Inclusion Criteria:  the patients were the available data of clinical and laboratory diagnosis of sepsis and septic shock detection of gram-negative bacterial agent in blood or sputum culture. patients who had the shock symptoms such as hypotension, tachycardia or fever during the course of sepsis.  Exclusion Criteria:  had uncontrolled hemorrhage, diagnosed with cardiac failure at stage 4 or renal failure at stage 4 or hepatic liver failure at stage 4 cancer at the end stage or admitted with acute coronary syndrome.