Among patients initially presenting to the ED in nonsevere sepsis, an initial serum albumin <3.5 g/dL (OR 4.82; 95 % CI 2.40–9.69) and an ED triage diastolic blood pressure <52 mmHg (OR 4.59; 95 % CI 1.57–13.39) were both independently associated with the development of severe sepsis or shock within 96 h of ED presentation. The gene discussed is ALB; the disease is Sepsis.