Safety and Efficacy of Early Administration of Dexamethasone in High-risk Sepsis

The purpose of this study is to investigate the safety and efficacy of early administration of two different doses of dexamethasone in high risk septic patients.

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