The efficacy of systemic inflammatory response and oxidative stress in erectile dysfunction through multi-inflammatory index: a prospective cross-sectional analysis

Abstract

Background: Systemic inflammation and oxidative stress increase the possibility of erectile dysfunction (ED) through a coordinated response to vascular endothelial damage.

Aim: The study aimed to evaluate the status of oxidative stress and systemic inflammation in ED.

Methods: The analysis was a prospective, cross-sectional, single-center study. The study included non-ED (n = 54) and ED (n = 104) groups. The study analyzed demographics, clinical outputs, oxidative stress (total antioxidant status [TAS], total oxidant status [TOS], oxidative stress index [OSI]), and an inflammatory condition (multi-inflammatory index 1 [MII-1], MII-2).

Outcomes: Oxidative stress and systemic inflammation were evaluated together in ED, which was evaluated with the help of the International Erectile Function Index (IIEF) scale.

Results: TAS significantly decreased in the ED group compared with the non-ED group (2.25 ± 0.83 mmol Trolox equivalents/L vs 1.45 ± 0.65 mmol Trolox equivalents/L; P = .001). TOS increased in the ED group (14.1 ± 6.2 μmol H2O2 equivalents/L) compared with non-ED group (11.05 ± 6.8 μmol H2O2 equivalents/L) (P = .002). OSI was as low as 0.74 ± 0.33 in the non-ED group and as high as 2.38 ± 0.85 in the ED group (P = .001). Both MII-1 (273 ± 398 vs 745 ± 1311; P = .012) and MII-2 (4.66 ± 5.02 vs 19.7 ± 29.4; P = .031) increased in the ED group compared with the non-ED group. IIEF was negatively correlated with MII-1 (r = -0.298; P = .009), MII-2 (r = -0.341; P = .006), and OSI (r = -0.387; P < .0001), while TAS had a strong positive correlation with the IIEF (r = 0.549; P = .0001). OSI was correlated with MII-1 (r = 0.304; P = .001) and MII-2 (r = 0.334; P = .001). OSI was the strongest parameter in predicting ED (P = .0001; area under the curve, 0.795; 95% confidence interval, 0.696-0.855). The cutoff was 0.71 at 80.5% sensitivity and 67.2% specificity.

Clinical implications: OSI showed diagnostic potential for ED as an oxidative stress indicator, while MII-1 and MII-2 showed the effectiveness.

Strengths and limitations: MIIs, a novel indicator of systemic inflammatory condition, were analyzed for the first time in patients with ED. The long-term diagnostic efficacy of these indices was lacking, as all patient data did not include long-term follow-up.

Conclusion: Considering their low cost and easy applicability compared with OSI, MIIs could be essential parameters in the follow-up for ED for physicians.

Keywords: erectile dysfunction; inflammation; multi-inflammatory index; oxidative stress.