Inclusion Criteria:  Sepsis defined by Sepsis-3 definition Initial systolic blood pressure < 90mmHg or blood lactate level >2mmol/L  Exclusion Criteria:  advanced directive for "Do not resuscitation" recent systemic administration of glucocorticoid (4 weeks) recent systemic administration of chemotherapy (4 weeks) recent systemic administration of immunosuppressant (4 weeks) expected life less than 90 days Transferred from other hospital Sepsis diagnosed 24 hours after ED admission Use of etomidate in ED pregnant or on lactation no informed consent