## 4 Discussion
In cirrhotic patients with PNI \(\leq\) 41.75, the incidence of major complications, such as gastrointestinal bleeding, hepatic encephalopathy, and infection, was found to be significantly higher [29]. These data suggest that a low PNI predicts mortality and morbidity in patients with cirrhosis. Patients presenting with signs of GI bleeding should be treated separately. In our study, patients presenting with upper GI bleeding symptoms, such as melena and hematemesis, constituted 14% of all admissions. The significant effect of the PNI value on the clinical course in patients presenting to the emergency department with gastrointestinal emergencies has been demonstrated [32]. In particular, the need for intensive care and serious diagnoses (e.g., upper gastrointestinal bleeding, decompensated cirrhosis, and acute pancreatitis) was significantly higher in patients with PNI \(<\) 38, whereas milder clinical pictures and more favorable outcomes were observed in patients with PNI \(\geq\) 38. This finding is consistent with the literature, indicating that a PNI below 38 indicates at least moderate malnutrition [10]. This suggests that PNI can predict the severity of the underlying diagnosis in patients with gastrointestinal emergencies. Although the differences in PNI between diagnoses were not statistically significant for all groups (especially benign causes had similar PNI values among themselves), there was a significant difference between the \"malignancy/advanced chronic disease\" group and the \"acute benign disease\" groups. This suggests that PNI may be particularly useful for identifying patients with severe comorbidities. In clinical practice, routine assessment of nutritional status in the emergency department is not common; however, our findings suggest that even a simple index such as the PNI can provide important clues to the general condition of the patient, especially in GI emergencies with hemorrhage or chronic disease. Although mortality was not directly analyzed in our study, patients admitted to the intensive care unit were mostly found to have a low PNI, which is similarly predictive of poor short-term prognosis. Our results suggest that PNI, an objective indicator of nutritional status, may significantly impact clinical outcomes. In the emergency department, patients with good nutritional status (high PNI) were mostly discharged as outpatients, whereas those with poor nutritional status (low PNI) more frequently required hospitalization and intensive care. The literature also supports this result. For example, [PERSON] and [PERSON] (2022) evaluated PNI as a prognostic marker in patients with sepsis in the emergency department and found that low PNI significantly increased the 30-day mortality risk [33]. In our study, the fact that the non-intensive care patient outcome was close to PNI levels was primarily because clinically severe diseases were admitted to our hospital, the criteria for hospitalization for diagnosis and treatment were kept wide, and the patients were usually hospitalized. A significant proportion of patients with gastrointestinal emergencies require hospitalization, a significant proportion require intensive care level support, and mortality is significant, especially in severe cases. This highlights the importance of risk markers such as PNI. PNI also remained an independent predictor of intensive care admission (the likelihood of intensive care was significant for those with PNI \(<\) 40 compared to those with PNI \(\geq\) 40). This finding is extremely valuable because it shows that nutritional status can influence clinical outcomes, independent of factors such as age or disease severity score. Indeed, in a study conducted in patients with sepsis, PNI remained independently predictive of mortality when PNI was added to the model in addition to APACHE-II and SOFA scores [34]. Patients with low PNI require closer follow-up, and if they are to be discharged, they should be followed up in outpatient clinics. Nutritional support should be planned if possible.