Macrophages are crucial immune cells in the body, with functions including phagocytosis, antigen presentation, immune defense, and inflammation regulation. Macrophages polarize into distinct subtypes within diverse microenvironments to further exert their immunoregulatory functions. Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, and it is the primary cause of mortality in critically ill patients. Macrophage polarization plays a significant role at different stages of the inflammatory response in sepsis, thereby influencing the clinical outcomes of septic patients. This review provides an overview of the characteristics of macrophage polarization and its role in sepsis immunity and organ dysfunction, aiming to offer new insights for improving the prognosis and treatment of septic patients.