The Prognostic Nutritional Index (PNI) Is a Powerful Biomarker for Predicting Clinical Outcome in Gastrointestinal Emergency Patients: A Comprehensive Analysis from Diagnosis to Outcome
Source abstract
Abstract
Objective: This study aimed to evaluate the relationship between the Prognostic Nutritional Index (PNI) and demographic characteristics, presenting complaints, clinical diagnoses, and patient outcomes in patients admitted to the emergency department for gastrointestinal (GI) emergencies. The predictive value of PNI for the clinical course of patients with GI emergencies was investigated. Method: This retrospective cross-sectional study included 583 patients with a diagnosis of GI emergencies in the emergency department of a tertiary university hospital between January 2021 and December 2024. Data such as age, sex, presenting complaints, final diagnosis, and emergency department outcomes (discharge, ward admission, and transfer to intensive care unit) were collected. The PNI value was calculated using serum albumin (g/dL) and total lymphocyte count (/mm3) with the formula PNI = 10 × albumin + 0.005 × lymphocyte. The PNI was calculated based on serum albumin levels and peripheral lymphocyte counts. Results: The mean age of the study group was 63.4 ± 17.4 years, and 52.1% of the patients were female. The number of patients with a PNI value < 38 was significantly higher in the intensive care unit (p < 0.001). PNI values were considerably lower, especially in patients diagnosed with malignancy, cirrhosis, and GI hemorrhage (X2 = 71.387; p < 0.001). The PNI was an independent predictor of outcomes in patients with GI emergencies. The mean PNI was significantly higher in discharged patients but significantly lower in patients admitted to the intensive care unit (p < 0.002). The cut-off score for PNI was calculated using the median value, and the cut-off score for PNI was <38. Conclusion: PNI is a powerful biomarker for predicting the clinical severity and prognosis of patients with GI emergencies. Since it can be easily calculated from routine biochemical tests, it can be used as a practical and effective risk stratification tool. The evaluation of PNI, especially for the early detection of critically ill patients at high risk of malnutrition, may contribute to the reduction of morbidity and mortality through the timely initiation of appropriate supportive therapies.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Esophageal and GI Pathology · Inflammatory Biomarkers in Disease Prognosis · Nutrition and Health in Aging
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Faculty of Medicine, Balıkesir University, Balıkesir 10145, Türkiye
References (37)
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1. Capurso, C., Lo Buglio, A., Bellanti, F., and Vendemiale, G. (2024). Prognostic nutritional index and instant nutritional assessement are associated with clinical outcomes in a geriatric cohort of acutely inpatients. Nutrients, 16.10.3390/nu16091359 ↗
2. Marmo, C., Bucci, C., Soncini, M., Riccioni, M.E., Marmo, R., and GISED Study Group (2025). Defining and Evaluating the Impact of Bleeding Severity on Time to Endoscopy and Mortality Risk: A Prospective Multicenter Cohort Study. J. Clin. Med., 14.10.3390/jcm14051643 ↗
3. Gan, T., Liu, X., Liu, R., Huang, J., Liu, D., Tu, W., and Wang, W. (2024). Machine learning based prediction models for analyzing risk factors in patients with acute abdominal pain: A retrospective study. Front. Med., 11.10.3389/fmed.2024.1354925 ↗
