The PRECISE trial aims to assess whether an electronic health record (EHR) alert recommending balanced crystalloids over normal saline for patients with group D sepsis reduces 30-day inpatient mortality. This pragmatic, randomized trial uses a machine learning algorithm to identify patients with a sepsis subphenotype (group D), previously shown to benefit from balanced crystalloids. The trial, conducted across multiple hospitals, could significantly influence sepsis resuscitation guidelines by introducing a precision medicine approach.
The group D sepsis sub-phenotype is characterized by lower body temperature, heart rate, and respiratory rate, along with hypotension. Patients in this group are typically older and show higher vasopressor use. Importantly, group D has a significantly higher 30-day mortality risk. However, in the SMART trial, group D patients experienced a substantial reduction in mortality when treated with balanced crystalloids compared to normal saline (OR 0.39, 95% CI 0.23-0.67, p < 0.001).
