Cirrhosis is a debilitating disease with substantial impact on health and prognosis. As the early stages of cirrhosis are asymptomatic or associated with non-specific symptoms, it was previously often diagnosed late in the disease course, after the development complications [1]. New biomarkers, liver scores and elastography have advanced noninvasive diagnosis, and the incidence and prevalence of cirrhosis are increasing [2]. Apart from liver transplantation and treatment of viral hepatitis, there is no recommended therapy for cirrhosis. However, effective interventions are available for cirrhosis-related complications, so timely outpatient follow up and care may improve patient outcomes.

Schechter and colleagues have published a registry study assessing the impact of follow-up after the diagnosis of cirrhosis. The cumulative incidence of patients with follow-up within 90 days was 42.7%, and mortality and rehospitalization rates were reduced. Patients who did not receive follow-up within 90 days, were more likely to have alcohol use disorder and a considerable proportion were re-hospitalised or died within 90 days of diagnosis. Patients who received follow-up, had less cardiovascular disease, lower rates of diabetes and a lower baseline health care utilisation rate [3].

Although limited by the lack of data from the primary sector and general practice visits, Schechter and colleagues establish the importance of follow-up in cirrhosis, as follow-up is becoming more frequent in every-day clinical practice.

The registry-based design does not reveal content, context, or clinical relevance of the follow-up. Prior studies have assessed various types and formats of follow-up for patients with liver disease [4, 5]. The natural course of cirrhosis varies with aetiology, severity and comorbidities, which is adjustable in registry-based studies. However, family network, frailty and social factors may also impact the prognosis of liver cirrhosis [6]. Better understanding of these factors may support the planning, the focus and content of the timely follow-up, to improve survival, prevent complications, unnecessary admissions to the hospital and loss of functions and quality of life in patients with liver cirrhosis.

An important finding of the study by Schechter and colleagues was that in unadjusted analyses, patients who received follow-up within 90 days were more likely to be younger, have fewer comorbidities, and have over 12 years of education [3]. Higher education is often linked to better health literacy, enabling patients to navigate the healthcare system and understand medical advice better. The findings, although not significant in adjusted analyses, suggest a risk of unequal access to follow-up care of those with fewer resources. To address this disparity, healthcare systems should implement strategies to support underserved populations. Studies suggest that comorbidities and provider-patient communication play an important role in adherence to follow-up [7].

Research is needed to identify the most effective follow-up strategies, understand barriers to care, and explore interventions that enhance patient adherence. Future research should focus on optimising care coordination, timely follow-up with a personalised approach, taking severity and stage of cirrhosis into account. A stronger focus on the quality of the follow-up, and evaluation of the reach, dose and fidelity of the follow-up interventions may support clinical decision-making for in the future.

肝硬化是一种使人衰弱的疾病，对健康和预后有重大影响。由于肝硬化的早期阶段无症状或伴有非特异性症状，因此以前通常在病程晚期，即发展并发症之后被诊断出来 [1]。新的生物标志物、肝脏评分和弹性成像具有先进的无创诊断，肝硬化的发病率和患病率正在增加 [2]。除了肝移植和病毒性肝炎的治疗外，没有推荐的肝硬化治疗方法。然而，对于肝硬化相关并发症，有有效的干预措施，因此及时的门诊随访和护理可能会改善患者的预后。

Schechter 及其同事发表了一项登记研究，评估了肝硬化诊断后随访的影响。90 天内随访患者的累积发生率为 42.7%，死亡率和再住院率降低。在 90 天内未接受随访的患者更有可能患有酒精使用障碍，并且相当一部分患者在诊断后 90 天内再次住院或死亡。接受随访的患者心血管疾病较少，糖尿病发病率较低，基线医疗保健利用率较低 [3]。

尽管由于缺乏来自初级部门和全科就诊的数据而受到限制，但 Schechter 及其同事确定了肝硬化随访的重要性，因为随访在日常临床实践中变得越来越频繁。

基于登记处的设计不揭示随访的内容、背景或临床相关性。先前的研究评估了肝病患者随访的各种类型和形式 [4， 5]。肝硬化的自然病程因病因、严重程度和合并症而异，这在基于登记的研究中是可调节的。然而，家庭网络、虚弱和社会因素也可能影响肝硬化的预后 [6]。更好地了解这些因素可能有助于及时随访的计划、重点和内容，以提高肝硬化患者的生存率、预防并发症、不必要的住院以及功能和生活质量的丧失。

Schechter 及其同事的研究的一个重要发现是，在未经调整的分析中，在 90 天内接受随访的患者更有可能更年轻，合并症更少，并且受教育程度超过 12 年 [3]。高等教育通常与更好的健康素养有关，使患者能够浏览医疗保健系统并更好地理解医疗建议。这些发现虽然在调整后的分析中并不显著，但表明资源较少的人存在获得随访护理的机会不平等的风险。为了解决这一差异，医疗保健系统应实施策略来支持服务不足的人群。研究表明，合并症和医患沟通在随访依从性中起着重要作用 [7]。

需要进行研究以确定最有效的随访策略，了解护理障碍，并探索提高患者依从性的干预措施。未来的研究应侧重于优化护理协调，采用个性化方法及时随访，同时考虑肝硬化的严重程度和阶段。更加关注随访质量，并评估随访干预的覆盖范围、剂量和保真度，可能有助于未来的临床决策。