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The AGR Test

The albumin to globulin ratio or AGR test is an important test to know about and is often included as part of a comprehensive metabolic panel (requested by your treating doctor). This test measures proteins and other substances in the blood. It may also be used to help diagnose kidney disease, liver disease, or nutritional problems.

There are two major types of protein in the blood:

  • Albumin, which helps keep blood from leaking out of blood vessels. It also helps move hormones, medicines, vitamins, and other important substances throughout the body. Albumin is made in the liver.

  • Globulins, which help fight infection and move nutrients throughout the body. Some globulins are made by the liver. Others are made by the immune system.

In general (and simplified briefly!), serum albumin can be used to reflect nutrition status, whereas serum globulin can serve as an indicator of chronic inflammation.

The albumin/globulin (A/G) ratio compares the amount of albumin in your blood to the amount of globulin. Recent studies identified the albumin–globulin ratio (AGR) as a valuable marker for predicting the survival of patients with different types of blood cancers, solid cancers and other diseases such as chronic kidney disease and chronic obstructive pulmonary disease. A higher AGR predicts a better outcome in many of these conditions.

In general, an albumin/globulin ratio between 1.1 and 2.5 is considered normal, although this can vary depending on the laboratory performing the test. Your blood usually contains a little more albumin than globulin, which is why a normal ratio is slightly higher than 1. For reference, the total amount of albumin in the blood is normally around 3.4 to 5.4 g/dL, and the total amount of globulin should be about 2.0 to 3.9 g/dL.

A recent (2021) study published in the Journal of International Medical Research by Cai et al suggests that increased AGR was significantly associated with better outcomes in patients with multiple myeloma, and the optimal AGR cut off is 1.16.

It is accepted that malnutrition and inflammation are common and related to outcomes of patients with cancers (and other conditions). Treatment with good anti-inflammatory nutrition and natural anti-inflammatory agents (such as curcumin) might improve outcomes in these patients. MGUS/SMM patients will also benefit from these measures and an optimum AGR ratio!

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