Comparison of Nutrition-Based Scoring Systems for Predicting Mortality in Patients with Acute Pancreatitis in the Emergency Department

Aim: In the emergency department (ED) management of patients with acute pancreatitis (AP), it is recommended not only to establish an early diagnosis but also to assess and apply risk stratification in clinical decision-making. Considering that AP is an immunonutritional disease, this study aimed to compare the performance of two immunonutrition-based scoring systems—the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT)—calculated using laboratory parameters obtained at ED admission, in predicting 30-day mortality among hospitalized AP patients. Material and Methods: This retrospective observational study analyzed the data of adult patients who were admitted to the hospital with a diagnosis of AP through the ED over a two-year period. PNI and CONUT scores were calculated using laboratory parameters obtained at initial presentation, and their predictive performance for 30-day mortality was compared. Results: A total of 330 patients with AP were included in the study. By the end of the 30-day follow-up, 42 patients (12.7%) had died. Deceased patients were significantly older compared to survivors (69.1 ± 11.4 vs. 52.2 ± 14.0 years, p < 0.001). Albumin and total cholesterol levels were significantly lower, while C-reactive protein (CRP) and the CRP/albumin ratio were significantly higher in non-survivors (all p < 0.001). The PNI score was significantly lower in the deceased group (36.1 ± 3.02 vs. 43.0 ± 3.50, p < 0.001), while the CONUT score was significantly higher (5.50 ± 1.71 vs. 2.50 ± 1.35, p < 0.001). Logistic regression analysis identified both scores as independent predictors of 30-day mortality (PNI: OR = 0.64, 95% CI: 0.55–0.72; CONUT: OR = 2.95, 95% CI: 2.20–4.05; p < 0.001). Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.82 (95% CI: 0.76–0.88) for PNI and 0.85 (95% CI: 0.80–0.90) for CONUT. No statistically significant difference in discriminative performance was found between the two scores (p = 0.116). Conclusion: This study compared the performance of the PNI and CONUT scores in predicting 30-day mortality among patients with acute pancreatitis admitted through the ED. Both scoring systems provided meaningful prognostic information. While the CONUT score was more sensitive in identifying high-risk patients, the PNI score was more effective in distinguishing those with lower mortality risk.