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All Journal Jurnal Kedokteran Diponegoro Bioscientia Medicina : Journal of Biomedicine and Translational Research Medica Hospitalia Bioscientia Medicina : Journal of Biomedicine and Translational Research Magna Neurologica
Hexanto Muhartomo
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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The Double Inflammatory Burden: Red Cell Distribution Width as an Exploratory Biomarker for Functional Outcome in Ischemic Stroke with Comorbid Systemic Lupus Erythematosus Resita Indah Sukraputri; Endang Kustiowati; Hexanto Muhartomo; Dodik Tugasworo; Aris Catur Bintoro; Elta Diah Pasmanasari
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1594

Abstract

Background: Ischemic stroke in patients with systemic lupus erythematosus (SLE) presents a highly unique clinical phenotype characterized by amplified systemic inflammation, profound endothelial dysfunction, and a pervasive prothrombotic state. The combined, synergistic effect of this double inflammatory burden exacerbates acute neuronal injury and leads to significantly poorer clinical recovery. This study evaluated Red Cell Distribution Width (RDW), a widely available surrogate marker of systemic inflammation, oxidative stress, and impaired erythrocyte deformability, as a prognostic biomarker for functional outcomes in this specific, high-risk inflammatory phenotype. Methods: In this retrospective analytical pilot study, 34 adult patients diagnosed with acute ischemic stroke and comorbid SLE were analyzed. Admission RDW values, National Institutes of Health Stroke Scale (NIHSS) scores, and 90-day Modified Rankin Scale (mRS) scores were collected. A poor functional outcome was rigorously defined as an mRS score of 3–6. Statistical evaluation included Mann-Whitney U tests, Spearman rank correlation, receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression to adjust for baseline neurological severity. Results: RDW demonstrated a statistically significant positive correlation with initial stroke severity (NIHSS; r = 0.397; p = 0.020) and 90-day functional disability (mRS; r = 0.711; p < 0.001). The median RDW was significantly higher in patients with poor outcomes compared to those with good outcomes (15.6% versus 13.4%, p < 0.001). ROC analysis yielded an excellent Area Under the Curve of 0.89 (p < 0.001) with an optimal predictive cut-off established at 13.75%. In multivariable analysis adjusting for baseline stroke severity, an admission RDW of 13.75% or higher remained a strongly associated factor for severe long-term disability (adjusted Odds Ratio: 14.82, 95% Confidence Interval: 1.95–112.45, p = 0.009). Conclusion: RDW is a promising, inexpensive, and universally available prognostic biomarker that demonstrates a strong association with severe functional disability in ischemic stroke patients with comorbid SLE, accurately reflecting the profound neurotoxic impact of the double inflammatory burden.
Co-Authors Alifianto Parham Parakkasi Arinta Puspita Wati Aris Catur Bintoro Arrilia Putri Pramadita Asrina Enggarela Dodik Tugasworo Dwi Pudjonarko Elta Diah Pasmanasari Endah Herdianti Endang Kustiowati Erna Setiawati Fully Asmandita Haryani Halomoan Simon Hardian Hardian Ignatius Eka Perwira Wicaksana Indah Saraswati Kurnianto, Aditya Pipin Ardhianto Puspita Wati, Arinta Rahayu, Fitriani Tri Resita Indah Sukraputri Rofat Askoro Bimandoko Tanti Ajoe Kesoema