Background Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from alcoholic hepatitis and evaluate its financial impact. Methods The National Inpatient Sample (NIS) databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals with age ≥ 21 years were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by NIS. Simple linear regression method was used to assess trends in mortality and length of stay over time. Results We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07 % (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared to 2002 (additional cost per hospitalization $11,044 in 2010 compared to 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (~25% – 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 days in 2002 to 6.1 days in 2010). Conclusion AH-related hospitalization continued to increase during the study period, despite the decreasing in the in-hospital mortality rate. Substantial increases in healthcare cost and utilization among hospitalized AH patients were observed.

Background The Metabolic syndrome (MetS) and/or its individual components have been linked to the development of cancer. Recent studies have suggested a similar link to hepatocellular carcinoma (HCC). The aim of this study was to evaluate the direction and magnitude of the association between the MetS and HCC. Methods Two reviewers independently conducted a systemic search to identify available evidence from databases from January 1980 to June 2012. Search terms included ‘Metabolic syndrome’, ‘insulin resistance syndrome’, ‘metabolic abnormalities’ combined with ‘hepatocellular carcinoma’ and ‘liver cancer’. No language restriction was applied to the search. Only studies reporting an effect measure for the association between MetS and HCC were eligible for inclusion. Publication bias was assessed using the Begg and Egger’s tests, with a visual inspection of funnel plot. All analyses were performed using Comprehensive Meta-Analysis version 2 software. Results Four studies (3 cohort and 1 case-control) with a total of 829,651 participants were included in the analysis. The age range of participants was between 30 and 84 years. The combined analysis showed an overall 81% increase risk of HCC in cases with MetS (RR: 1.81, 95% CI: 1.37–2.41). After excluding the single case-control study from analysis, the overall risk ratio remained statistically significant (RR: 1.49, 95% CI: 1.27–1.74). Funnel plot inspection, Begg and Egger’s tests showed no evidence of publication bias for combined analysis. Conclusions Though studies are scarce, currently available epidemiologic data is suggestive of significantly higher risk of hepatocellular carcinoma among patients with metabolic syndrome.

Background There has been constant speculation about the association between metabolic syndrome (MetS) and colorectal neoplasia (CN); however, the published results are conflicting. The aims of this study are to systematic search, and assess literature to determine the available evidence on the association between these two conditions. Methods Meta-analysis was conducted based on relevant studies identified through a systematic literature review from PubMed, OvidSP and Cochrane database during January 1980 to July 2011. A combined analysis was performed, followed by a subgroup analyses stratified by the study design, type of colorectal lesions and gender. Publication bias was assessed using the Begg’s and Egger’s tests and visual inspection of funnel plot. Results Eighteen studies were included in the final analysis. Overall, MetS was associated with 34% increase in the risk of CN (summary RR - 1.34, 95% CI 1.24–1.44). The association between MetS and CN was found to be statistically significant in separate analysis for both case-control studies (summary RR -1.58, 95% CI 1.44–1.79) and cohort studies (summary RR – 1.21, 95% CI 1.13–1.29). The association remained significant when analyses were restricted by type of colorectal lesions (colorectal cancer: RR – 1.30, 95% CI 1.18–1.43; colorectal adenoma: RR – 1.37, 95% CI 1.26–1.49). Further subgroup analysis by gender showed significant association between MetS and CN in both male and female population. Conclusion Our meta-analysis showed significant association between presence of MetS and CN. These results may help in identifying high risk individuals at early stage that might benefit from targeted CRC screening intervention.