Albumin/Globulin Ratio: High and Low Ratios + Normal Range - SelfDecode Labs (2024)

Albumin/Globulin Ratio: High and Low Ratios + Normal Range - SelfDecode Labs (1)

Many illnesses can throw off the balance between albumin and globulin in your blood. Read on to learn what results are considered normal, the causes of high and low ratios, and what you can do to fix them.

What is an Albumin/Globulin Ratio Test?

The albumin/globulin ratio (A/G ratio for short) is a test that compares the concentrations of albumin and globulin in the blood [1, 2, 3]

Albumin and globulin are proteins that are naturally found in the serum, the liquid part of your blood that doesn’t include blood cells or clotting components [1].

An imbalance in the ratio of albumin to globulin may signify ongoing inflammation, liver problems, or in rare cases immunodeficiency. There is emerging evidence that a low ratio (less albumin and more globulin) may be associated with the risk of cancer and may also predict worse outcomes in cancer and heart disease patients [4, 5, 6, 7].

Overview of Serum Proteins

Albumin is the most common protein found in the bloodstream. Its main function is to maintain osmotic pressure, the mechanism that prevents fluids from leaking out of the blood vessels and into surrounding tissues [1].

Many substances (including some hormones, nutrients, and medications) can attach to albumin, making it an important transporter in the blood. Albumin also binds fats and helps with fat metabolism [1].

Globulins are a class of proteins found in the blood which come in several forms. Alpha and beta globulins act as transporters and can inhibit some enzymes. Gamma globulins, the immunoglobulins, act as antibodies. They bind to pathogens like viruses and play a vital role in the immune system [1].

Both albumin and globulin are primarily made in the liver, although some types of globulin are created by white blood cells [1].

Check out our articles on albumin and globulin for more information on each protein.

Albumin transports many nutrients, hormones, and medications and prevents fluid from leaking out of the blood vessels. Globulins are a class of proteins that include transporters and antibodies.

Albumin/Globulin Ratio

Your albumin/globulin ratio is usually checked during routine health examinations. The A/G ratio is derived from a total protein test, which uses a blood sample to measure the total combined amount of albumin and globulin in the blood [1].

In turn, the total protein test is part of a comprehensive metabolic panel (CMP), which is a series of 14 tests that check how well your metabolism is functioning. CMPs are commonly performed at annual checkups or during hospital stays [8].

As the name implies, results are reported as a ratio of albumin to globulin. For example, a result of 2:1 means you have twice as much albumin than globulin in your blood.

Because globulin is always set to a value of 1 in the ratio, results will sometimes omit the globulin number. For example, a ratio of 1.5:1 can be shortened to 1.5 instead. We’ll use this shortened version in the rest of the article for clarity.

The A/G ratio is derived from the total protein test, which itself is part of a comprehensive metabolic panel.

Normal Albumin/Globulin Ratio

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 [4].

Your blood usually contains a little more albumin than globulin, which is why a normal ratio is slightly higher than 1 [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 [1, 9].

Low Albumin/Globulin Ratio


There are several ways your albumin/globulin ratio may become low.

  • Your albumin is normal, but your globulin is very high
  • Your globulin is normal, but your albumin is very low
  • Your albumin is low and your globulin is high

Causes listed below have been commonly associated with a low A/G ratio. Your doctor will interpret your value, taking into account your medical history, symptoms, and other test results.

Here we’ll explore the common reasons for low albumin or high globulin levels in the blood.

Low Albumin

A wide range of health problems can cause low albumin in the blood, a condition called hypoalbuminemia.

One of the most common causes of low albumin is inflammation. During an illness or injury, your body focuses on producing proteins involved with the immune system, such as C-reactive protein (CRP). Under this kind of stress, the liver creates more immune-related proteins and less albumin [10, 11].

Liver disease is also a big factor. Albumin is made in the liver, so any disorder that affects the liver (like cirrhosis) may reduce albumin production [12].

Some other health conditions that can reduce albumin include:

  • Chronic illness and infection [13, 14, 15]
  • Malnutrition or gut disorders that cause malabsorption of protein, such as celiac or Crohn’s disease (also decrease globulin) [16, 13, 14, 1]
  • Kidney disease (also decrease globulin) [17]
  • Heart failure [18]
  • Extensive burns [19]
  • Obesity [20]

Inflammation, infection, chronic illness, and liver disease are the most common causes of low albumin.

