Serum Albumin to Globulin Ratio is Associated with the Presence and Severity of Inflammatory Bowel Disease

OBJECTIVE: Serum albumin to globulin ratio (AGR) is a marker of inflammatory disease, but its role in inflammatory bowel disease (IBD) remains unknown. The primary purpose of the present research was to explore the relationship between serum AGR and inflammatory bowel disease (IBD). METHODS: A total of 179 patients with ulcerative colitis (UC), 210 patients with Crohn’s disease (CD), and non-IBD controls (age- and gender-matched controls who have gastrointestinal (GI) symptoms) were enrolled in the research. Demographic data, endoscopic score, and serum biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and Ca(2+) were included. The Mayo score and the Harvey-Bradshaw Index (HBI) were applied to evaluate the disease activity of UC and CD, respectively. RESULTS: Serum AGR was significantly lower among IBD patients compared with non-IBD controls. There was a negative association between serum AGR and Mayo score in patients with UC (r = −0.413, p < 0.001), and serum AGR was also associated with HBI score in patients with CD (r = −0.471, p < 0.001). After adjusting other potential variables, low serum AGR (below-median) was independently associated with Mayo score (β = −0.196, p = 0.026) and HBI score (β = −0.162, p = 0.022), respectively. The area under the curve (AUC) for AGR to distinguish UC was 0.701, and the AUC of CD was 0.759. Based on the optimal cut-off value, multivariate logistic regression indicates that low AGR can differentiate UC from non-UC (OR = 2.564, 95% CI = 1.433–4.587, p = 0.002) and CD from non-CD (OR = 3.732, 95% CI = 1.640–8.492, p = 0.001). CONCLUSION: AGR may become a promising candidate to help clinicians differentiate IBD and evaluate IBD disease activity. Inflammation and nutritional status might be the future directions to explore its mechanism.