The VWF-ADAMTS13 balance is disturbed in patients who develop MODS and does not normalize over time, associated with platelet consumption and circulation of larger VWF multimers. Data are boxplots with range. (A) VWF propeptide. (B) VWF antigen. (C) Platelet count. (D) ADAMTS13 antigen. (E) ADAMTS13 activity. (F) HMW VWF multimers. (G) ADAMTS13 antigen/VWF antigen ratio. (H) ADAMTS13 activity/VWF antigen ratio. (I) Gel electrophoresis of VWF multimers. Dotted horizontal line in panel F is standard pool plasma level of VWF HMW VWF multimers. Two outliers in the MODS groups had 0% and 9.1% HMW multimers and were not incorporated in the statistical analysis. In panel I, “C” means control (normal human plasma pool) and “M” means patient developing MODS. *P < .05 and **P < .01 between patients without MODS and patients with MODS. VWFpp, human VWF propeptide.