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

Abstract

Yanyan Wang,1,2,* Chengyong Li,1,2,* Weiyi Wang,1,2 Jiajia Wang,1,2 Jinhui Li,1,2 Shuangjie Qian,1,2 Chao Cai,3 Yuntao Liu1 1Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China; 2School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China; 3Department of Infectious Disease, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Disease, Hepatology Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuntao Liu, Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China, Tel +8657755579362, Email 18267850815@163.com Chao Cai, Department of Infectious Disease, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Disease, Hepatology Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of China, Tel +8613506662567, Email 13506662567@163.comObjective: 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 Ca2+ 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.Keywords: inflammatory bowel disease, biomarker, inflammation, malnutrition, activity evaluation