{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T16:15:08Z","timestamp":1762272908811,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>The American Association for the Study of Liver Diseases recommends a high index of suspicion for nonalcoholic steatohepatitis and advanced fibrosis in patients with type 2 diabetes (T2D) and an elevated fibrosis\u20104 index (FIB\u20104). We investigated the referral pattern of patients with T2D and FIB4\u00a0&gt;\u00a03.25 to the hepatology clinic and evaluated the clinical benefits to the patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included patients aged 18\u201380\u00a0years with T2D and a FIB4 score &gt;3.25 who had visited the internal medicine, family medicine, endocrinology clinic from 01\/01\/2014\u20135\/31\/2019. The first time point of high\u2010risk FIB\u20104 was identified as the baseline for time\u2010to\u2010event analysis. The patients were classified based on whether they had visited the hepatology clinic (referred <jats:italic>vs<\/jats:italic> not referred).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2174 patients, 290 (13.3%) were referred to the hepatology clinic, and 1884 (86.7%) were not referred. In multivariate analyses, the referred patients had a lower overall mortality risk (Hazard Ratio: 0.57; 95% CI: 0.38\u201387). Notably, the referred patients had the same rate of biochemical decompensation, as measured by progression to MELD \u2265\u00a014, but a substantially higher rate of diagnosis in cirrhosis (27, 19\u201338) and cirrhosis complications, including ascites (2.9, 2.0\u20134.1), hepatic encephalopathy (99, 13\u2013742), and liver cancer (14, 5\u201338).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found that patients with T2D and high\u2010risk FIB4 are associated with better overall survival after referral to a hepatology clinic. We speculate that the survival difference is due to the increased recognition of cirrhosis and cirrhosis complications in the referred populations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.15900","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T01:49:05Z","timestamp":1653529745000},"page":"1815-1821","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Patients with type 2 diabetes and elevated fibrosis\u20104 are under\u2010referred to hepatology and have unrecognized hepatic decompensation"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4246-6998","authenticated-orcid":false,"given":"Winston","family":"Dunn","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Kansas Medical Center  Kansas City Kansas 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