Clinical Research Directory

Inclusion Criteria: * presence in the surgery or trauma intensive care unit (ICU) at University of Florida (UF) Health Shands Hospital where clinical care can be managed by surgical critical care guided by standard operating procedures. * age of ≥18 years * placed on EMR sepsis protocol with sepsis/septic shock by Sepsis-3 criteriad * ability to obtain informed consent. Exclusion Criteria: * patients deemed to be futile care or have advanced care directives or goals of care limiting resuscitative efforts. * severe traumatic brain injury (evidence of neurologic injury on CT scan and a Glasgow Coma Scale (GCS) \<8 after resuscitation). * refractory shock (i.e., patients who die within 12 hours). * uncontrollable source of sepsis (e.g., irreversible disease state such as unresectable dead bowel) * severe Congestive Heart Failure (CHF) (NY Heart Association Class IV) * severe chronic liver disease (Childs-Pugh Class B/C and /or MELD \> 14) or pre-liver transplant. * known HIV infection with CD4 count \<200 cells/mm3 * organ transplant recipient on immunosuppressive agents * known pregnancy * prisoners * institutionalized patients * inability to obtain informed consent. * pre-hospital bedridden status (WHO/Zubrod score ≥ 4). * patient's with an exacerbation of historic CVD or new onset CVD * alternative or confounding diagnosis causing shock state (e.g. MI or PE) * enrollment \> 96 hours after suspected sepsis onset. * pre-existing state of Chronic critical illness (ICU LOS ≥ 14 days, includes outside facility) * interfacility transfer patients with \> 96 hour critical illness prior to transfer. * subsequent clinical adjudication not consistent with sepsis/septic shock by Sepsis-3 criteria Healthy Controls Inclusion criteria will be: * all adults (age ≥18) * Ability to obtain Informed Consent prior to blood collection. Exclusion Criteria will be: * Current, chronic steroid use * Pregnancy