## 4 Discussion
Our findings are largely similar to the distribution in other studies: While appendicitisis, gallbladder diseases, pancreatitis, and intestinal obstruction are the most common specific diagnoses in the literature, \"non-specific abdominal pain diagnosis\" has an important place, around 20-30% of the time [14]. In the emergency department, both conditions, such as appendicitisis and perforation, which require surgical intervention, and conditions such as gastroenteritis and pancreatitis, which can be managed with medical treatment, are seen together. Therefore, a multidisciplinary approach and comprehensive evaluation are essential for managing gastrointestinal emergencies [26]. In the evaluation of PNI based on the presenting complaint, the lowest mean PNI values were found in patients presenting with symptoms of GI bleeding. This finding is highly logical and consistent with the indirect data in the literature [27]. Many of our patients presenting with upper gastrointestinal bleeding had underlying chronic processes such as cirrhosis, peptic ulcer, or malignancy, which may have adversely affected their nutritional status for a long time. For example, chronic malnutrition and hypoalbumin are common in patients with cirrhosis, and cirrhotic patients presenting with esophageal varical bleeding usually have low albumin levels. Although there are no direct studies in the literature comparing nutritional status according to the presenting symptoms, our findings imply that the underlying pathology, rather than the symptoms, determines nutritional status. That is, even if a patient presents with abdominal pain, if the underlying disease is chronic and debilitating (e.g., malignancy), the PNI may be low. Similarly, in an acute, first-time problem (e.g., acute appendicitisis), PNI is usually maintained regardless of the patient's complaint. PNI has been found to be significantly lower in acute conditions associated with chronic diseases. This clearly demonstrates the effects of the chronic disease burden and long-term malnutrition on PNI. Numerous studies have also demonstrated that a low PNI predicts poor prognosis in patients with malignancies [28]. For example, in patients with gastrointestinal stromal tumors, [PERSON] reported that long-term survival was significantly worse in those with a low PNI (PNI has been identified as an independent marker reflecting tumor biological behavior) [29]. In contrast, PNI was observed to be preserved in cases of sudden acute surgical abdomen in previously healthy individuals, such as acute appendicitisis or traumatic splenic rupture. In this group of patients, the PNI was mostly >45, and none had a value <40. This shows that in acute-onset surgical pathologies, the patient's immune nutritional reserves are generally good unless there is an underlying chronic problem. These patients usually recover rapidly and without complications in the postoperative period. Interestingly, PNI values in patients with acute pancreatitis were distributed in two extremes: While PNI was within normal limits in patients with mild pancreatitis, the mean PNI was as low as 34 in patients with necrotizing pancreatitis. In patients with severe pancreatitis, albumin levels may decrease rapidly due to systemic inflammation and hypermetabolism, and lymphopenia may develop [30]. [PERSON] et al. reported that PNI \(\leq\) 34 in patients with acute pancreatitis predicted the development of necrosis, and mortality increased significantly in these patients [31]. Our data also support this, with a difference in PNI between mild and severe pancreatitis. In a recent study on patients with cirrhosis, PNI was strongly associated with disease severity and prognosis [29]. Our findings are consistent with those of similar studies in the current literature. In this study, which analyzed 513 patients with decompensated cirrhosis, disease severity increased as the PNI value decreased, and the group with a low PNI was exposed to significantly more complications.