Distant metastases conferred a substantially greater mortality risk, confirming previous findings.19 Unsurprisingly, higher SOFA scores and lactate were associated with reduced survival, as has been found in previous studies in patients with cancer and sepsis.7,8,10,16 Interestingly, the only other biochemical marker associated with survival was albumin, with a lower value conferring reduced survival. This evidence concerns the gene ALB and cancer.