4. Allo, G., Gillessen, J., Gülcicegi, D., Kasper, P., Chon, S.H., Goeser, T., and Bürger, M. (2023). Comparison of lactate clearance with established risk assessment tools in predicting outcomes in acute upper gastrointestinal bleeding. J. Clin. Med., 12.10.3390/jcm12072716 ↗
5. Reduction of operative morbidity and mortality by combining preoperative and postoperative nutritional support10.1097/00000658-198019250-00004 ↗
6. Cavdar, S., Savas, S., Tasbakan, S., Sayıner, A., Basoglu, O., Korkmaz, P., and Akcicek, F. (2024). Predictivity of the prognostic nutritional index and systemic inflammation index for all-cause in-hospital mortality in geriatric and adult COVID-19 inpatients. J. Clin. Med., 13.10.3390/jcm13154466 ↗
7. Jabłońska, B. (2025). Nutritional Status and Nutritional Support in Patients with Gastrointestinal Diseases. Nutrients, 17.10.3390/nu17020270 ↗
8. Alius, C., Serban, D., Tribus, L.C., Costea, D.O., Cristea, B.M., Serboiu, C., and Bratu, D.G. (2023). When Not to Operate on Acute Cases—A Surgeon’s Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography. J. Imaging, 9.10.3390/jimaging9100200 ↗
9. Ayenew Mekuria, T., Liyew Wudu, B., Zegeye, A.F., Eshete Tadesse, E., and Demis Nimani, T. (2024). Incidence of mortality and its predictors among septic shock patients admitted to the intensive care unit of comprehensive specialized hospitals in the northwest of Amhara, Ethiopia. Front. Disaster Emerg. Med., 2.10.3389/femer.2024.1405753 ↗
10. Coşkun, B., Ayhan, M., and Ulusoy, S. (2024). Relationship between prognostic nutritional index and amputation in patients with diabetic foot ulcer. Diagnostics, 14.10.3390/diagnostics14070738 ↗
11. Predictive significance of the prognostic nutritional index (PNI) in patients with severe COVID-19
12. Öztop, H., Hunutlu, F.Ç., Ekizoğlu, S.İ., Gül, Ö.Ö., Cander, S., and Şahin, A.B. (2025). Effect of Hemoglobin, Albumin, Lymphocyte Count, and Platelet (HALP) Score on Survival of Patients with Metastatic Thyroid Cancer Treated with Tyrosine Kinase Inhibitors. J. Clin. Med., 14.10.3390/jcm14041306 ↗
13. Hung, K.C., Ko, C.C., Wang, L.K., Liu, P.H., Chen, I.W., Huang, Y.T., and Sun, C.K. (2022). Association of prognostic nutritional index with severity and mortality of hospitalized patients with COVID-19: A systematic review and meta-analysis. Diagnostics, 12.10.3390/diagnostics12071515 ↗
14. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: Retrospective analysis of 5340 cases10.21037/atm.2016.09.10 ↗
15. Mjema, K.M., Sawe, H.R., Kulola, I., Mohamed, A.S., Sylvanus, E., Mfinanga, J.A., and Weber, E.J. (2020). Aetiologies and outcomes of patients with abdominal pain presenting to an emergency department of a tertiary hospital in Tanzania: A prospective cohort study. BMC Gastroenterol., 20.10.1186/s12876-020-01313-z ↗
16. Costa, G., Fransvea, P., Puccioni, C., Giovinazzo, F., Carannante, F., Bianco, G., and Sganga, G. (2022). Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups. (The GESEMM study). Front. Surg., 9.10.3389/fsurg.2022.927044 ↗
17. Clinical and economic burden of emergency department visits due to gastrointestinal diseases in the United States10.1038/ajg.2013.199 ↗
18. Gender differences in esophageal variceal bleeding in the United States10.1080/07853890.2022.2104920 ↗
19. Yau, F.F.F., Yang, Y., Cheng, C.Y., Li, C.J., Wang, S.H., and Chiu, I.M. (2021). Risk factors for early return visits to the emergency department in patients presenting with nonspecific abdominal pain and the use of computed tomography scan. Healthcare, 9.10.3390/healthcare9111470 ↗
20. Comparison of nutritional risk indices (PNI, GNRI, mNUTRIC) and HALP score in predicting adverse clinical outcomes in older patients staying in an intensive care unit10.1097/MD.0000000000038672 ↗
