# Association between serum albumin-to-globulin ratio and subtypes of cerebral atherosclerotic stenosis in acute ischemic stroke

## TL;DR

Lower albumin-to-globulin ratio is linked to higher risk of specific cerebral atherosclerotic stenosis in stroke patients.

## Contribution

This study identifies AGR as a potential biomarker for cerebral atherosclerotic stenosis subtypes in acute ischemic stroke.

## Key findings

- Lower AGR levels were associated with posterior circulation and intracranial stenosis.
- The association remained significant after adjusting for BMI, age, and sex.
- AGR showed a linear negative relationship with specific stenosis subtypes.

## Abstract

The albumin-to-globulin ratio (AGR) is a biomarker reflecting both nutritional status and inflammation, which has recently been implicated in the development of ischemic stroke. However, its potential association with the occurrence of cerebrovascular stenosis remains unclear. This study aimed to investigate the relationship between AGR and the incidence of cerebral atherosclerotic stenosis.

Data from 766 adult patients with acute ischemic stroke (AIS) were included in this cross-sectional analysis. Binary logistic regression was used to evaluate the independent association between AGR and the risk of various cerebrovascular stenosis, including anterior circulation stenosis, posterior circulation stenosis, intracranial and extracranial stenosis. To explore the potential non-linear relationship between AGR and these outcomes, restricted cubic spline models were employed to further clarify these associations. Stratified analyses by body mass index (BMI), age, and sex were additionally conducted to explore the correlation between AGR and cerebral atherosclerotic stenosis under different conditions.

Patients with cerebral atherosclerotic stenosis had lower AGR levels than those without corresponding vascular stenosis. After adjusting for multiple covariates, AGR levels were negatively associated with the presence of stenosis in the posterior circulations (OR = 0.59, 95%CI = 0.38 ~ 0.90, p = 0.015) and intracranial stenosis (Q4: OR = 0.55, 95% CI = 0.34 ~ 0.89, p = 0.015). This association was essentially unaffected by BMI, age, or sex. Furthermore, a negative linear relationship was observed between AGR levels and the occurrence of posterior circulation stenosis (p for overall = 0.001, p for non-linear = 0.228) and intracranial vascular stenosis (p for overall <0.001, p for non-linear = 0.440).

Higher AGR is associated with a reduced risk of multiple cerebral atherosclerotic stenosis. AGR levels are significantly associated with the presence of specific stenosis subtypes and could be hypothesized as a marker for risk stratification; this utility requires validation in prospective cohorts.

The association between serum albumin-to-globulin ratio and cerebral atherosclerotic stenosis in patients with acute ischemic stroke: a study stratified by body mass index, age, and sex.Illustration depicting the physiological process involving liver, thymus, spleen, and bone marrow leading to plasma cell formation. Plasma cells and an albumin/globulin ratio (AGR) are linked with an obese woman and a fit man, indicating differences in health status. The diagram also shows a human brain and mentions digital subtraction angiography (DSA) examination, suggesting a connection between these elements and health diagnostics. Arrows and colored figures imply pathways and potential outcomes related to obesity and health.

The association between serum albumin-to-globulin ratio and cerebral atherosclerotic stenosis in patients with acute ischemic stroke: a study stratified by body mass index, age, and sex.