Severe Sepsis and Septic Shock Registry

Inclusion Criteria: * two of more systemic inflammatory reaction syndrome criteria fever \> 38.3 'C or hypothermia \< 36'C, tachycardia over 90 bpm tachypnea over 20 per minute, leukocytosis (WBC over 12k/microL) or leukopenia (WBC below 4k/microL) * suspected or proven infection * any organ dysfunction as follows: 1. cardiovascular (hypotension, systolic blood pressure \<90 mmHg, mean arterial pressure \<70mmHg) 2. tissue hypoperfusion (lactate above upper limits laboratory normal) 3. acute lung injury (PaO2/inspired oxygen fraction \< 250 in the absence of pneumonia, PaO2/inspired oxygen fraction \< 200 in the presence of pneumonia) 4. acute kidney injury (Urine output \< 0.5mL/kg/hr for at least 2 hrs Serum creatinine \> 2.0 mg/dL) 5. acute liver injury (Total bilirubin \> 2mg/dL) 6. acute coagulopathy (Platelet count \< 100,000/μL or prothrombin time, international normalized ratio \> 1.5) Exclusion Criteria: * age less than 18 years old * patients with cardiac arrest at presentation * patients with advanced directives not to deliver aggressive organ supportive management