Early Steroid Treatment for Severe Sepsis

Inclusion Criteria: * Age of 18 years or older * Suspected or definite sepsis Sepsis is defined by SEPSIS-3 definition as Sequential Organ Failure Assessment (SOFA) score ≥ 2 from baseline with suspected infection.2 Suspected sepsis is defined as patients with suspected infection who meet 2 or more criteria of quick SOFA (altered mentation, respiratory rate ≥ 22/min, systolic blood pressure ≤ 100 mmHg). * Hypotension (mean arterial pressure \< 65 mmHg) Exclusion Criteria: * Randomization and administration of the study drugs are not able to be executed within 3 hours after the onset of hypotension * Causes of shock other than sepsis identified * Immunocompromised A patient is considered immunocompromised if one of the following criteria is met: history of human immunodeficiency virus infection or acquired immunodeficiency syndrome, hematologic malignancy, receiving chemotherapy, active cancer receiving chemotherapy, current use of immunosuppressive medication) * Hyperglycemic crisis (diabetic ketoacidosis, hyperosmolar hyperglycemic state) * Pregnancy * Post-cardiac arrest * Received etomidate before randomization * Systemic corticosteroids indicated for other conditions * Received systemic corticosteroids within 4 weeks at any dose * Cancer patients who are receiving palliative treatment * Do-not-resuscitate order