Fig. 1

Trial schedule of the ADJUST study. Eligibility screening includes diagnosis, inclusion/exclusion criteria, urine pregnancy test for female, demographics, medical history and physical examination,as well as the presence of shock, ARDS, SIRS, Acute Circulatory Failure, time from diagnosis of sepsis, number of impaired organs. Vital signs include blood pressure, body temperature, heart rate, respiratory rate. Lab tests include complete blood count, serum alanine aminotransferase, aspartate aminotransferase and serum creatinine. Inflammatory biomarkers include hs-CRP, IL-6, TNF-α and IL-10, which are sent to central lab for test.*intervention means blinded ulinastatin 400000 IU 3 times a day or matching placebo and usual care.#The timeframes for D14, D28 and D90 allow deviations of 1, 3, 7 days, respectively.