{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:54:42Z","timestamp":1785369282074,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The neutrophil percentage-to-albumin ratio (NPAR) is a novel composite marker reflecting both inflammatory and nutritional status. However, its association with arteriogenic erectile dysfunction (AED) has not been previously investigated. This study aimed to evaluate the relationship between NPAR and AED and to determine its diagnostic performance compared with conventional hematologic parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 265 men were enrolled from three hospitals between April 2023 and August 2025, including 115 with AED, 53 with venogenic ED (VED), and 97 healthy controls. Erectile function was assessed by the five-item International Index of Erectile Function (IIEF-5), nocturnal penile tumescence and rigidity (NPTR) test and color duplex Doppler ultrasonography (CDDU) was used to classify ED subtypes. Laboratory parameters, including white blood cell (WBC) count, neutrophil percentage (NP), albumin, and NPAR, were measured. Group differences were analyzed using ANOVA or the Kruskal\u2013Wallis test, and independent predictors of AED were identified using multivariate logistic regression. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Subgroup analyses were conducted to assess robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with controls, individuals with AED exhibited significantly higher WBC levels (5.97 \u00b1 1.13 vs. 5.45 \u00b1 0.90 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L; P &amp;lt; 0.05). NPAR values were markedly elevated in the AED group (16.31 [6.36]) relative to both VED (12.65 [5.57]) and controls (12.61 [7.05]) (P &amp;lt; 0.001). In the fully adjusted multivariate model, NPAR remained independently associated with AED (OR = 1.258; 95% CI: 1.159\u20131.362; P &amp;lt; 0.001), as did WBC (OR = 1.984; P &amp;lt; 0.001). ROC analysis revealed that NPAR had the greatest discriminative ability among all hematologic markers (AUC = 0.742; 95% CI: 0.676\u20130.809), with an optimal cut-off of 15.046 (sensitivity = 0.652; specificity = 0.753), outperforming WBC, NP, albumin, C-reactive protein (CRP), and neutrophils\/lymphocytes ratio (NLR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated NPAR levels were significantly associated with AED. Compared with WBC and its individual components, NPAR exhibited superior discriminative ability for identifying AED. These findings suggest that NPAR may serve as a convenient and cost-effective hematologic parameter for assessing vascular risk in men with ED, although prospective studies are needed to validate this association.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1729618","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T05:28:03Z","timestamp":1768800483000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Neutrophil percentage-to-albumin ratio as a novel hematologic biomarker for predicting arteriogenic erectile dysfunction"],"prefix":"10.3389","volume":"16","author":[{"given":"Yangyang","family":"Mei","sequence":"first","affiliation":[{"name":"Department of Urology, Jiangyin People\u2019s Hospital, the Jiangyin Clinical College of Xuzhou Medical University","place":["Jiangyin, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renfang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Urology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, Anhui, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianchao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Urology, The Second Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology, The Second Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingliang","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianfeng","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, Jiangsu, China"]},{"name":"Department of Urology, The First People\u2019s Hospital of Changzhou","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1001\/jama.1993.03510010089036","article-title":"Impotence. NIH Consensus Development Panel on Impotence","volume":"270","author":"Consensus Conference","year":"1993","journal-title":". JAMA"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0002-8614.2004.52413.x","article-title":"Changes in sexual function in middle-aged and older men: longitudinal data from the Massachusetts Male Aging Study","volume":"52","author":"Araujo","year":"2004","journal-title":"J Am Geriatr Soc"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.4065\/84.2.108","article-title":"A population-based, longitudinal study of erectile dysfunction and future coronary artery disease","volume":"84","author":"Inman","year":"2009","journal-title":"Mayo Clin Proc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2006.00423.x","article-title":"Prevalence of sexual problems and its association with social, psychological and physical factors among men in a Malaysian population: a cross-sectional study","volume":"5","author":"Quek","year":"2008","journal-title":"J Sex Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-0816","article-title":"Symptoms of diabetes and their association with the risk and presence of diabetes: findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD)","volume":"30","author":"Clark","year":"2007","journal-title":"Diabetes Care"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/ijir.2009.40","article-title":"Is erectile dysfunction a predictor of cardiovascular events or stroke? A prospective study using a validated questionnaire","volume":"22","author":"Ponholzer","year":"2010","journal-title":"Int J Impot Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4103\/aja.aja_74_18","article-title":"Mean platelet volume might be an effective indicator of arterial erectile dysfunction","volume":"21","author":"Wang","year":"2019","journal-title":"Asian J Androl"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4081\/aiua.2016.3.183","article-title":"Penile vascular diagnostic categorization using penile duplex Doppler ultrasound: Differences in vascular hemodynamics parameters by differences in anatomic sampling location","volume":"88","author":"Pezzoni","year":"2016","journal-title":"Arch Ital Urol Androl"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/andr.13437","article-title":"Capogrosso P et\u00a0al: The atherosclerotic cardiovascular disease risk score is a reliable tool to identify patients with arteriogenic erectile