What this test measures
Alpha-1 acid glycoprotein (AGP), also called orosomucoid, is a glycoprotein produced primarily by the liver and released into blood in response to acute inflammation, trauma, infection, or malignancy. It binds basic and neutral lipophilic drugs (lidocaine, propranolol, imipramine, methadone) and changes their free fraction during inflammation.
AGP is part of the acute-phase response together with CRP, fibrinogen, haptoglobin, and serum amyloid A. It rises more slowly than CRP (peaks at 3–5 days) and falls more slowly, so it tracks subacute and chronic inflammation better than CRP alone.
Why it matters
AGP is used as a secondary inflammation marker — especially in chronic disease where CRP may have normalised but inflammation persists. Indian rheumatologists use AGP alongside CRP and ESR to track rheumatoid arthritis and inflammatory bowel disease activity. Oncologists look at AGP as part of risk stratification in some malignancies (it rises in advanced cancer). Anaesthetists and intensive-care doctors recognise its role in shifting protein-bound drug pharmacokinetics in critical illness.
AGP is also a recognised biomarker of inflammation in nutritional assessment surveys — including ICMR-supported micronutrient surveys — because it lets researchers correct ferritin and retinol-binding protein for inflammation when interpreting iron and vitamin A status in populations.
How to prepare
No fasting required. Avoid testing during an obvious acute infection unless that is the question being asked. Tell your doctor if you are pregnant, on oestrogen, or recently underwent surgery — all can elevate AGP.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Alpha-1 Acid Glycoprotein (mg/dL)[1][2] | 50 – 120 mg/dL (adult) | < 50 mg/dL: uncommon — seen in severe liver disease (reduced synthesis), protein-losing enteropathy, nephrotic syndrome, or rare congenital deficiency. | > 120 mg/dL: acute-phase response — infection, inflammation, post-operative state, burns, trauma, active rheumatoid arthritis, IBD flare, malignancy. Rises 2–5 fold in active inflammation. |
Acute-phase protein kinetics
| Marker | Onset | Peak | Fall |
|---|---|---|---|
| CRP | 6 – 12 h | 24 – 48 h | ~50% per day |
| Serum Amyloid A | 6 – 12 h | 24 – 48 h | Days |
| Alpha-1 acid glycoprotein | 24 – 48 h | 3 – 5 days | Slow (days–weeks) |
| Haptoglobin | 48 h | 4 – 6 days | Slow |
| Fibrinogen | 24 – 48 h | 3 – 5 days | Days |
Frequently asked questions
How is AGP different from CRP?
Both are acute-phase proteins, but CRP rises and falls faster (within hours) while AGP rises and falls more slowly (peaks over days). AGP is therefore more useful in chronic or subacute inflammation, while CRP is better for acute events.
When is AGP measured?
Less often than CRP. Common uses include monitoring chronic inflammatory disease (RA, IBD), nutritional epidemiology (correcting ferritin and vitamin A in surveys), oncology risk stratification, and research on drug pharmacokinetics in critical illness.
Can AGP be low?
Yes — in severe liver disease, protein-losing states (nephrotic syndrome, IBD), or rare congenital deficiency. Low AGP is uncommon and rarely the primary clinical question.
Does pregnancy or hormonal therapy affect AGP?
Pregnancy mildly raises AGP. Oral oestrogen (oral contraceptives, hormone replacement) can also raise it modestly. Tell the lab so the result can be interpreted correctly.
Why is AGP important for drug dosing?
AGP binds basic and lipophilic drugs (lidocaine, propranolol, methadone, some tricyclic antidepressants). In inflammation AGP rises and binds more drug, reducing the free (active) fraction. Critical-care doctors take this into account when interpreting drug levels.
Does AGP screen for cancer?
No — it is not a cancer screening test. AGP is elevated in many cancers but also in many non-cancer conditions, so it has no diagnostic specificity. It may be used as a research or risk-stratification tool, never alone.
Related Immunology tests
Tests commonly ordered alongside ALPHA1 ACID GLYCOPROTEIN, or that help interpret an unexpected result.
Sources & references
- NCBI StatPearls — Acute Phase Reactants · accessed 2026-05-30T00:00:00.000Z
- Mayo Clinic Labs — Alpha-1 Acid Glycoprotein · accessed 2026-05-30T00:00:00.000Z
- NIH PMC — Orosomucoid in disease · accessed 2026-05-30T00:00:00.000Z
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