High Globulin

High levels of globulin in the blood may be caused by:

  • Viral and bacterial infections [1, 21]
  • Inflammatory disorders [1]
  • Autoimmune disease [22, 23]
  • Liver disease [1]
  • Some types of cancer [24, 25, 26, 27]
  • Some drugs, such as amiodarone (Cordarone, Nexterone), used to treat and prevent irregular heartbeat [28]

The immunoglobulins, a common type of globulin also known as antibodies, bind to pathogens and foreign material, tagging them for your immune system to attack. Your body naturally produces more antibodies during an infection, resulting in higher globulin levels [29, 21].

High globulin levels are also commonly seen in people with chronic liver diseases like cirrhosis. The liver breaks down excess globulin and eventually eliminates it from the body. Liver disease can reduce this ability to remove globulins, and these proteins can build up in the blood [30].

Certain drugs may cause globulin to rise as well. A small study of 15 people found that some patients who experience toxicity from amiodarone also have high globulin levels; the reason for the rise in globulins is unknown [28].

Infections, liver disease, and certain types of cancer may cause high globulin levels.

Health Effects

Low albumin/globulin ratios are associated with a poor prognosis in many different diseases, which is unsurprising, given that these proteins are linked to inflammation and immune system dysfunction [1, 31].

In this section, we’ll explore the potential long-term effects of low A/G ratios, according to research. Keep in mind that it’s not clear if albumin or globulin themselves cause disease; rather, a low A/G ratio probably represents a deeper, underlying issue [1, 31].

1) Is Associated With The Risk of Cancer

A low albumin/globulin ratio may be putting you at risk for developing cancer. In an observational study of almost 27,000 people, participants with A/G ratios below 1.1 had an increased risk of developing cancer on average, even if they were otherwise healthy [4].

Liver and blood cancers were the most common in this study, but low ratios were associated with over 10 types of cancer altogether, including breast and lung cancers [4].

Researchers believe the common denominator and root cause is chronic inflammation, which leads to both lower A/G ratios and higher incidences of cancer [4, 32].

A low albumin/globulin ratio is associated with a higher risk of developing cancer.

2) May Help Predict Cancer Mortality

Apart from being associated with the risk of developing cancer, an A/G ratio may also indicate how well a cancer patient will respond to treatment [31].

In several studies, a lower A/G ratio has been associated with worse overall survival in:

  • Lung cancer [33]
  • Esophageal cancer [34]
  • Liver cancer [35, 36]
  • Colon cancer [37]
  • Kidney cancer [38]
  • Lymphoma [39]
  • Pancreatic cancer [40]
  • Intestinal cancer [40]

A study in 276 lung cancer patients has found that people with A/G ratios less than 1.29 were 1.35 times more likely to die on average than people with ratios greater than 1.29 [33].

How does this information help? If a doctor finds that a cancer patient has a low A/G ratio, they may decide to use a more intensive treatment to improve the chances of survival [31, 37, 34].

Lower albumin/globulin ratios are associated with a higher risk of death in cancer patients.

3) Is Associated With The Risk of Dying From Heart Diseases

One study investigated A/G ratios in 570 patients who had experienced a heart attack. They found that a ratio below 1.12 was associated with a 47% risk of death within 4 years of the heart attack. On the other hand, a ratio greater than 1.34 was associated with only a 10% risk of death [41].

Multiple studies have also found a link between low A/G ratios and the risk of death in heart failure patients. In an observational study of over 13,000 patients with heart failure, an A/G ratio below 1.1 was associated with a higher risk of dying within 1 year [5, 6, 7].

Another study of 999 people found very similar results: a ratio of less than 1.2 was a strong predictor of dying within a year in heart failure patients [6].

A low albumin/globulin ratio may increase the risk of death in people with heart failure or in those who have had a heart attack.

4) May Predict Poor Outcomes After Stroke

A study of 319 people found that stroke patients with ratios under 1.45 may be more likely to develop additional blood clots (and, thus, suffer another stroke) in the future [42].

According to a different study, a low A/G ratio increased both the risk of another stroke and death in 125 stroke patients [43].

