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We read with interest the article by Gibbs et al¹ describing preoperative serum albumin concentration as a predictor of operative mortality and morbidity. The authors are correct in identifying that preoperative hypoalbuminemia reflects preoperative disease severity, and therefore hypoalbuminemia would be expected to be associated with the risk of postoperative organ failures and a poorer outcome. In 1985, Fleck² showed that trauma, surgery, sepsis, and malignancy were all major causes of hypoalbuminemia owing to increased capillary permeability, which allowed albumin to escape from the vascular space. Preoperative hypoalbuminemia facilitates postoperative edema, which is powerfully associated with sepsis syndrome, acute renal failure, coma, and respiratory dysfunction requiring prolonged mechanical ventilation.³ We write to suggest that monitoring capillary permeability by measuring urine microalbuminuria before and after surgery provides a more sensitive way of predicting and caring for patients who will later develop clinical capillary leak syndrome, of which preoperative and surgically induced . . . [Full Text of this Article]