Precision medicine in sepsis: reappraising glucocorticoid therapy through the lens of molecular endotypes

Sepsis is a life-threatening organ dysfunction syndrome with high mortality. Due to the heterogeneity of its clinical manifestations and treatment responses, it has long faced great challenges in clinical management. In recent years, the progress of molecular biology and omics technology has promoted the application of precision medical strategies based on molecular endotypes in sepsis research, which has opened up a new way for individualized treatment. Glucocorticoids are commonly used drugs in sepsis treatment, but their efficacy and safety vary significantly among patients with different molecular endotypes. The traditional one-size-fits-all therapy has been difficult to meet the complex clinical needs. This review systematically summarizes molecular endotype classifications in sepsis. It explores glucocorticoid mechanisms across different endotypes and summarizes recent clinical and preclinical advances. The article aims to provide theoretical foundations and practical guidance for precision therapy in sepsis, ultimately promoting personalized medicine in this field.