Prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis: a systematic review and meta-analysis

Background and aims Liver cirrhosis is associated with an increased risk of developing erectile dysfunction (ED). The aim of this systematic review and meta-analysis was to evaluate the prevalence of ED and its risk factors in male patients with liver cirrhosis. Methods A systematic search of PubMed (Medline), EMBASE, OVID Medline, the Cochrane Library, and other databases was performed for this review. Two investigators reviewed the abstracts obtained from the search and selected manuscripts for full-text review. The event rates were calculated with random-effects model and quality effects model. Results Fourteen studies evaluating ED with the International Index of Erectile Function (IIEF) scores were selected. A total of 770 patients with liver cirrhosis were analyzed. The prevalence of ED in cirrhotic patients was 79% [decompensated: 88.4%, CI 35.95–70.84%, I 2 heterogeneity 85%; compensated: 53.6%, CI 77.64–32%, I 2 heterogeneity 80%]. Through a meta-regression analysis, we discovered that the presence of decompensation, use of beta-blocker and diuretics were related with ED. In addition, risk factors for ED included high body mass index [odds ratio (OR) 1.13, 95% CI 1.01–1.26], advanced Child–Pugh class (OR 2.29, 95% CI 1.12–4.72), MELD score (OR 1.19, 95% CI 1.05–1.35), diabetes (OR 3.44, 95% CI 1.38–8.57), and hypertension (OR 8.24, 95% CI 1.62–41.99). Conclusion ED is relatively common in male patients with cirrhosis, and presence of risk factors increases the prevalence of ED. Clinical trial number PROSPERO (International Prospective Register of Systematic Reviews), CRD42020220411.