Albert Park, MD

All Publications

• Prior GLP-1 agonist use is not associated with adverse inpatient critical care outcomes: A propensity-matched analysis. Journal of hospital medicine Park, A. K., Hom, J., Lorenzo, J., Rao, V., Hui, G., Vickers, M., Ahuja, N. 2025

  Abstract

  Glucagon-like peptide-1 (GLP-1) agonists are increasingly prescribed for obesity and type 2 diabetes. GLP-1 agonists influence body composition through effects on both fat mass and fat-free mass. Given that critically ill patients experience severe protein catabolism and commonly develop intensive care unit (ICU)-acquired weakness, questions arise about outcomes when metabolic demands are high during critical illness.The objective of this study is to examine the relationship between prior GLP-1 agonist use and critical care outcomes.We conducted a retrospective cohort study using Stanford Health Care data from January 2015 to July 2024. Adults aged 18-89 years admitted to intensive care with body mass index (BMI) 20-60 kg/m2 were included. Of 15,191 eligible ICU patients, 468 (3.1%) received GLP-1 agonist prescriptions within 12 months before hospitalization. Using high-dimensional propensity score matching with lasso regression, we created 452 matched pairs and compared in-hospital mortality, hospital length of stay, and ICU length of stay between groups.Baseline characteristics were well-balanced. The matched GLP-1 agonist and comparison groups showed similar in-hospital mortality (5.1% vs. 4.9%, odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.58 to 1.91, p = .88), mean hospital length of stay (13.7 ± 21.3 vs. 13.4 ± 18.1 days, mean difference [MD]: 0.38, 95% CI: -2.21 to 3.05, p = .77), and ICU length of stay (5.9 ± 9.0 vs. 5.4 ± 6.6 days, MD: 0.51, 95% CI: -0.52 to 1.50, p = .33).In this first study examining the relationship between prior GLP-1 agonist use and critical care outcomes, we found no significant associations with in-hospital mortality, hospital length of stay, or ICU length of stay.

  View details for DOI 10.1002/jhm.70228

  View details for PubMedID 41286572

• Quantifying the Relationship Between Renal Function and Procalcitonin: A Study of 14 431 Blood Cultures. Open forum infectious diseases Park, A. K., Nakasone, T. S., Kaushal, A., Renault, C. 2025; 12 (11): ofaf654

  Abstract

  Negative procalcitonin (PCT) values may decrease suspicion for bacterial bloodstream infections among patients presenting with symptoms of infection; however, the reliability of PCT in patients with renal dysfunction remains poorly characterized. We quantified the relationship between estimated glomerular filtration rate (eGFR) and positive PCT values in patients with suspected bacterial bloodstream infections.We conducted a retrospective cohort study of 2,832 patients with 14 431 blood cultures at a Veterans Affairs Medical Center (2016-2024). PCT values within 48 hours of culture were analyzed across eGFR categories based on chronic kidney disease staging. We used multivariate logistic regression to assess the relationship between eGFR and positive PCT (≥0.5 ng/mL), adjusting for age and race.Among 14 431 blood cultures, 1417 (9.8%) were positive. When cultures were positive, the proportion of positive PCT values was 47.0% with normal renal function (eGFR ≥90 mL/min/1.73m²) and 91.7% in severe renal dysfunction (eGFR 0-14.9 mL/min/1.73m²). When cultures were negative, the proportions of positive PCT values were 27.6% and 84.0%, respectively. For each lower eGFR category, the odds of a positive PCT value were 40-43% higher (OR 1.40 for positive cultures, 1.43 for negative cultures), after adjusting for age and race. This inverse relationship was consistent across multiple PCT thresholds (0.25-1.50 ng/mL).This large-scale analysis uncovers an inverse relationship between renal function and positive PCT values in patients both with and without culture-positive bloodstream infections. The discriminatory power of PCT for bloodstream infection diminishes in patients with impaired renal function.

