index, smoking status, metabolic parameters, testosterone levels, and comorbidities, EASIX remained independently associated with AED (OR 1.339, 95% CI 1.239–1.448, P .001). When analyzed by quartiles, participants in the highest EASIX quartile had a significantly increased likelihood of AED compared with the lowest quartile (P .001). A significant negative correlation was observed between EASIX and IIEF-5 score (r = −0.291, P = .004). ROC analysis demonstrated that EASIX had moderate diagnostic performance for identifying AED (AUC 0.728, 95% CI 0.656–0.799), which was higher than LDH (AUC 0.680) and creatinine (AUC 0.689). Conclusion EASIX was significantly associated with AED and demonstrated moderate diagnostic performance. Prospective studies are warranted to validate its clinical applicability.