21. Shestopalov, A.E., Yakovleva, A.V., Yadgarov, M.Y., Sergeev, I.V., and Kuzovlev, A.N. (2024). Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records. Nutrients, 16.10.3390/nu16152396 ↗
22. The Prognostic Role of Prognostic Nutritional Index and Controlling Nutritional Status in Predicting Survival in Older Adults with Oncological Disease: A Systematic Review10.3390/onco4020009 ↗
23. Emergency department utilization for gastrointestinal care and patient characteristics associated with hospital admission in a national cohort10.1093/gastro/goad045 ↗
24. S684 Assessing the Weekend Effect on Outcomes of Adults with Non-variceal Upper Gastrointestinal Hemorrhage as the Reason for Emergency Department Presentation in the United States10.14309/01.ajg.0000859376.22383.81 ↗
25. Boccatonda, A., D’Ardes, D., Tallarico, V., Vicari, S., Bartoli, E., Vidili, G., and Accogli, E. (2023). Gastrointestinal ultrasound in emergency setting. J. Clin. Med., 12.10.3390/jcm12030799 ↗
26. Mauro, A., Scalvini, D., Borgetto, S., Fugazzola, P., Mazza, S., Perretti, I., and Anderloni, A. (2024). Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers, 16.10.3390/cancers16040821 ↗
27. Chun, M., Vongsavath, T., Sonaiya, S., Liu, L., Tun, K.M., Batra, K., and Gish, R.G. (2025). A Systematic Review and Meta-Analysis on the Role of Somatostatin Therapy in Non-Variceal Gastrointestinal Bleeding. Gastroenterol. Insights, 16.10.3390/gastroent16020018 ↗
28. Pan, Y., Ma, Y., and Dai, G. (2023). The prognostic value of the prognostic nutritional index in patients with advanced or metastatic gastric cancer treated with immunotherapy. Nutrients, 15.10.21203/rs.3.rs-2503613/v1 ↗
29. Ao, Z., Chen, X., Zhu, W., Long, H., Wang, Q., and Wu, Q. (2025). The prognostic nutritional index is an effective prognostic and nutritional status indicator for cirrhosis. BMC Gastroenterol., 25.10.1186/s12876-025-03599-3 ↗
30. Akkuzu, M.Z., Altıntaş, E., Yaraş, S., Sezgin, O., Ateş, F., Üçbilek, E., and Özdoğan, O. (2022). Controlling Nutritional Status (CONUT) Score and Prognostic Nutritional Index (PNI) are good candidates for prognostic markers for acute pancreatitis. Medicina, 59.10.3390/medicina59010070 ↗
31. Efgan, M.G., Karakaya, Z., Kanter, E., Kırık, S., and Tekindal, M.A. (2024). Can CONUT and PNI Scores Predict Necrotizing Pancreatitis in Acute Pancreatitis Patients Presenting to the Emergency Department?. J. Clin. Med., 13.10.3390/jcm13195902 ↗
32. Ge, Y., Wang, Z., and Zhang, C. (2025). Association between prognostic nutritional index and all-cause mortality among intestinal obstruction patients in the intensive care unit: A retrospective study. Front. Nutr., 12.10.3389/fnut.2025.1583201 ↗
33. Prognostic nutrition index is associated with the all-cause mortality in sepsis patients: A retrospective cohort study10.1002/jcla.24297 ↗
34. Kyo, D., Tokuoka, S., Katano, S., Hisamune, R., Yoshimoto, H., Murao, S., and Yamakawa, K. (2023). Comparison of nutrition indices for prognostic utility in patients with sepsis: A real-world observational study. Diagnostics, 13.10.3390/diagnostics13071302 ↗
35. Griffin, A., O’Neill, A., O’Connor, M., Ryan, D., Tierney, A., and Galvin, R. (2020). The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: A secondary analysis of the OPTI-MEND trial. BMC Geriatr., 20.10.1186/s12877-020-01852-w ↗
36. Jin, Z., Yang, T., and Wang, Z. (2025). Immune-nutritional indicators predict short-term mortality in older patients after emergency gastrointestinal surgery: A retrospective study. BMC Gastroenterol., 25.10.1186/s12876-024-03583-3 ↗
37. Controversies regarding albumin therapy in cirrhosis10.1097/HEP.0000000000000521 ↗