a. prothrombin time (PT) >30 seconds (International Normalized Ratio (INR) >6.5, OR; b. Encephalopathy Grade II, III or IV and at least one of the following: i. Arterial pH <7.30 at ≥2 hours after initial diagnosis, OR; ii. renal failure documented by urine output less than 2 mL/kg/hr over 12 hours, OR; iii. creatinine >2.5 mg/dL; OR