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Development of a Risk Predictive Model for Erectile Dysfunction at 12 Months after COVID-19 Recovery: A Prospective Observational Study - Beyond the Abstract

Erectile dysfunction (ED) is a disease with a high and growing prevalence worldwide.1 Since the emergence of COVID-19 in 20192 ED has shown a relationship with COVID-19.3

It seems that the deleterious impact of COVID-19 on erectile function could last for at least one year after COVID-19 recovery.4 Erectile function, apart from the sexual sphere, is a well-known marker of cardiovascular3,5 and general health.5 Therefore, it would be important to recognise those patients who are at risk of having long-lasting ED after COVID-19 recovery.

In our work, we aimed to develop a risk-predictive model for the identification of features involved in the prediction of ED 12 months after COVID-19 recovery, through a prospective multicentric study. 361 participants were divided into 2 cohorts: 1)Patients with a history of COVID-19 (n=166) and 2)Patients with no history of COVID-19 (n=195). We assessed ED in both groups using the 5-item International Index of Erectile Function (IIEF-5). While the individuals of the first cohort were assessed for ED at approximately 12 months after COVID-19 recovery, those of the second cohort were assessed within the same time window. To compare the differences in the proportions of ED for both cohorts, we performed a test of proportions. We used a binary logistic regression model for the selection of the variables involved in the prediction of ED in our sample.

We found a higher prevalence of ED in the cohort of patients with a history of COVID-19 (55.9%) than in the non-COVID-19 cohort (44.1%), while the test of proportions showed statistical significance (p=7.4x10-5). We developed a regression model of 40 variables that showed an Area Under the Curve (AUC) of 0.8. The top 15 variables in the model are shown in Table 1. A history of COVID-19 behaved as an independent predictor of ED, which demonstrates the relationship between COVID-19 and ED, even 12 months after recovery.

Table 1. Top 15 variables with the highest weight in the ED predictive model.

Given that COVID-19 seems far from being eradicated, the application of post-COVID-19 ED predictive models in community settings could lead to the early diagnosis of this condition.6,7 These patients could then be subjected to a cardiovascular assessment that could avoid the onset of cardiovascular diseases and their adverse impact on healthcare systems. Future investigations should include a specific analysis of the effect of SARS-CoV-2 vaccination on the erectile function of recovered COVID-19 patients.

Written by: Fernando Natal Alvarez,1,2 Maria Consuelo Conde Redondo2 and Eduardo Tamayo Gomez3,4

  1. Urología Clínica Bilbao, Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
  2. Department of Urology, Clinic University Hospital of Valladolid, 47003 Valladolid, Spain
  3. BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain
  4. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
References:

  1. Goldstein I, Goren A, Li VW, Tang WY, Hassan TA. Epidemiology update of erectile dysfunction in eight countries with high burden. Sex Med Rev. 2020 Jan;8(1):48-58. DOI: 10.1016/j.sxmr.2019.06.008.
  2. Lamers MM, Haagmans BL. SARS-CoV-2 pathogenesis. Nat Rev Microbiol. 2022 May;20(5):270-284. DOI: 10.1038/s41579-022-00713-0
  3. Sansone A, Mollaioli D, Ciocca G, Colonnello E, Limoncin E, Balercia G et al. “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID‐19. Andrology. 2021;9(4):1053-1059. DOI: 10.1111/andr.13003.
  4. Gök A, Altan M, Dogan AE, Eraslan A, Uysal FS, Öztürk U et al. Does post-COVID-19 erectile dysfunction improve over time? J Clin Med. 2023;12(3):1241. DOI: 10.3390/jcm12031241.
  5. Jannini EA. SM = SM: The interface of systems medicine and sexual medicine for facing non-communicable diseases in a gender-dependent manner. Sex Med Rev. 2017 Jul;5(3):349-364. DOI: 10.1016/j.sxmr.2017.04.002.
  6. Ghasemiyeh P, Mohammadi-Samani S. Lessons we learned during the past four challenging years in the COVID-19 era: pharmacotherapy, long COVID complications, and vaccine development. Virol J. 2024 Apr 26;21(1):98. DOI: 10.1186/s12985-024-02370-6
  7. Hu X, Hu Z, Xu T, Zhang K, Lu HH, Zhao J et al. Equilibrium points and their stability of COVID-19 in US. Sci Rep. 2024; 14:1628. DOI: 10.1038/s41598-024-51729-w
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