Hypoalbuminaemia was strongly associated with increased mortality, and this is in line with previous reports on perforated peptic ulcer.17 Indeed, several past studies found a relation between preoperative hypoalbuminaemia and poor post-operative outcomes across several surgical disciplines.18–20 This association may be due to the fact that a low serum albumin is closely correlated to a poor preoperative status of the patient, due to chronic disease, presence of underlying cancer, state of cachexia or other causes of malnutrition. The gene discussed is ALB; the disease is malnutrition.