Integrative analysis of inflammatory biomarkers and clinical features in endometriosis: insights into pain severity and diagnostic utility

Background & objective: Endometriosis is an estrogen-dependent inflammatory condition linked with chronic pelvic pain and infertility. It is usually associated with considerable morbidity, and offers diagnostic dilemmas. Biochemical analysis for inflammatory biomarkers can help the clinicians in early identification of this debilitation condition. This study aimed to explore the inflammatory profile in endometriosis by integrating clinical, demographic, and biomarker data. Methodology: A case-control study was conducted involving 90 premenopausal women; 45 with laparoscopically confirmed endometriosis and 45 age-matched controls) between October 2023 and December 2024 at specialized clinics in Al-Sadr Teaching Hospital, Iraq. Clinical data—including smoking status, infertility, and pain severity (assessed via a 10-point Visual Analog Scale)—were collected. Fasting serum samples obtained during the early follicular phase were analyzed for IL-6, TNF-α, LIF, and CRP using ELISA and immunoturbidimetric assays. Multivariable regression evaluated associations with pain severity. ROC analysis assessed diagnostic performance. Results: Women with endometriosis showed significantly elevated IL-6, TNF-α, CRP, and LIF levels. Inflammatory markers, more than BMI or age, were primary contributors to the pain severity. ROC analysis revealed moderate diagnostic accuracy for individual biomarkers. Conclusion: Our integrative study highlights the central role of inflammation in endometriosis and suggests that multi-marker panels may enhance diagnostic and prognostic strategies. Abbreviations: BMI: Body mass index, CRP: C-reactive protein, IL-6: interleukin-6, LIF: Leukemia inhibitory factor, TNF-α: tumor necrosis factor-alpha, VAS: Visual Analog Scale, VEGF: vascular endothelial growth factor Keywords: Endometriosis; Inflammatory Biomarkers; Pain Severity; Cytokines; Diagnosis Citation: Yaseen BR, Mohammed AJ, Salman SA, Alredha RDA. Integrative analysis of inflammatory biomarkers and clinical features in endometriosis: insights into pain severity and diagnostic utility. Anaesth. pain intensive care 2025;29(4):276-82. DOI: 10.35975/apic.v29i4.2812 Received: March 30, 2025; Revised: April 20, 2025; Accepted: April 20, 2025