Risk Factors for Ifosfamide-induced Encephalopathy: A Case Control Study at Dr. Kariadi Central General Hospital

Ifosfamide is a cytotoxic agent used in chemotherapy, with neurotoxicity—particularly encephalopathy occurring in approximately 10–30% of patients. This study aims to identify the risk factors associated with ifosfamide-induced encephalopathy (IIE) to aid in its prevention. A case-control study was conducted using secondary data from electronic medical records at the Pharmacy Installation of Dr. Kariadi Central General Hospital between January and June 2024. A total of 48 cancer patients who received ifosfamide were included, comprising 19 patients in the case group (with encephalopathy) and 29 in the control group (without encephalopathy). The analysis revealed that a higher dose of ifosfamide (5000 mg/m²) was significantly associated with increased risk of encephalopathy, with odds ratios ranging from 2.5 to 8.3 compared to a lower dose (1200 mg/m²). Patients with no history of prior chemotherapy had 0.3 to 8.8 times higher odds of developing encephalopathy than those with previous chemotherapy exposure, suggesting potential adaptive tolerance or protective mechanisms. Neo-adjuvant treatment was also associated with an increased risk (OR 0.5 to 0.14) compared to adjuvant therapy, possibly due to differences in disease burden or patient condition at the time of treatment. Additionally, patients with impaired liver function showed substantially higher risk (OR 6.1 to 7.4), highlighting the liver’s critical role in ifosfamide metabolism and neurotoxic metabolite clearance. High-dose ifosfamide, absence of prior chemotherapy, neo-adjuvant treatment, and impaired liver function are significant risk factors for ifosfamide-induced encephalopathy (IIE). These findings underscore the importance of individualized risk assessment before ifosfamide administration to improve patient safety and optimize therapeutic outcomes