ALB and cancer: Nevertheless, increased creatinine is a well-recognized risk factor for mortality both in PPU patients and in other patient groups.5,20 Indeed, we recognize that several of the factors deemed to be of importance (e.g. albumin, bilirubin and creatinine levels) may be surrogates or indicators for other underlying factors, most likely attributed to pre-existing disease (such as presence of cancer or severe chronic illness) or the state of the acute disease (e.g. reflecting dehydration, state of infection or sepsis, or altered physiology or pending organ failure).