## 4 Discussion
In conclusion, demographic findings revealed that our patient population was compatible with the general GI emergency profile in the literature and that age and sex may affect the clinical course. When the PNI values of our patients at the time of emergency admission were analyzed, the mean PNI was lower than expected. Malnutrition is a critical prognostic risk factor for many diseases, and advanced malnutrition is correlated with high levels of inflammation ([PERSON] et al., 2016). Therefore, patients with low PNI scores are likely to have a more severe inflammatory response and inadequate immune-nutritional reserves, which may predispose them to poor clinical outcomes. The mean PNI value for the entire study was lower than the expected PNI of around 50 in a healthy population ([PERSON] et al., 2017). This distribution shows that malnutrition is common in gastrointestinal patients presenting to the emergency department. Especially, the low PNI values in patients with chronic diseases or elderly patients are striking. For example, in our study, PNI \(<\) 45 was found in the majority of patients over 65 years of age. This finding is in parallel with studies conducted in elderly patients in intensive care conditions; in one study, 73% of internal medicine intensive care patients older than 65 years were found to be at risk of severe malnutrition according to PNI ([PERSON] et al., 2017). In our study, approximately one-third of the patients were in the severe malnutrition category with PNI \(<\) 40, emphasizing the seriousness of the risk of malnutrition in the emergency department. The distribution of PNI values also provides insights into the underlying disease profile. For example, almost all our patients with a history of malignancy or chronic liver disease had PNI values below 40. This is an expected result, since low albumin levels and lymphopenia are common in patients with malignancies due to cancer cachexia and chronic inflammation, and PNI values also decrease. Although the high prevalence of conditions such as malignancy may be a regional difference, the fact that nutritional indices were significantly lower in patients with malignancy in our series is in parallel with the literature ([PERSON] et al., 2017). In contrast, PNI was generally found to be within normal limits in the presence of an emergency, such as acute appendicitis, in previously healthy individuals. This suggests that a low PNI is more likely to be associated with a chronic disease burden or systemic compromise. In conclusion, the PNI data in Table 2 suggest that a large proportion of patients with gastrointestinal emergencies are at risk of malnutrition and that PNI should be evaluated prognostically in this population. Abdominal pain was the most common complaint among patients presenting to the emergency department. It has been reported that abdominal pain is the primary diagnosis in approximately 42% of patients presenting with gastrointestinal complaints [23]. An important group of our patients presented with signs of GI bleeding, such as hematemesis and/or melena. Patients presenting with signs of upper GI bleeding (vomiting coffee grounds, melena) are of special importance in emergency evaluation because these complaints indicate serious underlying pathologies (peptic ulcer, variacel bleeding, etc.). In the literature, it has been reported that GI bleeding constitutes a relatively lower percentage of all ED admissions, but the mortality and hospitalization rates are high [24]. In our study, although it constituted a small proportion of total admissions, a significant proportion of patients were hospitalized, and some were admitted to the intensive care unit. Our findings are similar to those reported in the literature regarding the distribution of GI complaints seen in the emergency department [25]. Abdominal pain and related symptoms (nausea and vomiting) are the most common, while bleeding symptoms are less frequent but serious. This shows that the etiology of gastrointestinal emergencies is extremely broad.