Association between Albumin–Globulin Ratio and Mortality in Patients with Chronic Kidney Disease

Abstract

Background: Malnutrition and inflammation are highly prevalent and tightly regulated with each other in chronic kidney disease (CKD) patients. Inflammation can lead to malnutrition in patients with sufficient nourishment, while malnutrition may also induce an inflammatory response. This study investigated whether the albumin-globulin ratio (AGR) can predict the mortality risk in CKD patients. Methods: We enrolled 956 stage 3–5 CKD patients retrospectively at a medical center. Patients’ baseline characteristics including demographics, laboratory data, pharmacotherapy, and comorbidities were collected for statistical adjustments. The study patients were stratified into three AGR groups according to similar magnitudes of hazards for mortality as follows: low AGR group, AGR ≤ 1.0; moderate AGR group, 1.1 ≤ AGR < 1.3; high AGR group, AGR ≥1.3. Multivariate Cox proportional hazard analysis was performed to evaluate the association of the AGR with the study outcomes, including overall and cardiovascular disease (CVD) mortality. Results: During a median follow-up duration of 2.44 years, 108 (11.3%) deaths were recorded and 50 patients died from CVD. In adjusted model 1, the moderate AGR group was associated with hazard ratios (HR) of 0.57 (95% CI = 0.36–0.90, p = 0.016) and 0.52 (95% CI = 0.28–0.98, p = 0.043) for all-cause and CVD mortality compared with the low AGR group, respectively. The high AGR group was associated with HRs of 0.49 (95% CI = 0.27–0.90, p = 0.021) and 0.27 (95% CI = 0.1–0.74, p = 0.01) for all-cause and CVD mortality compared with the low AGR group, respectively. Similar results were obtained in the adjusted model 2 (inverse probability of the group weighted Cox model). In addition, the association between the AGR and mortality risk remained significant when the AGR was treated as a continuous variable. Conclusion: AGR is a significant biomarker predicting overall and cardiovascular mortality risk independent of various important factors amongst stage 3–5 CKD patients. We suggest that the AGR may be a simple and inexpensive measurement for detecting CKD patients at risk of mortality.

The Diagnostic Significance of Usual Biochemical Parameters in Coronavirus Disease 19 (COVID-19): Albumin to Globulin Ratio and CRP to Albumin Ratio

“…The AGR can be decreased in those conditions. In chronic kidney disease patients, it has been shown that AGR was associated with patient mortality of all causes as well as of cardiovascular diseases (14). Acute liver injury due to COVID-19 is associated with increased death risk, as it has been shown by Fu (15).…”

Predictors of in-hospital mortality in critically ill Geriatric patients

“…Also, non-survivors had a statistically significant lower serum total protein in comparison to survivors (5.7±.8 versus 6.2±1.1, P value .000), a finding supported by another prospective study showing a relationship between total protein and mortality in hospitalized patients [34] . Despite these statistically significant associations between low serum albumin, low total protein and observed mortality, only low total protein has remained as an independent predictor in the regression model that elicits the search for the potential role of the albumin-globulin ratio as a novel prognosticator and a reflective of both malnutrition and inflammation as reported in a previous study including patients with chronic kidney disease [35] .…”

Prognostic value of the albumin–globulin ratio and albumin–globulin score in patients with multiple myeloma

“…4 Recent studies identified the albumin-globulin ratio (AGR) as a valuable marker for predicting the survival of patients with different types of lymphoma 5,6 and other diseases such as chronic kidney disease and chronic obstructive pulmonary disease. 7,8 However, there is a lack of evidence regarding the predictive role of AGR and the albumin-globulin score (AGS) for mortality in patients with MM. The purpose of the current study was to evaluate the influence of AGR and AGS on clinical prognosis in patients with MM.…”