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. This evidence concerns the gene ALB and nutritional deficiency disease.