dysfunction","volume":"11","author":"Bertini","year":"2023","journal-title":"Andrology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2006.07.015","article-title":"Association between erectile dysfunction and coronary artery disease: Matching the right target with the right test in the right patient","volume":"50","author":"Montorsi","year":"2006","journal-title":"Eur Urol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1161\/CIRCOUTCOMES.112.966903","article-title":"Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies","volume":"6","author":"Vlachopoulos","year":"2013","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/BF03347500","article-title":"Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men","volume":"27","author":"Giugliano","year":"2004","journal-title":"J Endocrinol Invest"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.24.2978","article-title":"Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial","volume":"291","author":"Esposito","year":"2004","journal-title":"Jama"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e14337","DOI":"10.1111\/and.14337","article-title":"A systematic review and meta-analysis of the relationship between erectile dysfunction and the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios","volume":"54","author":"Zhang","year":"2022","journal-title":"Andrologia"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra043430","article-title":"Inflammation, atherosclerosis, and coronary artery disease","volume":"352","author":"Hansson","year":"2005","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S102819","article-title":"Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements","volume":"9","author":"Levitt","year":"2016","journal-title":"Int J Gen Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/j.0894-0959.2004.17603.x","article-title":"Serum albumin: relationship to inflammation and nutrition","volume":"17","author":"Don","year":"2004","journal-title":"Semin Dial"},{"key":"B18","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ejim.2018.04.014","article-title":"Human serum albumin in cardiovascular diseases","volume":"52","author":"Arques","year":"2018","journal-title":"Eur J Intern Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1557507","article-title":"The association between neutrophil percentage-to-albumin ratio and cardiovascular disease: evidence from a cross-sectional study","volume":"12","author":"Huang","year":"2025","journal-title":"Front Cardiovasc Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/resp.14589","article-title":"Predictive role of neutrophil-percentage-to-albumin, neutrophil-to-lymphocyte and eosinophil-to-lymphocyte ratios for mortality in patients with COPD: Evidence from NHANES 2011-2018","volume":"28","author":"Lan","year":"2023","journal-title":"Respirology"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14194892","article-title":"Prognostic value of neutrophil percentage-to-albumin ratio in patients with oral cavity cancer","volume":"14","author":"Ko","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.84.10.6079","article-title":"A critical evaluation of simple methods for the estimation of free testosterone in serum","volume":"84","author":"Vermeulen","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.sxmr.2018.10.005","article-title":"The role of nocturnal penile tumescence and rigidity (NPTR) monitoring in the diagnosis of psychogenic erectile dysfunction: A review","volume":"7","author":"Zou","year":"2019","journal-title":"Sex Med Rev"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)64071-2","article-title":"Penile duplex pharmaco-ultrasonography revisited: revalidation of the parameters of the cavernous arterial response","volume":"169","author":"Speel","year":"2003","journal-title":"J Urol"},{"key":"B25","first-page":"S64","article-title":"Evidence based assessment of erectile dysfunction","author":"Broderick","year":"1998","journal-title":"Int J Impot Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1093\/jsxmed\/qdae070","article-title":"Efficient use of penile Doppler ultrasound for investigating men with erectile dysfunction","volume":"21","author":"Flores","year":"2024","journal-title":"J Sex Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1192113","article-title":"Association between neutrophil to lymphocyte ratio and erectile dysfunction among US males: a population-based cross-sectional study","volume":"14","author":"Feng","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1038\/s41443-017-0007-1","article-title":"Relationship between erectile dysfunction and the neutrophil to lymphocyte and platelet to lymphocyte ratios","volume":"30","author":"Sambel","year":"2018","journal-title":"Int J Impot Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/S0302-2838(02)00027-1","article-title":"Prevalence and correlates of erectile dysfunction in Turkey: a population-based study","volume":"41","author":"Akkus","year":"2002","journal-title":"Eur Urol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1186\/s12872-023-03472-9","article-title":"The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with chronic heart failure","volume":"23","author":"Wang","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1397422","article-title":"Huang W et\u00a0al: Associations of neutrophil-percentage-to-albumin ratio level with all-cause mortality and cardiovascular disease-cause mortality among patients with hypertension: evidence from NHANES 1999-2010","volume":"11","author":"Liu","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-11-844530","article-title":"Neutrophils and NETs in modulating acute and chronic inflammation","volume":"133","author":"Castanheira","year":"2019","journal-title":"Blood"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22126272","article-title":"Endothelial dysfunction and neutrophil degranulation as central events in sepsis physiopathology","volume":"22","author":"Mart\u00edn-Fern\u00e1ndez","year":"2021","journal-title":"Int J Mol Sci"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1729618\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:36:04Z","timestamp":1771918564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1729618\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":33,"alternative-id":["10.3389\/fendo.2025.1729618"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1729618","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,19]]},"article-number":"1729618"}}