  View details for DOI 10.1093/ofid/ofaf654

  View details for PubMedID 41229879

  View details for PubMedCentralID PMC12604010

• SIRT4 loss reprograms intestinal nucleotide metabolism to support proliferation following perturbation of homeostasis. Cell reports Tucker, S. A., Hu, S. H., Vyas, S., Park, A., Joshi, S., Inal, A., Lam, T., Tan, E., Haigis, K. M., Haigis, M. C. 2024; 43 (4): 113975

  Abstract

  The intestine is a highly metabolic tissue, but the metabolic programs that influence intestinal crypt proliferation, differentiation, and regeneration are still emerging. Here, we investigate how mitochondrial sirtuin 4 (SIRT4) affects intestinal homeostasis. Intestinal SIRT4 loss promotes cell proliferation in the intestine following ionizing radiation (IR). SIRT4 functions as a tumor suppressor in a mouse model of intestinal cancer, and SIRT4 loss drives dysregulated glutamine and nucleotide metabolism in intestinal adenomas. Intestinal organoids lacking SIRT4 display increased proliferation after IR stress, along with increased glutamine uptake and a shift toward de novo nucleotide biosynthesis over salvage pathways. Inhibition of de novo nucleotide biosynthesis diminishes the growth advantage of SIRT4-deficient organoids after IR stress. This work establishes SIRT4 as a modulator of intestinal metabolism and homeostasis in the setting of DNA-damaging stress.

  View details for DOI 10.1016/j.celrep.2024.113975

  View details for PubMedID 38507411

  View details for PubMedCentralID PMC11639042

• The United States Experience with One Anastomosis Gastric Bypass at MBSAQIP-Accredited Centers. Obesity surgery Jung, J. J., Park, A. K., Hutter, M. M. 2022; 32 (10): 3239-3247

  Abstract

  One anastomosis gastric bypass (OAGB) has emerged as a potentially safe and effective weight-loss procedure. Worldwide, OAGB is the third most commonly performed primary bariatric procedure, comprising 4% of the annual volume. In the USA, OAGB has yet to be endorsed as a primary bariatric procedure and can only be performed under research protocols or as a revision procedure.We performed an observational cohort study to describe the preoperative, intraoperative, and postoperative characteristics of adult patients who underwent primary or revision OAGB from 2015 to 2019 at MBSAQIP centers. Exclusion criteria included emergent surgery, incomplete 30-day follow-up, and non-laparoscopic- or robotic approach.During the study period, 803,906 bariatric procedures were performed and 645 (0.08%) were OAGB. Among these, 436 (67.6%) were primary and 209 (32.4%) were revision OAGB. The mean operation time was 89 min (SD, 59) and 8% were performed using a robotic approach. The overall complication rate was 7.4% and there was one death (0.2%). The post-operative complication rates were generally higher than the early complication rate (3.4%) reported in the YOMEGA trial, an RCT from France. Revision OAGB had a longer mean operation time of 141 min (SD, 85, p < 0.001).Primary OAGB was a rarely performed bariatric procedure at MBSAQIP-accredited centers comprising only 0.05% compared to 4% worldwide. Future studies should compare safety of OAGB to that of established bariatric procedures like Roux-en-Y gastric bypass and sleeve gastrectomy.

  View details for DOI 10.1007/s11695-022-06002-2

  View details for PubMedID 36008649

  View details for PubMedCentralID 4905566

• Pembrolizumab-Induced Acquired Amegakaryocytic Thrombocytopenia and Successful Combination Treatment With Eltrombopag, Romiplostim and Cyclosporine: A Brief Communication. Journal of immunotherapy (Hagerstown, Md. : 1997) Park, A. K., Park, J. C., Al-Samkari, H. 2022; 45 (7): 321-323

  Abstract

  Pembrolizumab is a humanized antibody directed against the programmed death-1 receptor on the cell surface, resulting in a T-cell-mediated immune response against tumor cells that can be complicated by immune-related adverse events. Here we present a novel case of pembrolizumab-induced acquired amegakaryocytic thrombocytopenia (AAT) in a patient with metastatic nasopharyngeal carcinoma. AAT is an incredibly rare and challenging entity for which there is no standardized treatment. We discuss our therapeutic approach using a calcineurin inhibitor and thrombopoietin receptor agonists for successful treatment of AAT and resumption of multiagent cytotoxic chemotherapy.

  View details for DOI 10.1097/CJI.0000000000000428

  View details for PubMedID 35791464

• Characterization and prognosis of temozolomide-induced aplastic anemia in patients with central nervous system malignancies. Neuro-oncology Park, A. K., Waheed, A., Forst, D. A., Al-Samkari, H. 2022; 24 (6): 964-973

