Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain.
BACKGROUND
Erectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed.


OBJECTIVE
Assess whether erectile function, defined with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI).


METHODS
Clinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI.


METHODS
Descriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1).


RESULTS
Complete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21-75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β=0.33; P=0.001) and decreased IIEF-EF values (β=-0.25; P=0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P=0.004) and IIEF-EF (OR: 0.95; P=0.04) emerged as significant predictors of categorized CCI.


CONCLUSIONS
Severity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED.
Department of Urology, University Vita-Salute San Raffaele, Milan, Italy. salonia.andrea@hsr.it
Andrea
A
Salonia
Giulia
G
Castagna
Antonino
A
Saccà
Matteo
M
Ferrari
Umberto
U
Capitanio
Fabio
F
Castiglione
Lorenzo
L
Rocchini
Alberto
A
Briganti
Patrizio
P
Rigatti
Francesco
F
Montorsi
D000328:Adult; D000368:Aged; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000503:physiopathology*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology*; D012307:Risk Factors; D012720:Severity of Illness Index