Evidence map›Paper›PMID 25887140›Full record

Trial reportTrials2015

The INCA trial (Impact of NOD2 genotype-guided antibiotic prevention on survival in patients with liver Cirrhosis and Ascites): study protocol for a randomized controlled trial.

Markus Casper, Martin Mengel, Christine Fuhrmann, Eva Herrmann, Beate Appenrodt, Peter Schiedermaier, Matthias Reichert, Tony Bruns, Cornelius Engelmann, Frank Grünhage and 2 more

Open access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Trials, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
0.8field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Exploring the Relationship Between NOD2 Risk Variants and First Decompensation Events in Cirrhotic Patients With Varices.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Article
  4. Article
  5. Gut-liver axis signaling in portal hypertension.World journal of gastroenterology · 2019
    Review
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 7 institutions in 2 countries.

Markus CasperDepartment of Medicine II, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg, Germany. markus.casper@uks.eu.
Martin MengelStudy Center Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53125, Bonn, Germany. martinmengel@web.de.
Christine FuhrmannStudy Center Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53125, Bonn, Germany. christine.fuhrmann@ukb.uni-bonn.de.
Eva HerrmannInstitute for Biostatistics and Mathematical Modelling, Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. herrmann@med.uni-frankfurt.de.
Beate AppenrodtDepartment of Medicine II, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg, Germany. beate.appenrodt@uks.eu.
Peter SchiedermaierDepartment of Medicine, Nardini Hospital, Kaiserstraße 14, 66482, Zweibrücken, Germany. schiedermaier@nardiniklinikum.de.
Matthias ReichertDepartment of Medicine II, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg, Germany. matthias.reichert@uks.eu.
Tony BrunsDepartment of Medicine IV, University Hospital Jena, Bachstraße 18, 07743, Jena, Germany. tony.bruns@med.uni-jena.de.
Cornelius EngelmannDepartment of Medicine II, University Hospital Leipzig, Liebigstraße 18, 04103, Leipzig, Germany. cornelius.engelmann@medizin.uni-leipzig.de.
Frank GrünhageDepartment of Medicine II, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg, Germany. frank.gruenhage@uks.eu.
Frank LammertDepartment of Medicine II, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg, Germany. frank.lammert@uks.eu.
INCA trial group
Saarland University · DEGoethe University Frankfurt · DEUniversity Hospital Bonn · DEUniversity Hospital Leipzig · DEJena University Hospital · DENational Archives and Records Administration · USUniversitätsklinikum des Saarlandes · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with liver cirrhosis have a highly elevated risk of developing bacterial infections that significantly decrease survival rates. One of the most relevant infections is spontaneous bacterial peritonitis (SBP). Recently, NOD2 germline variants were found to be potential predictors of the development of infectious complications and mortality in patients with cirrhosis. The aim of the INCA (Impact of NOD2 genotype-guided antibiotic prevention on survival in patients with liver Cirrhosis and Ascites) trial is to investigate whether survival of this genetically defined high-risk group of patients with cirrhosis defined by the presence of NOD2 variants is improved by primary antibiotic prophylaxis of SBP. METHODS/

designThe INCA trial is a double-blind, placebo-controlled clinical trial with two parallel treatment arms (arm 1: norfloxacin 400 mg once daily; arm 2: placebo once daily; 12-month treatment and observational period). Balanced randomization of 186 eligible patients with stratification for the protein content of the ascites (<15 versus ≥ 15 g/L) and the study site is planned. In this multicenter national study, patients are recruited in at least 13 centers throughout Germany. The key inclusion criterion is the presence of a NOD2 risk variant in patients with decompensated liver cirrhosis. The most important exclusion criteria are current SBP or previous history of SBP and any long-term antibiotic prophylaxis. The primary endpoint is overall survival after 12 months of treatment. Secondary objectives are to evaluate whether the frequencies of SBP and other clinically relevant infections necessitating antibiotic treatment, as well as the total duration of unplanned hospitalization due to cirrhosis, differ in both study arms. Recruitment started in February 2014. DISCUSSION: Preventive strategies are required to avoid life-threatening infections in patients with liver cirrhosis, but unselected use of antibiotics can trigger resistant bacteria and worsen outcome. Thus, individualized approaches that direct intervention only to patients with the highest risk are urgently needed. This trial meets this need by suggesting stratified prevention based on genetic risk assessment. To our knowledge, the INCA trial is first in the field of hepatology aimed at rapidly transferring and validating information on individual genetic risk into clinical decision algorithms. TRIAL REGISTRATIONS: German Clinical Trials Register DRKS00005616 . Registered 22 January 2014. EU Clinical Trials Register EudraCT 2013-001626-26 . Registered 26 January 2015.

Indexed as

Antibiotic ProphylaxisClinical ProtocolsAscitesDouble-Blind MethodElectrocardiographyGenotypeHumansLiver CirrhosisNod2 Signaling Adaptor ProteinSample SizeNOD2 protein, humanNod2 Signaling Adaptor Protein

Identifiers

PMID25887140
PMCPMC4359533
OpenAlexW2139349913

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.