## 4 Discussion
Especially in elderly and comorbid patients, PNI calculation at the time of emergency admission may detect \"hidden malnutrition\" cases that may require intervention. For example, [PERSON] et al. (2020) reported that malnutrition or risk was detected in one-third of elderly patients evaluated in the emergency department, but most of them did not receive specific nutritional interventions [35]. However, malnutrition prolongs hospital stays and increases mortality in frail older adults. A large study evaluating data from 4120 elderly patients who underwent emergency gastrointestinal surgery showed that PNI was significant in predicting 90-day mortality. In this study, PNI, together with other nutrition-based scores, was among the reliable parameters predicting short-term survival after major surgery; as a result, it was emphasized that immune-nutritional indicators are important prognostic markers in elderly patients undergoing emergency gastrointestinal surgery [36]. This finding supports the notion that the PNI may contribute to clinical risk stratification in emergency situations, which is consistent with our data. In conclusion, when all the findings of our study are evaluated together, it is understood that the PNI is closely related to the clinical course in patients with gastrointestinal emergencies. The PNI is lower in elderly or chronically ill patients with GI emergencies, indicating that these patients present with more severe symptoms and require more intensive care. The correlation of PNI with both admission findings and final diagnoses is valuable in terms of reflecting the systemic effects of the underlying pathology. The fact that the PNI can be calculated using only routine blood tests provides wide applicability to clinical practice. This index, which has been previously used in oncological and cardiovascular diseases, seems to be useful for decision support in emergency medicine, especially in gastrointestinal emergencies. Early recognition of patients with low PNI may allow the management of this high-risk group with interventions such as intensive care follow-up and aggressive fluid and nutritional support. In the future, it would be appropriate to test the value of PNI as a decision support tool in large-scale, prospectively designed studies. It may also be clinically useful to investigate whether nutritional interventions to improve PNI (e.g., early nutritional support and albumin replacement) impact outcomes in the acute phase. However, recent studies have shown that the use of albumin is controversial due to complications caused by volume overload [37]. This study has several limitations. First, the exclusion of patients with gynecological and trauma-related abdominal pathology, although methodologically justified, may have caused a degree of selection bias, particularly by excluding older female patients with comorbid GI conditions. Since our study has a retrospective and single-center design, it is not easy to clarify the causal relationship, and further multicenter studies are required to generalize the results. In addition, future research should include direct comparisons between PNI and established scoring systems such as MELD (for cirrhosis) and APACHE-II, in order to better understand the unique predictive value of PNI in gastrointestinal emergencies.