The Global Immune-Nutrition-Inflammation Index (GINI) in Acute Pancreatitis Severity Assessment: A Comparative Study.

Abstract

Purpose: Acute pancreatitis (AP) is a common inflammatory disease with variable clinical severity. The Global Immune-Nutrition-Inflammation Index (GINI) has shown prognostic value in oncology but has not been investigated in AP. We aimed to evaluate its value for early severity stratification in AP and to compare it with established inflammatory indices across complementary severity references.

Methods: This retrospective single-center study included 152 patients with AP treated at Erciyes University Faculty of Medicine between January 2022 and December 2025 and 164 healthy controls. Demographic, clinical, and laboratory data obtained at admission were analyzed. Disease severity was assessed primarily using the 2012 Revised Atlanta Classification, with the Ranson score and the Bedside Index of Severity in Acute Pancreatitis (BISAP) as complementary early prognostic references, and etiology was recorded (biliary vs. non-biliary). The performance of GINI and other indices was evaluated using ROC analysis, DeLong comparisons, and multivariate logistic regression.

Results: GINI showed the highest discrimination for moderately severe/severe AP (AUC 0.813, 95% CI 0.738-0.888; cut-off 3134; sensitivity 79%, specificity 77%, NPV 92%) and was significantly superior to CRP, CAR, PLR, PIV, SII and PNI (all p < 0.05). GINI was an independent predictor (OR 3.73 per SD; p < 0.001). Its performance was preserved across biliary and non-biliary etiologies (AUC 0.848 and 0.817; interaction p = 0.68). GINI also clearly separated patients from healthy controls (AUC 0.959).

Conclusion: GINI outperforms most conventional inflammatory and nutritional markers for predicting AP severity, is etiology-independent, and carries a high negative predictive value. It may serve as a practical adjunct for early risk stratification; multicenter prospective validation is warranted.