These studies are relatively small. More independent studies are needed to support these findings.

5) May Predict Severity of Myasthenia Gravis

Myasthenia gravis is an autoimmune disorder wherein a person’s antibodies attack their own nerves. This type of nerve damage leads to muscle weakness, drooping eyelids, and trouble speaking [44].

A study of 135 patients with myasthenia gravis found that people with albumin/globulin ratios below 1.34 had more severe symptoms and generally did worse than people with higher ratios [45].

Again, additional independent studies are needed to confirm this.

6) Linked to Cognitive Decline

According to one study of 151 people, those with mild cognitive impairment tended to also have lower A/G ratios. These are both likely symptoms of a deeper problem, such as a chronic inflammation [46].

High Albumin/Globulin Ratio

A high albumin/globulin ratio could mean that your albumin levels are high, your globulin levels are low, or both. There are only a few reasons why the A/G ratio may be high and a high ratio is much less common compared to a low ratio.

In this section, we’ll explore how your albumin can become high or how your globulin levels can become low.


Causes listed below have been commonly associated with a high A/G ratio. Your doctor will interpret your value, taking into account your medical history, symptoms, and other test results.

High Albumin

By far, the most common reason for high albumin is dehydration. There is some evidence that a high-protein diet may also increase albumin levels [1, 47].

On the other hand, dehydration and high-protein intake can also increase levels of globulin, leaving the ratio of albumin to globulin largely unchanged [1, 48].

There are several studies that have found a link between insulin resistance and higher blood albumin levels [49, 50, 51]. Therefore, a high insulin may contribute to a high A/G ratio.

However, a drug interaction is the most likely culprit behind high albumin in a high A/G ratio. A couple of studies have shown that certain medications can increase the production of albumin, including:

  • Prednisolone (a corticosteroid used to treat inflammatory disease) [52]
  • Human growth hormone (somatropin, used to treat some growth disorders in children) [53, 54]

Low Globulin

Many factors that lower globulin levels can also lower albumin, such as malnutrition and kidney disease. These conditions are less likely to alter the albumin/globulin ratio because they lower both types of protein at similar rates [55, 1].

However, a few factors lower only globulin. For example, genetic defects can cause a disorder called immunodeficiency, which disrupts the body’s ability to create antibodies (immunoglobulins). This condition, thus, lowers total globulin levels [1, 56].

There is also acromegaly, a disorder characterized by excess production of growth hormone, usually caused by a tumor. Symptoms typically include abnormal growth, headaches, and joint pain [57].

In one study of 35 people with acromegaly, almost half of the participants had low levels of globulin [58].

Finally, some immunosuppressive drugs, such as corticosteroids, can decrease globulin levels [1].

Health Effects

Few studies have looked at the effects of a high albumin/globulin ratio. Research does show that higher ratios may improve survival in cancer, but it’s unknown if this benefit extends to ratios above the normal range [31].

A high A/G ratio result may be more useful as an indicator of an underlying genetic disorder. A rare disease called immunodeficiency occurs when genetic defects prevent the body from properly creating antibodies. This leads to low globulin levels and a high A/G ratio, though other tests would be needed to confirm the diagnosis [1, 59].

How To Normalize Your Albumin/Globulin Ratio

Remember that a low or high A/G ratio usually stems from an underlying condition, such as inflammation, liver disease, or drug interactions. You need to consult with your doctor to treat any potential underlying cause to manage your A/G ratio. Only a qualified physician can ascertain the cause of the abnormal ratio and make recommendations to fix it.

If your albumin/globulin ratio is either too high or too low, consult with your doctor to treat any underlying conditions.


An albumin/globulin ratio compares the concentrations of albumin and globulin (two types of protein) in the blood. A low albumin/globulin ratio may put you at risk for developing cancer. Low ratios may also increase the risk of death for those with cancer or heart disease. A low ratio usually indicates some kind of underlying disorder, such as liver or kidney disease. Treating the underlying condition is the best way to correct the balance of albumin and globulin.

Albumin/Globulin Ratio: High and Low Ratios + Normal Range - SelfDecode Labs (2024)


Albumin/Globulin Ratio: High and Low Ratios + Normal Range - SelfDecode Labs? ›

Your blood usually contains a little more albumin than globulin, which is why a normal ratio is slightly higher than 1 [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 [1, 9].

