Association between inflammatory burden index and erectile dysfunction: a retrospective case-control study

Erectile dysfunction (ED) is a vascular disease associated with systemic inflammation and endothelial dysfunction. The role of inflammatory markers in the pathogenesis of ED is gaining increasing importance. This study aimed to evaluate the relationship between the Inflammatory Burden Index (IBI), calculated by combining C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), and erectile dysfunction.

This retrospective study included 126 patients with erectile dysfunction and 128 healthy controls who presented to the urology outpatient clinic between January 2023 and October 2025. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5). NLR was calculated as the ratio of absolute neutrophil count to absolute lymphocyte count, and IBI was obtained using the formula CRP × NLR. Diagnostic performance was examined using ROC analysis. Multivariate logistic regression analysis was performed to identify independent risk factors for erectile dysfunction.

IBI values were found to be significantly higher in the ED group compared to the control group (median 3.31 vs. 0.91, p < 0.001). No significant difference was found between the groups in terms of NLR. There was no significant difference in IBI values between the ED severity groups (p = 0.346). ROC analysis showed modest discriminatory ability of IBI for ED (AUC = 0.754; 95% CI: 0.696-0.813; p < 0.001). Based on the Youden index, the optimal cutoff value was 3.785, with sensitivity 43.7% and specificity 84.3% (Youden index = 0.280). Additionally, a weak positive correlation was found between IBI and body mass index (r = 0.197; p = 0.027). In multivariate logistic regression analysis, diabetes mellitus and cardiovascular disease were identified as independent predictors of erectile dysfunction, while IBI was not found to be an independent predictor.

IBI levels were significantly higher in patients with erectile dysfunction and may reflect systemic inflammatory burden associated with ED. However, because IBI was not an independent predictor in multivariable analysis and its discriminatory performance remained modest, its clinical utility as a standalone diagnostic or screening marker appears limited.