The ratio of albumin to globulin is a clinically important indicator of liver function, with a normal ratio of 1.5:1. Below this value is considered an inverted albumin-to-globulin ratio, which means that albumin is reduced and globulin is increased. The causes of this condition include many. Decreased albumin is seen in cirrhosis, hepatitis, hypoproteinemia, malnutrition, ascites, autoimmune disorders, and many other causes. Elevated globulin is most often seen as a result of bone marrow system disorders, autoimmune deficiencies, viral infections, etc. Any inversion of the albumin ratio can have a significant impact on surgery, the presence of poor wound healing, advanced disease loss to surgery, and nutritional deficiencies, which require identification of the cause, early correction, and administration of targeted therapy.