Inclusion Criteria:  Adult patients (≥ 18 years) who visit an ED directly and are suspected of sepsis with shock Shock is defined as hypotension (mean arterial blood pressure (MAP) < 65 or systolic blood pressure < 80) and tissue hypoperfusion such as an initial serum lactate level ≥ 4 mmol/dL.  Exclusion Criteria:  patients who are transferred from another hospital after initial fluid administration patients who have set limitations on treatment (e.g. patients with a signed do-not-resuscitate order) patients with moribund conditions with life expectancy less than 28 days due to secondary diseases or advanced malignant disease and palliative situations with life expectancy less than 6 months patients who have been administered albumin before enrollment patients who have known hypersensitivity to albumin Clinical conditions, where albumin administration may be unfavorable (e.g. pulmonary edema, congestive heart failure, traumatic brain injury) lactation patients who do not voluntarily consent to participate in the trial.