ObjectiveTo investigate the differences in serum levels of ischemia-modified albumin (IMA) and IMA/albumin ratio (IMAR) in patients with liver cirrhosis of various causes, as well as the significance of IMA measurement and IMAR in evaluating liver function. MethodsA total of 456 patients with liver cirrhosis who were admitted to China-Japan Union Hospital of Jilin University from February 2012 to February 2014 were enrolled. The patients underwent liver function evaluation, and according to the serum albumin (Alb) level, they were divided into normal Alb group (152 patients) and reduced Alb group (304 patients). According to the cause of the disease, the patients were further divided into hepatitis B virus (HBV) group, hepatitis C virus (HCV) group, and alcoholic cirrhosis group, and healthy subjects were enrolled as controls. The serum IMA level was measured for all patients with liver cirrhosis, IMAR was calculated, and the correlations of IMA and IMAR with liver function parameters and Child-Pugh score were analyzed. An analysis of variance was used for comparison of coutinuous data between groups, and the least significant difference t-test was used for further comparision between any two groups; the chi-square test was used for comparison of categorical data between group and the Spearman rank correlation was used to analyze the correlation of IMA、IMAR、Child-Puch score. ResultsCompared with the healthy controls, the patients with liver cirrhosis showed significant increases in the serum IMA level and IMAR(all P＜005), and the cirrhotic patients with hypoproteinemia had significantly higher serum IMA level and IMAR than those without hypoproteinemia(all P＜005). In addition, the patients with alcoholic cirrhosis had significantly higher serum IMA level and IMAR than those with HBV- or HCV-associated liver cirrhosis (F=6765，8276；P＜0.01). The serum IMA level was correlated with Alb, total bilirubin (TBil), international normalized ratio (INR), and cholinesterase (CHE)(r=-0510，0731,0327,-0679；all P＜005). IMAR was correlated with TBil, INR, and CHE(r=0488，0327，-0896；all P＜005). The serum IMA level and IMAR were positively correlated with Child-Pugh score(r=-0801，0899；all P＜005). ConclusionPatients with liver cirrhosis experience a reduced Alb function before the development of hypoproteinemia, and serum IMA level and IMAR differ significantly between the patients with liver cirrhosis of various causes.