Endothelial activation and stress index (EASIX) in restless legs syndrome: association with disease severity and comparison with healthy controls
Year: 2026
Type: article
Abstract: Background Endothelial dysfunction and chronic low-grade inflammation have been implicated in the pathophysiology of restless legs syndrome (RLS). The Endothelial Activation and Stress Index (EASIX), a composite biomarker calculated from serum lactate dehydrogenase, creatinine, and platelet count, reflects endothelial activation and systemic biological stress. However, its association with RLS has not previously been investigated. Objective To compare EASIX levels between patients with RLS and healthy controls and to evaluate the relationship between EASIX and disease severity. Methods This retrospective case–control study included 199 patients diagnosed with RLS according to the International Restless Legs Syndrome Study Group criteria and 190 healthy controls. Demographic, clinical, and laboratory data were collected retrospectively. EASIX was calculated as LDH (U/L) × creatinine (mg/dL) / platelet count (10⁹/L). Correlations between EASIX and disease duration, disease stage, and International Restless Legs Syndrome Rating Scale (IRLS) scores were assessed using Spearman’s correlation analysis. To account for the potential confounding effect of age, analysis of covariance (ANCOVA) was performed with age as a covariate. Results Patients with RLS had significantly higher unadjusted EASIX levels than healthy controls (0,520 ± 0,228 vs. 0,465 ± 0,159, p = 0.005). Serum lactate dehydrogenase, urea, WBC, Neutrophil and EASİX levels were also significantly higher, whereas serum iron levels were significantly lower in the RLS group. EASIX demonstrated weak but significant positive correlations with IRLS score ( r = 0.167, p = 0.018), disease stage ( r = 0.180, p = 0.011), and disease duration ( r = 0.198, p = 0.005). However, after adjustment for age, the difference in EASIX between the RLS and control groups was no longer statistically significant ( p = 0.490). In multivariable logistic regression analysis, EASIX was not independently associated with RLS (OR = 1.202, 95% CI: 0.621–2.328, p = 0.585). Conclusions EASIX levels were higher in patients with RLS than in healthy controls in the unadjusted analysis; however, this difference was no longer statistically significant after adjustment for age, and EASIX was not independently associated with RLS in multivariable analysis. Although weak correlations with disease severity and duration were observed in unadjusted analyses, these associations were not significant after age adjustment. These findings should therefore be considered exploratory and hypothesis-generating. The diagnostic, severity-related, and prognostic utility of EASIX as a biomarker in RLS remains to be established in prospective, longitudinal, and externally validated studies. Clinical trial number Not applicable.
Source: BMC Neurology
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7222894006
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