  Abstract

  Temozolomide-induced aplastic anemia (TIAA) is a rare but highly challenging complication of temozolomide (TMZ) therapy. Evidence describing prognosis, clinical characteristics, and treatment of this entity is very limited.We performed a multicenter, 22-year observational cohort study of patients with central nervous system (CNS) malignancies treated with temozolomide who developed TIAA, retrospectively analyzing prognosis, complications, and recovery. TIAA was defined using adapted evidence-based severe aplastic anemia criteria incorporating profound cytopenias and a minimum duration (4 weeks) without hematologic recovery.Of 3821 patients with CNS malignancies receiving TMZ, 34 patients (0.89%) met criteria for TIAA. Onset was rapid, with 29 patients (85.3%) developing TIAA before completing a second TMZ cycle. 23 patients (67.6%) ultimately achieved a hematologic recovery. Patients without recovery were more likely to develop febrile neutropenia (72.7% vs. 30.4%, P = .03), infectious complications (45.5% vs. 8.7%, P = .02), require hospitalization (81.8% vs. 43.5%, P = .04), and die (100.0% vs. 60.9%, P = .02). Median overall survival from TIAA diagnosis was 752 days in patients achieving a partial hematologic recovery versus 28 days in those who did not (P < .0001). 29 patients (85.3%) received one or more hematopoietic growth factors; hematologic recovery rates were higher in patients receiving thrombopoietin receptor agonists (81.8% vs. 60.9%) but were not higher in patients receiving granulocyte colony-stimulating factors.TIAA occurs in <1% of patients receiving TMZ for CNS malignancies, but is highly morbid when it occurs and frequently fatal in the one-third of patients not achieving hematologic recovery. Thrombopoietin receptor agonists may improve the likelihood of a hematologic recovery.

  View details for DOI 10.1093/neuonc/noab240

  View details for PubMedID 34647594

  View details for PubMedCentralID PMC9159424

• Comparison of Short-term Safety of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in the United States: 341 cases from MBSAQIP-accredited Centers. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Jung, J. J., Park, A. K., Witkowski, E. R., Hutter, M. M. 2022; 18 (3): 326-334

  Abstract

  One anastomosis gastric bypass (OAGB) is the third most common (4%) primary bariatric procedure worldwide but is seldom performed in the United States and is currently under consideration for endorsement by the American Society for Metabolic and Bariatric Surgery. Evidence from the United States on safety of OAGB compared to Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) is limited.To compare the short-term safety outcomes of the three primary bariatric procedures.Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited hospitals in the United States and Canada.Using the 2015-2019 MBSAQIP database, we compared the safety outcomes of adult patients who underwent primary laparoscopic OAGB, RYGB, and SG. Exclusion criteria included age over 80 years, emergency operation, conversion, and incomplete follow-up. The primary outcome was 30-day overall complication. Secondary outcomes were 30-day surgical and medical complications and hospitalization length.A total of 341 patients underwent primary OAGB. Using propensity scores, we matched the OAGB cohort 1:1 with two cohorts of similar baseline characteristics who underwent RYGB and SG, respectively. The OAGB cohort had a lower overall complication rate than the RYGB cohort (6.7% versus12.3%, P = .02) and a similar rate to the SG cohort (5.0%, P = .43). The OAGB cohort had a similar rate of surgical complication to the RYGB cohort (5.0% versus 8.5%, P = .1) and a higher rate than the SG group (1.2%, P = .009). The OAGB cohort had a shorter median hospitalization than the RYGB cohort (1 d [interquartile range (IQR) 1-2 d] versus 2 d [IQR 1-2 d], P < .001) and a similar hospitalization length to the SG cohort ([1-2 d], P = .46).Using the largest and the most current U.S. data, this study demonstrated that the short-term safety profile of primary OAGB is acceptable, but future studies should determine the long-term safety.

  View details for DOI 10.1016/j.soard.2021.11.009

  View details for PubMedID 34896012

• Characterization and Prognosis of Temozolomide-Induced Aplastic Anemia Park, A. K., Waheed, A., Forst, D. A., Al-Samkari, H. ELSEVIER. 2021

  View details for DOI 10.1182/blood-2021-146376

  View details for Web of Science ID 000736413900191

• Risperidone for successful treatment of postictal psychosis refractory to olanzapine. Proceedings (Baylor University. Medical Center) Park, A. K., Jesudasen, S. J., Olson, K. R. 2021; 34 (2): 318-320

  Abstract

  Postictal psychosis (PIP) in patients with epilepsy is often mistaken for other primary psychiatric disorders. Depending on its severity, PIP often prompts empiric treatment with atypical antipsychotics, which are balanced against the risk of lowered seizure thresholds. Here we present a case of olanzapine-resistant PIP, where risperidone was used as a safe and effective abortive treatment.

  View details for DOI 10.1080/08998280.2020.1860450

  View details for PubMedID 33678978

  View details for PubMedCentralID PMC7901375