Elevated albumin ratios are commonly due to two causes, as follows: on the one hand, firstly, elevated ratios due to decreased albumin levels, most commonly due to liver diseases, such as liver failure, chronic hepatitis, and cirrhosis, which result in a decrease in the liver’s ability to synthesize albumin. It can also be seen in kidney diseases such as glomerulonephritis, chronic nephrotic syndrome, and renal failure, resulting in increased excretion of albumin from the urine, causing a decrease in plasma albumin levels. Secondly, it can also be seen in systemic wasting diseases, such as malignant tumors, hyperthyroidism, systemic burns, and severe malnutrition, which can also result in a significant decrease in albumin levels. On the other hand, elevated albumin ratio is not related to albumin level, but is due to elevated globulin, which is commonly seen clinically in chronic hepatitis, liver cirrhosis, liver cancer, and also in autoimmune diseases, rheumatoid arthritis, lupus erythematosus, multiple myeloma, leukemia, etc. Therefore, the elevated albumin ratio should be considered from both albumin and globulin.