Prospective evaluation of the EASIX score for predicting erectile dysfunction: a comparative model analysis

This prospective study aimed to evaluate the predictive utility of the Endothelial Activation and Stress Index (EASIX) score in determining the presence and severity of erectile dysfunction (ED) and to compare its performance against a baseline clinical model. A total of 236 male patients (aged 18–65) were prospectively enrolled. Clinical data and laboratory parameters for EASIX calculation (LDH, creatinine, and platelet count) were recorded. ED severity was assessed via the IIEF-5 score. Multivariate logistic regression models were constructed to compare a baseline model (Model A: age, DM, and HT) against an integrated model (Model B: Model A + EASIX). Model performance was validated using AUC, Nagelkerke, and AIC. ED was identified in 57.6% of participants. Multivariate analysis identified the EASIX score (OR: 6.46, 95% CI: 3.76–11.9, p < 0.001), age, and DM as independent predictors of ED. A negative correlation was observed between EASIX and IIEF-5 scores (rho = -0.53, p < 0.001). Model B (baseline clinical variables + EASIX) demonstrated significantly higher predictive accuracy than Model A (baseline clinical variables: age, DM, HT) (AUC: 0.859 vs. 0.729; p < 0.001), with an improved Nagelkerke R 2 (0.482 vs. 0.204) and lower AIC. An EASIX cut-off of 1.123 yielded 86% sensitivity and 73% specificity. This study indicates that the EASIX score is a significant and independent predictor of erectile dysfunction. Its high predictive accuracy (AUC: 0.859) suggests that it may offer clinicians a valuable, cost-effective, and readily available screening tool to identify patients at higher risk of ED.