Objective and Aim: There are conflicting results regarding the relationship between free cortisol levels and septic shock and mortality during sepsis. This study aims to determine the effect of free cortisol levels in septic shock and threshold free cortisol levels to predict mortality and septic shock in sepsis. Material and Methods: This study was conducted between January 2018 and January 2019 including patients with sepsis hospitalized in the intensive care unit (ICU). Free cortisol levels, demographic and clinical characteristics were recorded at the time of hospitalization. Cortisol levels, demographic and clinical characteristics were compared in non-survivor and survivor patients, patients with sepsis / severe sepsis and septic shock. Receiver operating characteristic (ROC) curves were used to examine the performance of variables in predicting sepsis mortality and septic shock. Area under the curve (AUC) was calculated from the ROC curve and cut-off values were noted. Results: During the study period, a total of 207 patients were diagnosed with sepsis and were enrolled into the study. Eighty-four (40.6%) of the patients died, 123 (59.4%) of them were discharged alive. Free cortisol levels (39.2 ± 16.8 µg / dL) in the non-survivor group were found to be significantly higher than the survivor group (28.7 ± 18.2 µg / dL) (p <0.001). The cortisol levels (32.1 ± 18.3 ug / dL) in patients with septic shock was found to be significantly higher than the cortisol level (21.8 ± 15.6 µg / dL) in patients with sepsis / severe sepsis (p <0.001). The AUC value of free cortisol for mortality predictivity in sepsis was 0.883 (95% confidence interval [CI]: 0.832-0.924; p <0.0001), and the cutoff value was> 21.4 µg / dL. The AUC value of free cortisol for septic shock predictivity was 0.702 (95% CI: 0.638-0.768; p <0.0001) and the cutoff value of free cortisol was> 17.2 µg / dL. Conclusion: There was significant association between increased free cortisol levels and septic shock and mortality in patients hospitalized in ICU due to sepsis.

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