What is the normal range for albumin globulin ratio high and low ratios? ›

A normal A/G ratio is between 1.1 and 2.5, although this can vary by lab. A low A/G ratio may be due to kidney disease, liver disease, chronic infections, type 2 diabetes, malnutrition, certain autoimmune diseases, and cancers.

What does it mean when albumin is low and globulin is high? ›

A low A/G ratio could indicate your albumin levels are too low (hypoalbuminemia), or your globulin levels are too high. High globulin indicates inflammation and immune system activity. certain cancers, including: liver cancer.

Can dehydration cause high albumin globulin ratio? ›

Dehydration may also lead to higher albumin levels. Making sure you have had enough water before the test will give an accurate result. If the band (tourniquet) is placed around your arm for too long during blood collection, this can also make your albumin level seem high.

What is the most common cause of high Ag ratio? ›

High A/G ratio: This can be a sign of disease in your liver, kidney, or intestines. It's also linked to low thyroid activity and leukemia.

Is 2.6 albumin globulin ratio bad? ›

Therefore, the ratio is presented as the level of albumin in the body. The normal ratio is always more than 1. A ratio of 1.1–2.5 is considered normal. A ratio above 2.5 represents high albumin levels.

What is the albumin globulin ratio for fatty liver? ›

The Albumin/Globulin ratio in the total protein test will help assess the general health of the patient, and this index may suggest liver and kidney related diseases and assess liver function. . The albumin/globulin ratio in patients will usually be in the 1-1.5 range.

What is an alarming globulin level? ›

Results more than 3.5 g/dL for globulin and more than 2.5 for an albumin/globulin ratio are considered high. But being on bed rest for too long, dehydration, and problems during the blood draw can also cause a high reading. Your healthcare provider will likely order additional tests.

What level of albumin indicates kidney failure? ›

Anything above 30 mg/g may mean you have kidney disease, even if your estimated glomerular filtration (eGFR) number is above 60. A high uACR may be an early sign of kidney disease, but your healthcare team will check you again to make sure albuminuria is not caused by something else.

Which could cause albumin to be falsely high? ›

Higher than normal levels may be due to severe hydration (of which there are many causes) or may be an erroneous result due to a tourniquet being applied for too long during the blood draw. Causes of high albumin include: Falsely elevated result due to prolonged tourniquet application.

What autoimmune disease causes low ag ratio? ›

If your A/G ratio was low, it may be caused by:

An autoimmune disease, such as lupus. Liver disease, including cirrhosis.

What infection causes high globulin? ›

Therefore, your healthcare provider will interpret your result in context of other test results and any symptoms you may have. Raised levels of globulin proteins may indicate [1, 2]: Acute infection — such as pneumonia or hepatitis. Chronic inflammatory disease — such as rheumatoid arthritis or lupus.

Which is the most common reason for an elevated serum albumin level? ›

An albumin blood test checks levels of albumin in your blood. Low albumin levels might indicate a problem with your liver, kidneys or other health conditions. High albumin levels are typically the result of dehydration or severe dehydration. The test is very quick and doesn't carry any serious risks.

What if the albumin-globulin ratio is low? ›

A low A/G ratio has been associated with many illnesses, which may be related to inflammation or certain cancer such as myeloma. The A/G ratio can be decreased with short-term problems that cause inflammation, such as tissue trauma or infection, chronic inflammatory conditions, and nutritional problems.

Is the 3.8 globulin level high? ›

Normal value ranges are: Serum globulin: 2.0 to 3.5 grams per deciliter (g/dL) or 20 to 35 grams per liter (g/L)

Is 4.9 a high albumin level? ›

A normal albumin range is 3.4 to 5.4 g/dL. If you have a lower albumin level, you may have malnutrition. It can also mean that you have liver disease, kidney disease, or an inflammatory disease. Higher albumin levels may be caused by acute infections, burns, and stress from surgery or a heart attack.

What are the levels of albumin by age? ›

Plasma albumin levels are low in neonates, typically between 28 and 44 g/L. Adult levels are reached after the first week of life. Levels are slightly higher in children (45 – 55 g/L) between the age of 6 years and young adulthood. Thereafter, levels decline to typical adult levels.


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