Laboratory results included a median aspartate aminotransferase and alanine aminotransferase level of 4,990 and 3,578 IU/L, respectively; a median creatinine, lactate, and bilirubin level of 1.0, 3.5, and 5.0 mg/dL, respectively; a mean pH of 7.35, bicarbonate level of 19.7 mg/dL, phosphate level of 3.3 mg/dL, and INR of 3.4. On check details admission, 39 (78%) patients with ALI had already developed hepatic encephalopathy, and 24 (48%) progressed to high-grade encephalopathy (grade 3 or

4) at some point over the first week of admission. Complications of the study population other than encephalopathy included infection in 13 (26%) patients, systemic inflammatory response syndrome in 28 (56%), renal failure in 18 (36%), and thrombosis and bleeding in 9 (18%) patients each. The thrombotic complications included bowel ischemia due to thrombosis detected by contrast tomography and ultrasound (n = 1), limb ischemia due to both arterial and venous Omipalisib research buy thromboses detected by Doppler ultrasound (n = 1), portal vein thrombosis detected by Doppler ultrasound

(n = 1), and thrombosed continuous veno-venous hemofiltration catheters (n = 6). Twenty-eight (56%) patients recovered spontaneously, 7 (14%) patients underwent liver transplantation, and 15 (30%) patients died. As shown in Fig. 1A, VWF:Ag levels were substantially elevated in patients with ALI/ALF (547% [242%-1,420%])) when compared with the reference group in which the median VWF:Ag level was 107% (38%-180%) (P < 0.01). Interestingly, VWF:Ag levels were not different between

patients with blood group O compared with those with non-O blood groups (583% [267%-1,027%] versus 558% [243%-1,429%], respectively) (P = 0.977). In Fig. 1B, it is shown that VWF:Rco activity was substantially elevated in patients with ALI/ALF (278% [11%-684%]) compared with the healthy control group in which the median activity was 105% (33%-222%) selleck kinase inhibitor (P < 0.01). However, the VWF:RCo levels, which reflect the ability of VWF to bind the platelet receptor glycoprotein Ib, are not elevated to the same extent as the VWF:Ag levels. In other words, although VWF is substantially elevated in patients with ALI/ALF, its binding to glycoprotein Ib is inferior in these patients. This is demonstrated in Fig. 1C by a significantly depressed VWF:RCo/VWF:Ag ratio in patients with ALI/ALF (0.55 [0.01-1.06] versus healthy controls (0.96 [0.67-1.54]) (P < 0.01). In Fig. 1D, it is demonstrated that the collagen binding activity of VWF is slightly but significantly decreased in patients with ALI/ALF when compared with healthy controls (97% [93%-115%] versus 105% [72%-133%]) (P < 0.01). As shown in Fig. 2A, ADAMTS13 activity was severely reduced in patients with ALI/ALF (28% [0%-106%]) when compared with the healthy control group in which the median activity was 92% [61%-135%] (P < 0.01).